Anatomical variations of the axilla.

Emerson Wander Silva Soares

doi:10.1186/2193-1801-3-306

Emerson Wander Silva Soares

Open Access

https://doi.org/10.1186/2193-1801-3-306

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Journal: SpringerPlus	Publication Date: Jun 24, 2014
Citations: 52	License type: CC BY 4.0

Affiliation: Universidade Estadual do Oeste do Paraná

Abstract

PurposeThe present study aimed to measure the thickness of the subcutaneous adipose tissue (SAT) at the site of the surgical incision for axillary lymph node dissection (ALND) and to record potential anatomical variations in the medial cutaneous nerve of the arm (MCNA), the intercostobrachial nerve (ICBN), the lateral thoracic vein (LTV), the lateral thoracic artery (LTA) and the pectoral muscle pedicle (PMP), considering that some details of the anatomy of these structures within the axilla are still unclear.MethodsA prospective study was conducted in 100 consecutive patients with breast cancer who underwent ALND as part of surgical treatment. The anatomy of the dissected axilla was video recorded.ResultsThe SAT thickness ranged from 8 mm to 60 mm, with an average thickness of 25.9 mm. A positive correlation was observed between the SAT thickness and the body mass index (BMI) of the evaluated patients (r = 0.68; p < 0.0001). The MCNA was the anatomical structure that was least commonly observed in the axilla (22% of cases), while the PMP was the most constant element, identified in 100% of cases. All of the studied anatomical structures observed within the axilla showed variation in at least one of the aspects analyzed, i.e., the point of entry and exit, path, number and location of divisions or branches.ConclusionThe present study demonstrated wide variation in thickness of the SAT overlying the axilla and identified the existence of broad normative anatomical variation of the axilla.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-3-306) contains supplementary material, which is available to authorized users.

Highlights

Detailed knowledge of the anatomy of the axilla represents a basic foundation for surgeons who explore the axilla searching for sentinel lymph nodes or to perform conventional axillary lymph node dissection (ALND)
The morbidities caused by ALND in the shoulder and arm, such as limited movement, pain, sensory changes and lymphedema (Warmuth et al 1998; Keramopoulos et al 1993; Ververs et al 2001; Soares et al 2014), are a result of unintentional damage to the lymphatic vessels, blood vessels and nerves interspersed with the dissected axillary lymph nodes
The anatomical variations of 100 axillae dissected for lymph node resection as part of the surgical treatment of patients with breast cancer were recorded

Summary

Introduction

Detailed knowledge of the anatomy of the axilla represents a basic foundation for surgeons who explore the axilla searching for sentinel lymph nodes or to perform conventional axillary lymph node dissection (ALND). In a systematic review of 5,448 patients, Verbelen et al (2014) found that in patients with breast cancer, even SLNB may result in chronic sequelae (two years after surgery), such as limitation of arm abduction (0-41.4%), pain (5.6-51.1%), paresthesia (5.1-51.1%) and lymphedema (0-27.3%). For this reason, the goal of refining the surgical technique for the dissection of axillary lymph nodes remains a current and recurring theme in the medical literature (Ung et al 2006; Ponzone et al 2009)

Methods

Results

Conclusion