Anterior approach to Cubital Fossa

Indications

Reinsertion of biceps tendon
Release of anterior capsular contractions
Repair of nerves

Position

Supine
Armboard

Landmarks

Brachioradialis
Tendon of biceps
Anterior elbow crease

Incision

Curved longitudinal Gentle S shaped incision over anterior aspect of elbow
Start: 5cm above elbow crease on medial side of biceps
Cross elbow crease oblique
End: Continue on the medial border of Brachioradialis

Internervous Plane

Proximally
- Brachioradialis
  - Radial nerve
- Brachialis
  - Musculocutaneous nerve
Distally
- Brachioradialis
  - Radial nerve
- Pronator teres
  - Median nerve

Superficial Dissection

Ligate numerous veins
Identify & preserve Lateral Cutaneous Nerve of Forearm
- Between biceps & brachialis
Identify bicipital aponeurosis & incise it close to its origins at the biceps tendon
- Being wary of Brachial artery which runs deep to aponeurosis
Identify Radial Artery & trace it proximally to it’s origin in the Brachial artery
- Brachial vein & median Nerve run medial to artery

Deep Dissection

Develop plane between
- Medially Biceps & Brachialis
- Laterally BR
Supinate forearm
Incise origin of Supinator

Dangers

Lateral cutaneous nerve of forearm
Radial artery
PIN