Dissection Manual

September 1
THE BACK
Objectives and Synopsis

In this area we will dissect and study:

The Surface Anatomy, Skin and Superficial Fascia of the Back:

This will show the importance of recognizing the landmarks of the body and how they can help
guide you in dissection. You will also understand the concept of fascial planes and the
segmental nature of the human body.

The Superficial Muscles of the Back:

Most of these muscles are concerned with movement of the upper limb (appendicular
muscles). Some are involved in respiration.

You will also identify nerves, vessels and various other structures. You should also be
constantly observing anatomical relationships. Review the osteology of this region from the
lecture notes and structure list below. Keep the skeletal morphology and relationships in mind
at all times while dissecting.

Structures:
Osteology:
Skull
External occipital protuberance
Mastoid process
Scapula
Acromion process
Spine
Superior, lateral and inferior angles
Lateral, medial and superior borders
Suprascapular notch
Supraspinous and infraspinous fossae
Subscapular fossa
Coracoid process
Clavicle
Proximal end (sternal end)
Distal end (acromial end)
Shaft
Vertebrae
Spine
Transverse processes
Lamina
Pedicles
Bodies
Sacrum
Median crest

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Coccyx
Iliac crest
Superficial back muscles

Muscles:
Trapezius
Latissimus dorsi
Rhomboids, major and minor
Levator scapulae
Serratus posterior superior and inferior

Nerves:
Greater occipital nerve
Third (least occipital nerve)
Dorsal rami of spinal nerves
Spinal accessory nerve
Thoracodorsal nerve
Dorsal scapular nerve

Vessels:
occipital artery
superficial and deep branches of the transverse cervical artery
thoracodorsal artery
dorsal scapular artery

Other structures
thoracolumbar fascia
Ligamentum nuchae

Media:

Skin flap
Superficial Vessels & Nerves
Remove Fascia
Muscle Introduction
Introduction to Trapezius
Introduction to Latissimus Dorsi
Triangle of Auscultation
Reflecting the Trapezius
Reflecting the trapezius 2
Lumbar Triangle
Reflecting the Latissimus Dorsi
Rhomboids
Levator Scapulae
Posterior Serratus

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Procedure:

Locate and mark (in your imagination or scratch with a probe or scalpel) the following
landmarks:

A external occipital protuberance of the skull

B mastoid processes of the skull
C tip of acromion process of each scapula
D spine of each scapula (difficult if the cadaver is fat)
E distal end of each clavicle
F median furrow of the back (not necessary to mark)
G spine of the 7th cervical vertebra
H spines of the thoracic and lumbar vertebrae (not necessary to mark)
I tip of the coccyx
J iliac crests
K lateral midline of arm, 2-3 inches below axilla (armpit)

Additional surface anatomy of the back

Draw the following lines: (again in your imagination or scratch with a probe or scalpel)

1. From the external occipital protuberance to the mastoid process of both sides (A-B).

2. From the external occipital protuberance to the tip of the coccyx (A-I). This line will
pass down the median furrow along the tips of the 7th cervical vertebra and thoracic
and lumbar vertebrae.

3. From the spine of the 7th cervical vertebrae to the tip of the acromion process of
both sides (G-C).

4. From the tip of the acromion process to point K (lateral midline of the arm about 2
or 3 inches below the armpit). Make an encircling line around the arm at the level
of point K.

5. From one side to the other side, midway between iliac crest (J) and the axilla
(armpit)

6. From the tip of the coccyx along and slightly superior to the crest of the ilium to the
midaxillary line (an imaginary line along the sides of the body which lines up with
the armpit) of both sides (I-J). Follow curve of iliac crest - do not cut across the
buttocks

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 SUPERFICIAL MUSCLES OF THE BACK

Using your scalpel, cut along the above lines.

Reflect skin from midline towards sides. To find superficial nerves and vessels pick one skin

flap and remove only the skin in this section (leave fat behind).

Probe the superficial fascia in the upper thoracic region near the midline and locate the stumps

of the segmental cutaneous vessels and nerves. The nerves are branches of the dorsal

(posterior) rami of spinal nerves. The vessels are branches of posterior intercostal vessels.

Nearer the midaxillary line you will also find the stumps of segmental vessels and nerves. The

nerves are branches of intercostal nerves (from ventral rami of thoracic spinal nerves).

Reflect the remaining flaps from the midline of the body to the lateral midline of the body,

including fat and skin, to level of deep fascia - do not remove skin until necessary as it can be

used to protect the dissection

You will not be able to preserve all of the cutaneous vessels and nerves. BE EXTREMELY

CAREFUL NOT TO DAMAGE UNDERLYING STRUCTURES. THIS IS

ESPECIALLY IMPORTANT ALONG THE CRANIAL ATTACHMENTS AND

SUPERIOR BORDER OF THE TRAPEZIUS MUSCLE TO PROTECT THE SPINAL

ACCESSORY NERVE AND OCCIPITAL ARTERY

Be on the lookout for the greater occipital nerve and occipital artery which pierce the

aponeurosis of the trapezius muscle near its attachment to the skull.

Be careful along the superior border of the trapezius muscle and look for the spinal accessory

nerve. This nerve will be seen passing from the posterior border of the sternocleidomastoid

muscle to the superior border of the trapezius muscle sandwiched between the layers of deep
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cervical fascia passing between these muscles. Do not destroy this fascia when removing the

overlying superficial fascia

Reflect the skin from the posterior shoulder and upper posterior arm leaving it attached in the

axilla. DO BOTH SIDES of the body.

Reflect the skin on the back of the neck by starting at the midline of the neck and reflecting

laterally BE EXTREMELY CAREFUL NEAR THE MASTOID PROCESS watching for

the greater occipital nerve and occipital artery.

Identify the trapezius muscle. Note the direction of its fibers and regional differences in its

thickness.

Reflect the trapezius muscle, by cutting about 1/2 inch lateral and parallel to its origin being

careful to avoid injury to underlying structures. Reflect the muscle laterally towards its

insertions on the scapular spine, the acromion and clavicle. Do not detach the muscle from it

insertions at this point. Exercise extreme care when reflecting the cranial portion of the

muscle.

Identify on the deep side of the trapezius the spinal accessory nerve, ventral rami of cervical

nerves 3 and 4 and the superficial branch of the transverse cervical artery or the superficial

cervical artery (in certain circumstances).

Identify the latissimus dorsi muscle and using your hand carefully separate it from underlying

structures and from the inferior angle of the scapula.

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Identify the thoracodorsal nerve, artery and vein entering the deep side of the muscle (look in

the gap between the superior border of the muscle and the lateral edge of the scapula). Identify

the thoracolumbar fascia.

At this point identify the boundaries of the lumbar triangle (medial - latissimus dorsi; lateral –

ext. abdominal oblique; inferior – iliac crest) and the triangle of auscultation (medial –

trapezius; superior – rhomboid major; inferior – latissimus dorsi).

Reflect both latissimus muscles from by cutting parallel to their attachments to the

thoracolumbar fascia leaving about 1/2 inch of the muscle attached to the thoracolumbar fascia.

Reflect both muscles to their insertions on the humerus. As you reflect, you will have to break

adhesions of the muscle to underlying structures, do so with your hand or other blunt

instrument taking not to break the nerves and vessels previously located.

Identify the rhomboid major and minor muscles. Carefully separate these muscles from

underlying structures with your hand or blunt instrument and reflect them by cutting 1/2 inch

from their origins and reflecting them to their insertions on the scapula.

Identify the dorsal scapular nerve and the deep branch of the transverse cervical artery (a

variation) or the dorsal scapular artery (a variation) on the deep side of the rhomboids near their

insertions on the vertebral border of the scapula.

Identify the levator scapulae muscle and carefully separate it from underlying structures. DO

NOT REFLECT THIS MUSCLE AT THIS TIME. Identify the serratus posterior superior

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and inferior muscles. Carefully separate the serratus posterior muscles from the deep back

muscles and reflect them by cutting 1/2 inch from their origins.

September 3

DEEP MUSCLES OF THE BACK

Objectives and Synopsis

In this area we will dissect and study:

The Deep (True, Intrinsic) Muscles of the Back

Most are concerned with movement of the spine (axial muscles). Some are involved in
respiration.

Within each region you will also identify nerves, vessels and various other structures. You
should also be constantly observing anatomical relationships. Review the osteology of this
region from the lecture notes Keep the skeletal morphology and relationships in mind at all
times while dissecting.

Structures:

Muscles:
Splenius cervicis and capitis
Erector spinae (sacrospinalis) muscles
Iliocostalis (lumborum, thoracis and cervicis)
Longissimus (thoracis, cervicis and capitis)
Spinalis (thoracis. cervicis, capitis)
Transversospinalis muscles
Semispinalis (thoracis, cervicis and capitis) and the
Rotatores (longus and brevis)
Multifidus muscle
Levatores costarum

Media:

Erector Spinae 1
Erector Spinae 2
Splenius Capitis/Cervicis
Semispinalis
Reflecting the Semispinalis Capitis

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Procedure:

Identify the erector spinae (sacrospinalis) muscles extending cranially as three columns from

the crest of the ilium. Carefully separate these three columns and identify their portions from

the picture.

Along ONE SIDE ONLY of the vertebral column in the mid to lower thoracic region, displace

the longissimus muscle laterally and dissect away the spinalis muscle along the vertebral spines

to expose the underlying transversospinalis muscles. Identify the semispinalis thoracis, cervicis

and capitis. We will not dissect the rotatores longi and breves muscles. Identify the multifidus

muscle in the lumbar region where it is best developed. The latter muscle lies just deep to the

thoracolumbar fascia which you may cut and reflect to see this muscle. Identify the levatores

costarum muscles.

September 9

POSTERIOR NECK AND SUBOCCIPITAL REGION, SPINAL CORD

Objectives and Synopsis

In this area we will dissect and study:

The Muscles of the Posterior Neck

which are concerned with movements of the neck and head (axial muscles).

The Muscles of the Suboccipital Region

which are concerned with movements of the head (axial muscles).

The Spinal Meninges and Spinal Cord

A laminectomy will reveal the spinal meninges, the spinal cord and associated structures.

Within each region you will also identify nerves, vessels and various other structures. You
should also be constantly observing anatomical relationships. Review the osteology of this
region from the lecture notes Keep the skeletal morphology and relationships in mind at all
times while dissecting.

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Structures

Suboccipital region

Muscles:
Obliquus capitis inferior and superior
Rectus capitis posterior major and minor

Nerves:
Suboccipital nerve

Arteries:
Vertebral artery
Deep cervical artery

Spinal cord

Dura mater
Arachnoid mater
Pia mater
Denticulate ligaments
Dorsal root ganglion
Dorsal and ventral roots of spinal nerves
Cauda equina
Conus medullaris
Filum terminale internus

Media:

Suboccipital Triangle
Vertebral Laminae
Laminectomy Introduction
Laminectomy
Spinal Dura, Arachnoid, Pia Mater
Conus Medullaris
Denticulate Ligaments
Spinal Ganglion
Dorsal Spinal Artery
Ligamentum Flava

Procedure:

POSTERIOR NECK

The portion of the trapezius muscle originating from the occipital bone and cervical vertebrae

should have been reflected during the dissection of the superficial back muscles.

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ON BOTH SIDES identify the splenius capitis and cervicis muscles and carefully separate

them from the underlying structures. Carefully detach and reflect the splenius where it arises

from the ligamentum nuchae and spinous processes. Identify the longissimus capitis and

semispinalis capitis muscles. The spinalis capitis muscle will usually be fused with the

semispinalis capitis but try to identify it. Identify the greater occipital nerve piercing the

semispinalis to reach the posterior aspect of the scalp.

Identify the occipital artery near the insertion of the longissimus capitis muscle. Identify the

deep cervical artery between the semispinalis capitis and cervicis. Notice that these latter two

arteries anastomose in the neck. ON ONE SIDE ONLY carefully detach the semispinalis

muscle from the occipital bone and reflect the muscle inferiorly. Be careful not to damage the

greater occipital nerve.

SUBOCCIPITAL REGION

After reflection of the semispinalis capitis, the suboccipital region of one side can be viewed.

Carefully clean the area and identify the muscles which form the suboccipital triangle: obliquus

capitis inferior, obliquus capitis superior and rectus capitis posterior major. Within the triangle

identify the suboccipital nerve, the vertebral artery and the posterior atlantooccipital membrane.

Note how the greater occipital nerve exits inferior to the obliquus capitis inferior muscle and

crosses the triangle to reach the posterior aspect of the scalp. ON THE SAME SIDE ONLY

carefully pull the rectus capitis posterior major muscle laterally to identify the rectus capitis

posterior minor muscle.

VERTEBRAL COLUMN AND SPINAL CORD

In a small region, one side only, carefully detach the iliocostalis muscle from the ribs, identify

the levatores costarum muscles, and note their fiber direction. Examine the vertebral column

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where it is exposed and identify the supraspinous and interspinous ligaments and the ligamenta

flava. Clean the vertebral laminae on both sides from approximately T10 to L4 (hint: L4 is at

the line drawn between the iliac crests).

LAMINECTOMY

Chisel or saw (use a Stryker saw) through the lamina from T10 to L4 making the cuts just

medial to the articular processes so that you do not cut into the pedicles. Using a scalpel cut the

interspinous and supraspinous ligaments between the T10 and the T11 vertebra and between

the L4 and L5 vertebra. Using your hands rock the cut section back and forth to loosen it. This

will also identify where you made need to cut more or use the chisel. When the cut section is

loose, carefully remove it taking care to loosen any attachments to deeper tissues. If done right

you should see the dural sac surrounding the spinal cord.

Cut through the dura mater to expose the spinal cord. Be careful when opening the dura and

observe the delicate denticulate ligaments (extensions of pia mater) between the dorsal and

ventral roots. Identify a dorsal root ganglion (swelling) in the mouth of an intervertebral

foramen. Identify spinal nerve nerves and ventral/dorsal rami. Identify the cauda equina,

conus medullaris (approximately at L2), and filum terminale internus.

September 10

DORSAL SCAPULA AND SHOULDER

Objectives and Synopsis

In this region we will dissect and study:

The Deltoid Muscle which is the major abductor of the humerus.

The Rotator Cuff Muscles that originate from the scapula and insert into the humerus to rotate
it and reinforce the shoulder joint.
The Long Head of the Triceps Brachii and Teres Major Muscles which have actions on the
humerus at the shoulder.
The Quadrangular and Triangular Spaces and the Triangular Interval and their contents.
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The Scapular and Spinoglenoid Notches and their associations.
The Major Bursae associated with the shoulder joint.

Within each region, you will also identify nerves, vessels and various other structures. You
should also be constantly observing anatomical relationships.
Review the osteology of this region from the lecture notes. Keep the skeletal morphology and
relationships in mind at all times while dissecting.

PECTORAL REGION AND BREAST

Objectives and Synopsis

In this area we will dissect and study:

The Surface Anatomy, Skin and Superficial Fascia of the Thoracic Wall.
In the back region we have already seen the posterior wall of the thorax. In this section we will
dissect the anterior and lateral walls.
The Breast and its relationship to the thoracic wall.
The Pectoral Region of the anterior thoracic wall where the muscles are involved with
movement of the upper limb.
The Serratus Anterior Muscle involved with moving the scapula.

Structures:

Osteology:
Scapula:
Spine
Acromion
Suprascapular Notch and Superior Transverse Scapular Ligament
Spinoglenoid Notch and (Inferior Transverse Scapular Ligament)
Supraglenoid Tubercle
Infraglenoid Tubercle
Supraspinous Fossa
Infraspinous Fossa
Subscapular Fossa
Clavicle
Acromial End
Shaft
Humerus: (anterior, posterior.)
Head
Neck
Surgical Neck
Greater Tubercle (not a tuberosity)
Lesser Tubercle (not a tuberosity)
Intertubercular Sulcus (Bicipital Groove)
Deltoid Tuberosity (not a tubercle)

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Muscles:
Deltoid:
Anterior Fibers
Middle Fibers
Posterior Fibers
Trapezius
Rotator Cuff Muscles:
Supraspinatus (rupture)
Infraspinatus
Teres Minor
Subscapularis
Teres Major
Triceps Brachii
Long Head

Nerves:
Suprascapular Nerve
Spinal Accessory Nerve
Axillary Nerve
Radial Nerve

Vessels:
Transverse Cervical Artery
Deep Branch
Dorsal Scapular Artery
Posterior Humeral Circumflex Artery
Anterior Humeral Circumflex Artery
Circumflex Scapular Artery
Profunda Brachii Artery (deep artery of the arm)

Misc.:
Subdeltoid Bursa (subacromial bursa)
Quadrangular Space
Triangular Space
Triangular Interval
Superior Transverse Scapular Ligament
Surface anatomy:
Jugular notch (Suprasternal notch)
Sternal angle (of Louis)
Manubriosternal joint
Xiphisternal joint
Costal margin
Deltopectoral triangle
Sternum:
Manubrium
Body of sternum
Xiphoid process
Costal cartilage

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Breast:
Nipple
Areola
Basic structure
Suspensory (Cooper's) ligaments

Mammary Gland:
Ducts
Vascular supply
Lymphatic drainage
Mammogram

Pectoral Region:
Platysma muscle
Supraclavicular nerves
Pectoralis major muscle
Pectoralis minor muscle
Subclavius muscle
Medial and lateral pectoral nerves
Thoracoacromial artery:
Clavicular branch
Pectoral branch
Acromial branch
Deltoid branch
Long thoracic nerve
Lateral thoracic artery
Serratus anterior muscle
Thoracoepigastric vein

Media:

Deltoid Muscle (including its reflection)

Reflection of Trapezius Muscle
Rotator Cuff Muscles
Suprascapular Notch, Ligament, Nerve and Artery
Thoracic Introduction and Landmarks
Superficial Fascia
Nipple - Section
Pectoral Fascia
Pectoralis Major Muscle & Cephalic Vein
Reflecting the Pectoralis Major Muscle
Lateral and Medial Pectoral Nerves
Pectoralis Minor Muscle
Serratus Anterior Muscle

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Procedure:

PLACE THE CADAVER IN THE PRONE POSITION.

Remove the skin (LEAVE THE SUPERFICIAL FASCIA) totally from the shoulder and
proximal arm down to the encircling cut made earlier being very careful in the axillary region.
DO BOTH SIDES

THE POSTERIOR SHOULDER AND DORSAL SCAPULA

Carefully remove the superficial fascia from the deltoid and scapular regions. Identify the
deltoid muscle. Note the deltoid fascia (deep fascia) covering the muscle. Note the different
fiber directions of the deltoid and consider their actions. ON ONE SIDE ONLY carefully
detach the deltoid muscle from its origin and as you reflect it identify the subdeltoid bursa. Be
careful during reflection of the deltoid to preserve nerves and vessels entering its deep surface.
Identify the surgical neck of the humerus.

ON ONE SIDE ONLY carefully cut the trapezius from the scapular spine leaving it attached
only to the acromion and clavicle.

ON BOTH SIDES clean the deep fascia from the dorsal scapular region and identify the
supraspinatus, infraspinatus, teres minor (three of the four rotator cuff muscles) and teres major
muscles and the long head of the triceps brachii muscle. Identify the boundaries of the
quadrangular and triangular spaces and those of the triangular interval. Identify the axillary
nerve and posterior humeral circumflex artery in the quadrangular space. Identify the scapular
circumflex artery in the triangular space. Identify the radial nerve and the profunda brachii
artery in the triangular interval.

ON ONE SIDE ONLY carefully cut transversely through the supraspinatus muscle at the level
of the suprascapular notch and reflect the segments. Identify the suprascapular artery passing
superficial to the superior transverse scapular ligament and the suprascapular nerve passing
deep.

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ON THE SAME SIDE ONLY carefully cut transversely through the infraspinatus muscle at
the level of the spinoglenoid notch and reflect the segments. Identify branches of the
suprascapular artery and nerve passing through the spinoglenoid notch. Try to identify the
inferior transverse scapular ligament.

PROCEDURE

PLACE THE CADAVER IN THE SUPINE POSITION with the upper limbs partially
abducted. Examine the anterior fibers of the deltoid and consider their actions. Identify the
subscapularis muscle on the ventral side of the scapula; this is one of the rotator cuff muscles.

Locate and mark the following surface anatomy landmarks:

Jugular notch
Manubrium
Sternal angle - manubriosternal joint
Costal cartilage of 2nd rib (either side of sternal angle)
Body of the sternum
Xiphisternal joint
Tip of the xiphoid process (may be hard to find, in this case mark the lowest palpable part of
the sternum you can find, shown on figure as black outline just below xiphisternal joint
Clavicle
Acromion process
Infrasternal angle
Costal arch
Nipple and areola of the breast

Using the landmarks as a guide draw or imagine (you can use a marker or simply scratch the
lines or just freehand) the following lines ON BOTH SIDES:

1. From the jugular notch to the tip of the acromion process of both sides A-E
2. From the jugular notch to the tip of the xiphoid process A-D.
3. From the tip of the xiphoid process along the costal arch to the midaxillary line of both
sides.
4. From the tip of the xiphoid process to the nipple, encircling it, and continuing along the
lateral border of the pectoralis muscle to the encircling cut on the upper arm.

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ON BOTH SIDES make incisions with your scalpel along the above lines and reflect and

remove the skin but do not disturb the superficial fascia. DO NOT REMOVE ANY SKIN

SUPERIOR TO THE CLAVICLE. Reflect the skin towards the midaxillary lines of both

sides and the encircling cuts around the arms. When you meet the loose skin from the back and

scapular dissections you may remove the skin. At this point the thoracic area should be

completely skinned ON BOTH SIDES as well as the upper one-third or so of both arms. BE

SURE TO LEAVE THE BREAST, NIPPLE AND AREOLA INTACT. Be very careful

along the clavicle and try not to disturb the superficial fascia. When you reach the midline, you

may remove the skin.

BREAST AND MAMMARY GLAND

On the female cadavers, identify the breast, nipple and areola.

Carefully probe the superficial fascia of the breast and observe the abundance of blood vessels.

Carefully remove the breasts from the female cadavers. Note the tough ligaments anchoring the

breast to the underlying deep (pectoral) fascia; these are the suspensory ligaments (of Cooper).

Dissect a breast and locate the mammary gland with its multiple lobes. In elderly females it will

be difficult to identify any glandular tissue of the mammary gland but you will be able to

identify fibrous septa.

Cut through a breast in the transverse plane passing through the nipple, look for lactiferous

ducts passing from the lobes to the nipple, and probe the nipple to find some of the multiple

openings on its surface. Examine models in the lab. In both sexes observe the relationship of

the nipple to the intercostal spaces.

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 PECTORAL REGION

Carefully probe the superficial fascia and identify the following structures:

the platysma muscle, supraclavicular nerves, segmental nerves and blood vessels along the

lateral margins of the sternum and the midaxillary line, and the thoracoepigastric vein

(communication between the axillary and femoral veins). Carefully remove the superficial

fascia from the thoracic wall and identify the pectoral fascia.

Carefully remove the pectoral fascia and identify the pectoralis major muscle and its clavicular

and sternocostal heads. Define the outline of this muscle and identify the cephalic vein in the

groove between the deltoid and pectoralis major muscles.

Identify the boundaries of the deltopectoral triangle (medial – clavicle; superior – deltoid;

inferior – pectoralis major) and probe for the coracoid process deep within. Separate the

clavicular portion of the pectoralis major muscle from the sternocostal portion. Carefully

separate both portions from underlying structures and then reflect both portions laterally by

detaching them from their origins. Identify the medial and lateral pectoral nerves and segmental

vessels and nerves that enter the deep surface of this muscle.

Identify the clavipectoral fascia that encloses the pectoralis minor and subclavius muscles.

Carefully remove this fascia and identify these two muscles. Clean and study the pectoralis

minor muscle but DO NOT REFLECT IT AT THIS TIME AND GUARD AGAINST

TEARING IT BY EXCESSIVE ABDUCTION OF THE ARM. This muscle will later serve

as a reference to delineate the axillary artery into three divisions.

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Identify the thoracoacromial artery at the medial border of the pectoralis minor muscle and its

branches, clavicular, pectoral, acromial and deltoid. Clean the cephalic vein and trace it to the

deltopectoral triangle where it joins the axillary vein.

SERRATUS ANTERIOR MUSCLE

Identify the serratus anterior muscle. Identify the long thoracic nerve and the lateral thoracic

artery on the superficial surface of the serratus anterior muscle.

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