Axillary Vessels Research Articles

Specific complications associated with shoulder joint replacement

Complications such as scapular notching or artery, nerve and deltoid muscle damage can outweigh the benefits of shoulder joint replacement and result in poor functional outcomes. Reverse shoulder joint replacement may cause traction deformation of the brachial plexus and axillary vessels due to constructive medialistion and distalisation of the shoulder component. Delayed surgery after a fracture can lead to bleeding from damage to the axillary artery wall during the release of scarred soft tissues. Although most neurological complications after reverse arthroplasty (RA) are reversible, some persist, particularly damage to the axillary nerve. These complications can occur due to various reasons such as the use of acute retractors, glenoidal cavity release and humerus traction with further distalisation. Fixing the scapular component with screws can damage the supra-scapular nerve. Deltoid muscle dysfunction remains a serious complication due to axillary nerve damage or muscle fibre ruptures. Notching syndrome occurs when the shoulder component of the endoprosthesis collides with the scapula. Shoulder component dislocation, often caused by insufficient soft tissue tension due to implant misplacement, is not uncommon.This study was necessitated by the significance of these complications, their varied causes, the relative rarity of reverse arthroplasty, previous shoulder trauma altering anatomy, poor functional outcomes, and diverse problem-solving approaches.

Surgical management of lymphedema: prophylactic and therapeutic operations.

Lymphedema is chronic limb swelling from lymphatic dysfunction and is currently incurable. Breast-cancer related lymphedema (BCRL) affects up to 5 million Americans and occurs in one-third of breast cancer survivors following axillary lymph node dissection. Compression remains the mainstay of therapy. Surgical management of BCRL includes excisional procedures to remove excess tissue and physiologic procedures to attempt improve fluid retention in the limb. The purpose of this review is to highlight surgical management strategies for preventing and treating breast cancer-related lymphedema. Immediate lymphatic reconstruction (ILR) is a microsurgical technique that anastomoses disrupted axillary lymphatic vessels to nearby veins at the time of axillary lymph node dissection (ALND) and has been reported to reduce lymphedema rates from 30% to 4-12%. Postsurgical lymphedema remains incurable. Surgical management of lymphedema includes excisional procedures and physiologic procedures using microsurgical technique. Immediate lymphatic reconstruction has emerged as a prophylactic strategy to prevent lymphedema in breast cancer patients.

Limb-sparing resection of axillary soft tissue sarcomas

For patients with soft tissue sarcoma, surgical resection is akey element of curative therapy. Surgery is performed as awide resection with microscopically negative margins (R0resection) and as limb-sparing procedure whenever possible to preserve maximum function. Soft tissue sarcoma, metastases. Extensive disease with major neurovascular involvement, placement of biopsy tract necessitates extensive resection, palliative care. Extended deltopectoral approach. Release of pectoralis major and minor tendons. Vascular and neurologic exploration, identification of the axillary vessels and brachial plexus, placing of loops around major structures. Mobilization of these structures to achieve adequate exposure. Clipping of vessels entering the tumor. Tumor resection, suture marking for histological analysis. Soft tissue reconstruction by transosseous reinsertion of the pectoralis minor to the coracoid process. Drill channel placement, transosseous refixation of the pectoralis major to the humerus. Shoulder abduction brace for 6weeks, passive mobilization for 6-12weeks followed by active mobilization. Compression sleeve. Oncological follow-up. Between 2017 and 2022, wide resection was performed in 6consecutive cases including 4 primary soft tissue sarcomas and 2metastases. Primary R0 resection was achieved in 100%. Mean follow-up was 22.5months (3-60months). There were no local recurrences. Mean active shoulder abduction was 135.0 ± 41.4° (90-180°). Neurological deficits were not observed. Mean subjective shoulder function was 80.0 ± 21.0% (50-100%). The mean Musculoskeletal Tumor Society (MSTS) score was 89.5% (32-100%), indicating good functional outcome in the study cohort.

A rare presentation site for osteochondroma scapula and pelvis, intramembranous ossifying bones of axial skeleton: case series

Osteochondroma is the most common primary bone tumour comprising over 33% of benign bone tumours. The formation of osteochondroma occurs because of exophytic protuberance on the surface of growing bones. The most common sites for osteochondroma are the distal femur, proximal tibia, and proximal humerus. We are presenting a case series of three patients with rare presentation sites of osteochondroma, scapula and pelvis. Osteochondroma is primarily disease of appendicular skeleton but we are reporting it in axial skeleton. Radiographic findings include fluffy cartilaginous outgrowth arising from the external surface of a long tubular bone that may be pedunculated or sessile. Osteochondromas usually develop in bones that develop by enchondral ossification and rarely develop in bones developing by intramembranous ossification like pelvis. These tumours are usually asymptomatic but can cause pubic visceral compression or neurovascular compromise by compressing external and internal iliac vessels and lumbosacral pluxes. Scapular osteochondroma can cause compression or neurovascular compromise in thoracic cavity and axillary vessels and brachial pluxes. Treatment with surgical excision gives consistent results and relief of pain.

Novel Diagnostic and Treatment Techniques for Neurogenic Thoracic Outlet Syndrome.

Neurogenic thoracic outlet syndrome is a challenging condition to diagnose and treat, often precipitated by the triad of repetitive overhead activity, pectoralis minor contracture, and scapular dyskinesia. The resultant protracted scapular posture creates gradual repetitive traction injury of the suprascapular nerve via tethering at the suprascapular notch and decreases the volume of the brachial plexus cords and axillary vessels in the retropectoralis minor space. A stepwise and exhaustive diagnostic protocol is essential to exclude alternate pathologies and confirm the diagnosis of this dynamic pathologic process. Ultrasound-guided injections of local anesthetic or botulinum toxin are a key factor in confirming the diagnosis and prognosticating potential response from surgical release. In patients who fail over 6 months of supervised physical therapy aimed at correcting scapular posture and stretching of the pectoralis minor, arthroscopic surgical release is indicated. We present our diagnostic algorithm and technique for arthroscopic suprascapular neurolysis, pectoralis minor release, brachial plexus neurolysis, and infraclavicular thoracic outlet decompression.

Soft Tissue Reconstruction Using the Free Forearm Fillet Flap in the Salvage of Forequarter Amputations for Recurrent Sarcoma: A Report of 2 Cases.

Reconstruction after radical forequarter amputation for recurrent proximal extremity sarcoma is challenging because the defect is significant, and the axillary or subclavian vessels are resected with the tumor, indicating that the pedicle of nearby flaps is often cut off. Free flaps are commonly used to cover the defect, but the donor site morbidity is problematic. Another problem with resecting the axillary or subclavian vessels is difficulty obtaining recipient vessels with matching calibers for another free flap. The authors presented 2 cases that successfully solved all these problems by covering the defects by the forearm fillet flaps.The forearm fillet flap has the advantage of using a portion that is usually discarded, so there is no donor site morbidity. Moreover, using the brachial artery as the pedicle of the flap allows the anastomosis to the stump of the resected axillary or subclavian artery because differences in caliber are slight.The use of the forearm fillet flaps has been reported less frequently than the fillet flaps in the lower extremities, and most cases are posttraumatic. In cases of trauma, complications are reported to occur in about 1 in 4 patients, but in cases after tumor resection, ischemic time can be controlled, and there are no risks of contamination or unnoticed forearm damage, so more stable results can be expected as in this report.Using the free flap from the distal portion of the resected upper limb, especially in cases with a short prognosis, is a viable option that effectively minimizes damage to the donor site and maintains quality of life.

Axillary Vessels and Brachial Plexus Traumas in Abidjan: Lesional Aspects and Surgical Difficulties

Axillary Vessels and Brachial Plexus Traumas in Abidjan: Lesional Aspects and Surgical Difficulties

MANAGEMENT OF A GIANT LIPOMA IN THE AXILLA: A CASE REPORT

Lipomas are the most common benign mesenchymal tumors in adults. Generally, they are less than 5 cm in size but sometimes they can present as giant lipomas. Axillary region is an unusual localization for lipomas in general, especially for giant lipomas. A case of a 62-year-old male with a giant lipoma in the axillary region is presented. The tumor was located in the left axillary region beneath the pectoralis major muscle and extended all along to the scapula. It was adjacent to the axillary vessels and the brachial plexus, but did not invade the neurovascular bundle. A team of a plastic and thoracic surgeon performed the operation. The pathology report confirmed a benign lipoma weighting 454 grams and measuring 13.5x8x7 cm. Follow-up examinations (clinical examination and ultrasound) revealed no recurrence three years after the operation. The mechanism of lipoma formation is not completely clear. It includes two potential and overlapping mechanisms in which trauma seem to have the major role. The treatment includes surgical excision or liposuction. However, excision of large lipomas can sometimes be a surgical challenge. Giant lipomas in axillary region should be removed in order to establish the pathohistological diagnosis and to prevent possible compression of the neurovascular structures. In our opinion, surgical excision is a preferred method of treatment because there is less possibility of damaging vital structures and it offers better control against local tumor recurrence.

3D color doppler ultrasound for postoperative monitoring of vascularized lymph node flaps.

Vascularized lymph node transfer (VLNT) is arelatively well-established microsurgical treatment for lymphedema that is especially beneficial for advanced cases in which lymphovenous anastomosis is not indicated due to lymphatic vessel sclerosis. When VLNT is performed without askin paddle, such as aburied flap, the possibilities for postoperative monitoring are limited. The aim of our study was to evaluate the use of ultra-high-frequency color Doppler ultrasound with 3D reconstruction in apedicled axillary lymph node flap. Flaps were elevated in 15 Wistar rats based on the lateral thoracic vessels. We preserved the axillary vessels to maintain the rats' mobility and comfort. The rats were divided into three groups as follows: Group A, arterial ischemia; group B, venous occlusion; and group C, healthy. Ultrasound and color Doppler scan images revealed clear information on flap morphology changes and pathology if it was present. Surprisingly, we detected venous flow in group Arats, supporting the pump theory and venous lymph node flap concept. We conclude that 3D color Doppler ultrasound is an effective method for monitoring buried lymph node flaps. 3D reconstruction makes it easier to visualize the flap anatomy and detect pathology if it is present. Moreover, the learning curve for the technique is short. Our setup is user-friendly even in the inexperienced hands of asurgical resident, and images can be reevaluated at any time if necessary. The use of 3D reconstruction removes the complications associated with observer-dependent monitoring of VLNT.

Early Blood Flow Abnormalities in Axillary and Brachial Arteries Precede the Onset of Persistent Lymphedema in Women Treated Surgically for Breast Cancer.

Background: surgery to treat breast cancer (BC) is associated with upper limb (UL) lymphedema, which in some cases may become permanent. It is uncertain whether lymphedema results from injury to either lymphatic or blood vessels, or to both. Methods and Results: a cohort of 200 BC patients was examined 1, 3, 6, 12, and 24 months after surgery. Axillary and brachial blood vessels were evaluated using Doppler Ultrasound, and patients had their UL examined for lymphedema at each visit. Patients who developed lymphedema 24 months after surgery presented with higher mean flow velocity (MFV) and end diastolic velocity (EDV) in both axillary (MFV = 13.57 vs. 10.7 cm/s, p = 0.02; EDV = 5.62 vs. 3.47 cm/s; p = 0.004) and brachial (MFV = 11.44 vs. 8.74 cm/s; p = 0.03; EDV = 5.08 vs. 3.04; p = 0.04) arteries as early as 1 month after surgery. Similar associations were found 3, 6, and 12 months after surgery. Early abnormalities of the resistive and pulsatility indexes were also significantly associated with persistent lymphedema. EDV measured 1 month after surgery had the best performance to detect patients who will later develop long-term lymphedema, (sensitivity = 73.7%; specificity = 71.2%; negative predictive value = 57.6%). Conclusion: vascular abnormalities precede and are possible causal factors for UL lymphedema in BC patients.

Axillary lymphangioma that developed following COVID-19 vaccination: a case report

BackgroundExtensive vaccination programs are being implemented worldwide for coronavirus disease 2019 (COVID-19). With the spread of vaccination, swelling of the lymph nodes after vaccination is frequently seen. We encountered a patient who developed left axillary lymphadenoma following vaccine administration.Case presentationThe patient was a Japanese woman in her 80 s who had previously undergone surgery for right breast cancer. She received two injections of the Pfizer-BioNTech COVID-19 vaccine in her left arm. Approximately 3 months later, she complained of left axillary swelling, and imaging resulted in a diagnosis of left axillary lymphangioma. In accordance with the patient’s wishes, we performed axillary mass resection. The pathological diagnosis was lymphangioma.ConclusionOur examination findings indicated that congestion of the axillary lymph vessels might have been caused by upper-arm injections of the COVID-19 vaccine.

Bilateral Transverse Upper Gracilis Flaps for Unilateral Breast Reconstruction: A 4-Year Retrospective Study of the "2-in-1" Technique and a Systematic Review With Meta-analysis.

The transverse upper gracilis (TUG) flap is a reliable alternative to abdominally based breast reconstruction because of its advantageous anatomy. However, the limited tissue volume prevents reconstruction of large breasts. The bilateral TUG flaps for unilateral breast reconstruction can overcome this problem. A retrospective analysis was performed regarding unilateral breast reconstruction with bilateral TUGs at the Queen Victoria Hospital from 2015 to 2019. Associations between categorical variables were examined with Fisher exact test, and any differences in continuous variables by complication status were evaluated with Mann-Whitney-Wilcoxon test for independent samples. A relevant systematic review was conducted with a meta-analysis of proportions using the Freeman-Tukey arcsine transformation for the estimation of the overall survival rates. Ten cases were identified with 6 having a delayed reconstruction. Median age and body mass index were 50.8 years and 23.9 kg/m 2 , respectively, and average flap weight was 268.3 g. One flap was placed superiorly with its pedicle anastomosed to the retrograde internal mammary vessels, except of half of the cases where a second anterograde vein was used. The mean follow-up was 21.4 months, and all flaps survived. Two patients returned to theater, and 4 experienced donor-site problems. The presence of complications was not associated with age, ever smoking, body mass index, TUG weight, or anastomosis to retrograde internal mammary vein. The systematic review resulted in 8 eligible articles with a total sample of 156 flaps. The overall survival rate was 96.8%. In 6 cases, the indication was Poland syndrome (7.7%), and in 48.7%, axillary vessels were also used as recipient vessels. The estimated overall flap survival rate was 100% (95% confidence interval, 99%-100%), and no significant heterogeneity was noted ( I2 = 0%, P = 0.71). The "2-in-1" technique can lead to symmetrical aesthetically pleasant results for both recipient and donor sites. Our case series and the conducted systematic review reiterate the reliability of this approach.

Axillary Anatomy and Pathology: Pearls and "Pitfalls" for Thoracic Imagers.

The axilla contains several important structures which exist in a relatively confined anatomic space between the neck, chest wall, and upper extremity. While neoplastic lymphadenopathy may be among the most common axillary conditions, many other processes may be encountered. For example, expanded use of axillary vessels for access routes for endovascular procedures will increase the need for radiologists to access vessel anatomy, patency, and complications that may arise. Knowledge of axillary anatomy and pathology will allow the imager to systematically evaluate the axillae using various imaging modalities.

Upper-Extremity Vascular Exposures for Trauma: Comparative Performance Outcomes for General Surgeons and Orthopedic Surgeons.

As combat-related trauma decreases, there remains an increasing need to maintain the ability to care for trauma victims from other casualty events around the world (e.g., terrorism, natural disasters, and infrastructure failures). During these events, military surgeons often work closely with their civilian counterparts, often in austere and expeditionary contexts. In these environments, the primary aim of the surgical team is to implement damage control principles to avert blood loss, optimize oxygenation, and improve survival. Upper-extremity vascular injuries are associated with high rates of morbidity and mortality resulting from exsanguination and ischemic complications; however, fatalities may be avoided if hemorrhage is rapidly controlled. In austere contexts, deployed surgical teams typically include one general surgeon and one orthopedic surgeon, neither of which have acquired the expertise to manage these vascular injuries. The purpose of this study was to examine the baseline capabilities of general surgeons and orthopedic surgeons to surgically expose and control axillary and brachial arteries and to determine if the abilities of both groups could be increased through a focused cadaver-based training intervention. This study received IRB approval at our institution. Study methods included the use of cadavers for baseline assessment of procedural capabilities to expose and control axillary and brachial vessels, followed by 1:1 procedural training and posttraining re-assessment of procedural capabilities. Inferential analyses included ANOVA/MANOVA for within- and between-group effects (P < .05). Effect sizes were calculated using Cohen's d. Study outcomes demonstrated significant differences between the baseline performance abilities of the two groups, with general surgeons outperforming orthopedic surgeons. Before training, neither group reached performance benchmarks for overall or critical procedural abilities in exposing axillary and brachial vessels. Training led to increased abilities for both groups. There were statistically significant gains for overall procedural abilities, as well as for critical procedural elements that are directly associated with morbidity and mortality. These outcomes were consistent for both general and orthopedic surgeons. Effect sizes ranged between medium (general surgeons) and very large (orthopedic surgeons). There was a baseline capability gap for both general surgeons and orthopedic surgeons to surgically expose and control the axillary and brachial vessels. Outcomes from the course suggest that the methodology facilitates the acquisition of accurate and independent vascular procedural capabilities in the management of upper-extremity trauma injuries. The impact of this training for surgeons situated in expeditionary or remote contexts has direct relevance for caring for victims of extremity trauma. These outcomes underscore the need to train all surgeons serving in rural, remote, expeditionary, combat, or global health contexts to be able to competently manage extremity trauma and concurrent vascular injuries to increase the quality of care in those settings.

Evaluation of the Effect of Axillary Radiotherapy Dose and the Development of Lymphedema in Breast Cancer Patients

Purpose: The present study is aiming to correlate different radiotherapy techniques, fractionations, and doses received by each axillary LN level and axillary vessels with the development of breast cancer-related lymphedema (BCRL). Methods and Materials: We retrospectively studied 181 female breast cancer patients who were diagnosed and treated by radiation therapy during the period from January 2012 to December 2017. The radiotherapy treatment plans were recalled from the archives. The axillary LN levels I, II, III, supraclavicular LN were contoured as well as axillary vessels. New dose volume histograms were generated to correlate between the radiotherapy dose t and the development of BCRL. Results: The study included 162 patients treated with a 3D radiotherapy technique and 19 treated with a 2D radiotherapy technique; 124 patients underwent MRM, while 57 patients underwent BCS; 117 patients were treated with a hypofractionated technique, while 64 patients were treated with a conventional radiotherapy technique. The cumulative incidence of BCRL after radiotherapy was 20.4%. There was a statistically significant relationship between the 2D radiotherapy technique compared with 3DCRT and development of lymphedema (55 vs. 16.6, respectively; p < 0.001). Patients who were treated with conventional radiotherapy had significantly higher rates of lymphedema (42.2%) compared with hypofractionated radiotherapy (8.5%) (p < 0.001). There was a non-significant relationship between mean radiotherapy dose to axillary levels or axillary vessels and development of lymphedema. Conclusion: Breast cancer radiotherapy with the 2D technique and conventional fractionation protocol might increase the risk of BCRL. No correlation was observed between radiotherapy dose to each axillary LN level, axillary vessels and BCRL.

Risk of Stroke with Impella Placement Is Not Associated with Access Vessel.

Objective: The Impella heart pump is an intravascular microaxial device that provides short-term mechanical circulatory support and can be placed through the femoral, axillary, or central vessels. One of the most feared complications is stroke. It is unclear if patient stroke risk varies based on access vessel. Methods: A retrospective review of consecutive patients who underwent Impella placement at an academic institution from January 1, 2007, through September 15, 2018, was performed. Four groups were compared: (1) minimally invasive Impella (femoral or axillary access), (2) minimally invasive Impella upgraded to another minimally invasive Impella, (3) minimally invasive Impella upgraded to a central Impella (ascending aorta), and (4) central Impella. Patient charts were reviewed to identify baseline characteristics. Outcome measures included length of stay, stroke, and mortality. Results: A total of 349 patients (or 407 Impellas) were identified, and the majority of the devices were inserted through a minimally invasive approach (n = 248, 60.9%), while the remainder were implanted via central access (n = 159, 39.1%). Minimally invasive Impellas were upgraded in 44 patients. The risk of stroke for the entire cohort was 10.3% (n = 36), with no difference observed in any particular group. Overall mortality was 44.4% (n = 155). Of the patients who initially received a minimally invasive Impella, those who were upgraded had higher rates of mortality (56.8% vs 39.4%, P = 0.03), postoperative dialysis (50.0% vs 27.4%, P < 0.01), and sepsis (43.2% vs 20.0%, P < 0.01). Conclusions: This study found no statistically significant difference in rates of postoperative stroke based on initial access vessel.

Utilization of Forearm Crutches to Avoid Lymphedema After Breast Cancer Lymph Node Surgery: A Case Report

Background: Despite many patients with breast cancer being advised to limit upper extremity (UE) use, there is growing evidence that UE use is not associated with lymphedema. Subsequently, clinicians may be unsure of how to advise patients with a history of breast cancer who need assistive devices to ambulate. Study Design/Case Description: A 51-year-old woman who had recently undergone treatment for breast cancer sustained a knee injury requiring the use of crutches. Forearm crutches were used instead of axillary crutches to minimize the potential for irritation to the axillary lymphatic vessels and thus reduce the risk for lymphedema. L-Dex measures were used to monitor for lymphedema. Outcomes: L-Dex scores did not exceed the change of more than +7.1 to indicate the presence of lymphedema. Furthermore, there were no clinical signs or symptoms of lymphedema while using crutches and in the 7 months following. Discussion: Prolonged rigorous UE use by ambulating non-weight-bearing with forearm crutches within 1 to 2 months of treatment for breast cancer did not result in UE lymphedema. This case report reinforces the growing body of evidence that avoiding aggressive UE activity may not be necessary in those at low risk of lymphedema and informs assistive device prescription for patients with breast cancer.

Open inferior Glenohumeral fracture dislocation with interposition of the Subscapularis and greater tuberosity

Open dislocations of the shoulder are extremely rare. Emergency stabilisation of the trauma patient, prompt joint reduction, and careful exploration of neurovascular structures are fundamental management principles. The report describes the case of a young male cyclist who suffered an open inferior Glenohumeral fracture dislocation. Urgent stabilisation of the patient was necessary prior to reduction of the fracture dislocation. Significant bleeding was observed from an axilla wound, the humeral head was found protruding through the skin. Emergency imaging revealed the integrity of the major upper limb arteries and persistent humeral head subluxation following emergency reduction. Early surgical exploration of the major axillary vessels was performed by a multi-disciplinary team. The Subscapularis was found reflected into the joint with a fragment of the greater tuberosity. Fracture fixation and reconstruction of the rotator cuff was performed. A review of the literature is included. Avascular necrosis and impaired function are common complications of this injury.

Mise au point sur l’anatomie de la région axillaire : l’arc musculaire du grand dorsal ou muscle de Carl Langer, un grand oublié dans la formation des internes

ObjectiveThe Carl Langer muscle is the main anatomical variation of the walls of the axillary area, its incidence being about 7%. The presence of this muscle crossing the anterior edge of the axillary vessels can induce difficulties of exposure, location and dissection during axillary surgery. In addition, it may be responsible for primary lymphedema of the upper limb, venous thrombosis of the axillary vein or thoracic outlet syndrome due to vascular or nervous compression. The objective of this work was to evaluate the state of knowledge on Carl Langer muscle of the gynecology-obstetrics medical residents of the French Eastern Region. Material and methodsAll the medical residents enrolled in the specialized diploma in gynecology-obstetrics in the 5 regions (Alsace, Bourgogne, Lorraine, Champagne-Ardenne and Franche-Comté) were questioned by means of a questionnaire sent by e-mail. ResultsFrom February to March 2021, 94 of the 160 medical residents interviewed answered to the questionnaire. Ninety-one of them (97%) did not know Carl Langer's muscle. Three medical residents thought they knew this muscle (3%) but their knowledge was imperfect. ConclusionOur work has highlighted the general lack of knowledge of this anatomical variation, which is relatively frequent, among French gynecology-obstetrics medical residents who are required to examine or perform surgery on this area. This updated review of the literature should optimize the knowledge of the anatomy of the axillary area and consequently its surgery.

Ultrasound-guided dorsal approach for the brachial plexus block in common kestrels (Falco tinnunculus): a cadaver study

ObjectiveTo develop an ultrasound-guided dorsal approach to the brachial plexus and to investigate the nerve distribution and staining of a dyed injectate in common kestrel (Falco tinnunculus) cadavers. Study designProspective, cadaver study. AnimalsA group of three common kestrel cadavers (six wings). MethodsAll cadavers were fresh-frozen at –20 °C and thawed for 10 hours at room temperature before the study. The cadavers were placed in sternal recumbency and their wings were abducted. A 8–13 MHz linear-array transducer was placed over the scapulohumeral joint, at the centre of a triangle formed by the scapula and the humerus. The brachial plexus was identified between the scapulohumeralis muscle and the pectoralis major muscle, as hypoechoic structures lying just cranially to the axillary vessels. After ultrasound-guided brachial plexus identification, a 22 gauge, 50 mm insulated needle was advanced in-plane using ultrasound visualization. A volume of 0.5 mL kg–1 of a 3:1 (2% lidocaine:methylene blue) solution was injected. Following cadaver dissection, the pattern of the spread was assessed, and the extent of nerve staining was measured with a calliper and deemed adequate if more than 0.6 cm of the nerve staining was achieved. ResultsThe brachial plexus was clearly identified in all wings with the dorsal approach. After dye injection, all the branches of the brachial plexus defined as nerves 1–5 (N1, N2, N3, N4 and N5) were completely stained in five (83%) and partially stained in one (17%) of the six wings. Conclusions and clinical relevanceThe ultrasound-guided dorsal approach allows a clear visualization of the brachial plexus structure. The injection of 0.5 mL kg–1of a lidocaine/dye solution produced complete nerve staining in most cases. Further in vivo studies are mandatory to confirm the clinical efficacy of this locoregional anaesthesia technique in common kestrels (Falco tinnunculus).