Modern Views on the Clinical Anatomy of the Medial Cutaneous Nerve of Arm and the Prospects for its Use in Reconstructive Surgery

Abstract

In the modern aspect, the relevance of damage to the medial cutaneous nerve of the arm during surgical interventions in the axilla and brachial region is displayed. Due to the superficial location in the subcutaneous layer, the nerve is most often subject to accidental damage, including in brachioplasty, axillary lymphodissection, breast cancer surgeries and breast augmentation. The material on variant anatomy, macroscopic structure and topography of the nerve is presented. The medial cutaneous nerve of the arm is formed from the medial cord of the brachial plexus, in some cases - from the posterior cord; isolated cases of the absence of the nerve are described. When exiting the axilla at arm level, the nerve penetrates into the deep brachial fascia, passes in the subcutaneous layer medially from the basilic vein of the arm and provides sensitive innervation to the skin of the medial surface of the arm, the skin of the medial epicondyle and the olecranon of the ulna. The medial cutaneous nerve of the arm has an average of 7-8 cutaneous branches, which are characterized by significant variability in the location under the skin. The significance of the medial cutaneous nerve of the arm in clinical practice, namely, in surgical interventions in the arm region, the development of neuropathic pain syndrome, brachial plexus blockages and the diagnosis of nerve damage, medial cord and inferior trunk of the brachial plexus. This review summarizes recent data, which allow to form a more complete picture of the clinical anatomy of the medial cutaneous nerve of arm and the possibilities of its use in reconstructive surgery. An especially relevant area is the possibility of using a medial skin flap of the arm with directed innervation by the medial cutaneous nerve of the arm for reconstruction and restoration of the sensitivity of the nipple-areola complex.