Book contents
- Atlas of Surgical Techniques in Trauma
- Atlas of Surgical Techniques in Trauma
- Copyright page
- Dedication
- Contents
- Contributors
- Foreword
- Preface
- Acknowledgments
- Section 1 The Trauma Operating Room
- Section 2 Resuscitative Procedures in the Emergency Room
- Section 3 Head
- Section 4 Neck
- Section 5 Chest
- Chapter 14 General Principles of Chest Trauma Operations
- Chapter 15 Cardiac Injuries
- Chapter 16 Thoracic Vessels
- Chapter 17 Lungs
- Chapter 18 Thoracic Esophagus
- Chapter 19 Diaphragm
- Chapter 20 Surgical Fixation of Rib Fractures
- Chapter 21 Video-Assisted Thoracoscopic Evacuation of Retained Hemothorax
- Section 6 Abdomen
- Section 7 Pelvic Fractures and Bleeding
- Section 8 Upper Extremities
- Section 9 Lower Extremities
- Section 10 Orthopedic Damage Control
- Section 11 Soft Tissues
- Index
Chapter 19 - Diaphragm
from Section 5 - Chest
Published online by Cambridge University Press: 21 October 2019
- Atlas of Surgical Techniques in Trauma
- Atlas of Surgical Techniques in Trauma
- Copyright page
- Dedication
- Contents
- Contributors
- Foreword
- Preface
- Acknowledgments
- Section 1 The Trauma Operating Room
- Section 2 Resuscitative Procedures in the Emergency Room
- Section 3 Head
- Section 4 Neck
- Section 5 Chest
- Chapter 14 General Principles of Chest Trauma Operations
- Chapter 15 Cardiac Injuries
- Chapter 16 Thoracic Vessels
- Chapter 17 Lungs
- Chapter 18 Thoracic Esophagus
- Chapter 19 Diaphragm
- Chapter 20 Surgical Fixation of Rib Fractures
- Chapter 21 Video-Assisted Thoracoscopic Evacuation of Retained Hemothorax
- Section 6 Abdomen
- Section 7 Pelvic Fractures and Bleeding
- Section 8 Upper Extremities
- Section 9 Lower Extremities
- Section 10 Orthopedic Damage Control
- Section 11 Soft Tissues
- Index
Summary
The diaphragm consists of a peripheral muscular segment and central aponeurotic segment. It is attached to the lower sternum, the lower six ribs, and the lumbar spine. During expiration it reaches the level of the nipples. The central tendon of the diaphragm is fused to the base of the pericardium.
It has three major openings, which include the aortic foramen – which allows passage of the aorta, the azygos vein, and the thoracic duct – the esophageal foramen for the esophagus, and the vagus nerves, and finally the vena cava foramen, which contains the inferior vena cava (Figure 19.1).
The arterial supply stems from the phrenic arteries that are direct branches off of the aorta as it exits the hiatus, while the venous drainage is directly into the inferior vena cava.
The diaphragm is innervated by the phrenic nerve, which originates from the C3–C5 nerve roots, courses over the anterior scalene muscle, continues into the mediastinum along the pericardium, and terminates in the diaphragm.
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- Atlas of Surgical Techniques in Trauma , pp. 150 - 155Publisher: Cambridge University PressPrint publication year: 2020