An Anatomic Study of the Cephalic Vein in the Deltopectoral Shoulder Approach

Abstract

There has been debate regarding medial or lateral retraction of the cephalic vein in the deltopectoral approach to the shoulder. Those who recommend lateral retraction of the vein cite multiple feeder vessels from the deltoid muscle; however, there is little evidence to support this in the orthopaedic literature. The purpose of our study was to determine if there are more lateral branches than medial branches to the cephalic vein in the deltopectoral groove. Forty fresh frozen cadaveric shoulders underwent retrograde latex injection of the cephalic vein. A deltopectoral incision was used, and the numbers of medial and lateral branches were recorded. In the deltopectoral groove there were more lateral than medial feeder vessels to the cephalic vein. There also were more branches to the vein in the proximal (1/2) of the incision compared with the distal (1/2). Most of the specimens dissected had more lateral branches to the cephalic vein than medial branches. Based on the number of feeder vessels to the cephalic vein, results of our study support lateral retraction of the cephalic vein in a majority of shoulders during the deltopectoral approach to the shoulder.

Deltopectoral approach for shoulder arthroplasty: anatomic basis

“…For this reason, we prefer to leave the vein in a medial position. However, larger tributaries come from the deltoid muscle, and caution must be taken to tie or coagulate them appropriately [10]. In case of bleeding from the vein during surgery, the consequences of ligature seem negligible, and we recommend cauterisation [2,10].…”

Surgical Approaches in Shoulder Arthroplasty

“…The authors found more branches from the cephalic vein on the deltoid side, allowing them to conclude that lateral retraction may be more efficacious in preventing bleeding [20]. Once the vein has been retracted, blunt dissection can be used to identify the undersurface of both muscle bellies.…”

Surgical Exposures of the Shoulder

“…We prefer to perform dissection medial to the vein because there are fewer medial branches than there are lateral branches. 21 Proximally, brisk bleeding may be encountered at the deltoid and acromial branches of the thoracoacromial trunk. In revision situations, the cephalic vein and the nonabsorbable suture placed during the prior closure can provide guidance.…”