Review on Axillary Arch and Its Surgical Implications

Abstract

Axillary arch commonly known as ‘Axillary arch of Langer’ is a muscular or musculo -tendinous arch that extends from the lower border of latissimus dorsi muscle to the tendinous insertion of pectoralis major muscle. There are a few variations of the arch reported in the past such as the chondroepitrochlearis extending from pectoralis major to medial epicondyle and some from pectoralis major to the coracoid process. The arch stretches across the axillary vessels and branches of brachial plexus, compressing on these structures resulting in several clinical manifestations that are reviewed in the article. The article also reviews the embryological basis of the arch. The incidence of the arch varies between 0.25 to 7%in diverse ethnic groups. The knowledge of its possible existence in the axillary region is essential in several surgical procedures involving the axilla in order to avoid neurovascular damage and post-surgical complications. The significance of the arch in hyper abduction syndromes, differential diagnosis of axillary swellings, post mastectomy breast reconstruction using latissimus dorsi myocutaneous flaps and several other clinical conditions is discussed.