Chapter 1 - Thorax Grant's Atlas of Anatomy, 12th Edition Nursing

1.3 Superficial dissection, female pectoral region

  • On the specimen’s right side, the skin is removed; on the left side, the breast is sagittally sectioned.
  • The breast extends from the 2nd to the 6th ribs. The axillary process (tail) of the breast consists of glandular tissue projecting toward the axilla.
  • The region of loose connective tissue between the pectoral fascia and the deep surface of the breast, the retromammary bursa, permits the breast to move on the deep fascia.
  • Interference with the lymphatic drainage by cancer may cause lymphedema (edema, excess fluid in the subcutaneous tissue), which in turn may result in deviation of the nipple and a leathery, thickened appearance of the breast skin. Prominent (puffy) skin between dimpled pores may develop, which gives the skin an orange-peel appearance (peau d’orange sign). Larger dimples may form if pulled by cancerous invasion of the suspensory ligaments of the breast.

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Nurse says she was ‘stunned’ by infant’s injuries

A nurse was the first witness today in Olmsted District Court to describe her reaction seeing the severely swollen legs of an infant boy who was brought to the hospital emergency room days after being released to his parents.

“I was completely stunned,” said Lindia Stein, a nurse, of her reaction to seeing Jordan James, an infant boy who had 25 fractures to his legs, ribs and arms when he was brought back to the hospital on Jan. 11, 2007.

Stein’s testimony came this morning in the trial of Robert Lee Heck III, the biological father of the boy. Heck is on trial on charges of first-degree assault and aiding an offender, accused of causing the injuries to his son, who was born conjoined on Nov. 9, 2006, then separated at birth. Jordan was released from the Saint Marys Hospital on Jan. 3 and lived with his parents at the Ronald McDonald House so the parents could visit the twin, Jacob, who was still in the hospital.

Heck denies the allegations. His case is being heard by Judge Kevin Lund. The trial is expected to last through next Wednesday.

Stein testified she was on duty in the pediatric emergency room on the day Heck and Valerie James, the biological mother, brought their son to the hospital with concerns about swelling in his thighs. The couple thought it might have been from immunizations the infant received days earlier.

The nurse said she pulled off the blanket and saw “extremely swollen” thighs that were purplish in color. She said the thighs were so swollen, the skin was hard to the touch.

A doctor ordered X-rays be taken. Dr. Kristen Thomas, a consultant in radiology, read those X-rays, and testified this morning that Jordan had multiple fractures in his legs, ribs and arms. She said some fractures in the legs were showing signs of healing, indicating trauma had occurred on separate occasions.

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