Lateral Thoracic Artery Research Articles

Fenestration of Axillary Vein by a Variant Axillary Artery

Variations of venous pattern in the arm are common. In this case report, we present a variation of axillary artery and vein. During routine educational dissections of axillary region, it was observed that a fenestrated axillary vein was perforated by a variant axillary artery in right arm of an old male cadaver. The axillary artery which was fenestrated through axillary vein had only two branches arising from its second part and no branches from its remaining distal parts. The branches are thoraco-acromial (usual) and another large collateral (unusual) branch. This collateral branch is the origin of several important arteries as the subscapular, circumflex scapular, posterior circumflex humeral and lateral thoracic arteries. We propose to name this artery as collateral axillary arterial trunk. The course of this collateral axillary arterial trunk and its branches and also clinical significance of this variation are discussed in the paper.

Neurovascular distribution within the abdominal head of the pectoralis major muscle: Application to breast and flap surgery.

The abdominal head of the pectoralis major (AHPM) is important in cosmetic and flap surgeries. Few studies have reported on its neurovascular entry points and distribution patterns. We aimed to determine the entry points and distribution patterns of the neurovascular structures within the AHPM. Thirty-two hemithoraxes were dissected, and the distribution patterns of the neurovascular structures were classified into several categories. The neurovascular entry points were measured at the horizontal line passing through the jugular notch (x-axis) and the midclavicular line (y-axis). The AHPM was innervated by the communication branches of the medial pectoral nerve (MPN) and the lateral pectoral nerve (LPN) in 78.1% of the specimens and of the MPN without the communication branches in 21.9%. All the LPNs had communication branches, which could be classified as independent in 46.9% of the samples, with the MPN in 21.9%, and with the LPN in 9.3%. The blood supply of the AHPM was composed of branches from the lateral thoracic artery (LTA) in 62.5% of the specimens, the thoracoacromial artery (TA) in 15.6%, and the LTA with the TA in 21.9%. The mean distance of the entry point was 6.3 cm ± 1.3 cm lateral to the y-axis, 8.1 cm ± 3.3 cm below the x-axis in the nerves, 6.5 cm ± 1.2 cm lateral to the y-axis, and 8.6 cm ± 3.0 cm below the x-axis in the arteries. This study defined the average neurovascular entry point and distribution pattern in detail using standard lines to enable the AHPM to be better understood.

Preoperative color Doppler ultrasound assessment of the lateral thoracic artery perforator flap and its branching pattern

The anatomy of the lateral thoracic artery perforator flap remains controversial, but this region is extremely useful as a reconstructive donor site. In this report, we describe the usefulness of the preoperative color Doppler ultrasound evaluation for the harvesting of the lateral thoracic artery perforator flap, and we clarify its branching pattern. Twenty-seven patients underwent the preoperative color Doppler ultrasound assessment before perforator flaps were harvested. We evaluated the branching pattern and the diameter of the flaps by direct observation. All flaps were successfully transferred, and it was found that the branching pattern of the lateral thoracic perforator is divided into three groups: the superficial branch, the medial branch, and the deep branch. Their appearance ratios were 48.1% (13/27), 14.8% (4/27), and 81.5% (22/27), respectively. The lateral thoracic artery perforator flap has a great deal of anatomical variation, and vessels with relatively small diameters compared to those of other flaps. This is why flaps from this region are not currently popular. This study revealed the superiority of the color Doppler ultrasound for preoperative planning of the lateral thoracic artery perforator flap elevation. Furthermore, the branching pattern and the diameters of the different branches were specified.

Head and neck reconstruction by using extended pectoralis major myocutaneous flap.

Pectoralis major flaps have been the workhorse in head and neck region reconstructions till date. However, pectoralis major flaps have disadvantages, including limitations regarding flap range and less stable blood flow than that in free flaps. Here, we report on the safe reconstruction to the oral cavity and neck area by using extended pectoralis major flaps. These flaps include both the normal vessels that feed pectoralis major flaps (the thoracoacromial artery and vein) and the lateral thoracic artery and vein to stabilize blood flow and expand flap survival area caudally. Eight patients who had undergone reconstruction with extended pectoralis major flaps after the resection of head and neck cancers from June 2009 to March 2013. In all cases, the pectoralis major flap was elevated with a vascular pedicle comprising the thoracoacromial artery and vein and the lateral thoracic artery and vein. No blood circulation disorders, such as ischemia or congestion, were observed after the flaps were elevated and moved to the resected areas. All flaps were sutured on without difficulty. The area the flaps were harvested from was closed in a single stage. No postoperative complications such as hematoma, abscess, or fistula were observed. Extended pectoralis major flaps have a wide range and more stable blood flow, so they are thought to be useful in situations in which free flaps cannot be used for a variety of reasons.

Lateral thoracic artery perforator (LTAP) flap in partial breast reconstruction

Partial breast reconstruction using pedicled perforator flaps from the thoracodorsal (TDAP) and lateral intercostal arteries (LICAP) is well described. The article introduces the lateral thoracic artery perforator (LTAP) flap as an additional valuable option from the lateral chest wall and reports clinical experience and outcomes. The anatomy of the LTAP flap is reviewed and the results of a consecutive series are reported. In a series of 75 consecutive cases of lateral chest wall perforator flaps used for reconstruction of partial breast defects, 12 (17%) were raised as pure LTAP flaps, and a further 19 (27%) as combined LTAP/LICAP flaps. The LTAP was therefore used in 44% of flaps overall. One LTAP flap (delayed case) had early venous compromise that settled spontaneously. The LTAP flap is a reliable option for partial breast reconstruction from the lateral chest wall, particularly in the immediate setting. It allows comparable flap size to be harvested compared to LICAP flaps. The LTAP flap can be raised on its own pedicle allowing greater mobilization or it can be incorporated into the more commonly used LICAP flap to augment perfusion.

Transcatheter Arterial Embolization for Chest Wall Trauma—10-Year Experience from a Single Trauma Center

Purpose To present our experience in transcatheter arterial embolization (TAE) for hemorrhage following blunt or penetrating chest wall trauma. We provide the reader with a pictorial summary of the full range of angiographic findings and embolization techniques utilized. Material and Methods We performed a retrospective review of all patients treated with TAE for this indication from August 2004 to August 2014 in our institution, a level I trauma center. Data were obtained from the electronic records, pre- and post-procedural imaging, procedure reports, and laboratory results. Results A total of 13 patients were treated during this period. Seven patients had blunt trauma to the chest wall. Four patients had penetrating injury (2 stabbings and 2 gunshot wounds). In 4 cases the injuries were iatrogenic (3 due to chest tube insertion and 1 blunt injury from cardiopulmonary resuscitation). Two patients were previously treated with thoracotomy, which failed to control the bleeding. Embolization of intercostal artery, internal mammary artery and branches of the lateral thoracic and axillary arteries were performed. In all cases, embolization was effective in controlling the hemorrhage. There were no complications related to the procedure. We discuss the spectrum of imaging findings in these cases. Technical aspects such as catheter and embolic material selection are also discussed with pictorial examples. Conclusions In our experience TAE is a safe and effective treatment option in the management of chest wall hemorrhage after blunt and penetrating trauma. This minimally invasive procedure is particularly valuable in patients with significant comorbidities and persistent hemorrhage. Interventionists working in a trauma setting must have a thorough knowledge of the anatomical features and collateral pathways of the chest wall vasculature.

Origin of the subscapular artery in the South African Black population.

There is great variability in the branching patterns of the axillary artery (AA). Racial differences have been reported to play a role in this variability. The subscapular artery (SA) is the largest and most variable branch of the AA. It usually arises from the third part of the AA at the inferior border of the subscapularis muscle. Approximately 4 cm from its origin, the SA divides into the circumflex scapular and thoracodorsal arteries. Two types of the SA have been described, depending on the site of its origin from the AA in relation to the point where the AA passes between the lateral and medial roots of the median nerve. It is referred to as the superficial SA (SSA), when proximal, and the deep SA (DSA), when distal to this point, respectively. This study aimed to determine the site and distance of origin of the SA from the outer border of the first rib in the South African Black population. The study comprised bilateral gross anatomical dissections of 50 adult Black South African cadavers (n = 100 AAs). The site and distance of origin of each vessel from the outer border of the first rib were recorded. Additional branches and variations were also noted. The SSA and DSA were found in 52.8% and 47.2% of cases, respectively. In 16.8% of cases, the SA gave rise to the posterior circumflex humeral artery and the lateral thoracic artery in 33.7% cases. The SA was absent in 11% of the cases. The prevalence of the SSA reported in this study differs from values ranging between 1.7% and 16% reported in the literature. The high incidence of the SSA in this study may have clinical significance as a superficial course of the arteries make them vulnerable to injury during surgical procedures.

An unusual high bifurcation and variable branching of the axillary artery in a Greek male cadaver.

IntroductionThe axillary artery presents abnormalities in its origin and course and a variable branching.Case descriptionA rare case of axillary artery bifurcation and branching was observed in a 60-years-old European male cadaver of Greek origin. The right axillary artery at the second part was bifurcated into a superficial and a deep brachial artery. The superficial brachial artery anteromedial to the median nerve and lateral to the ulnar nerve gave off the acromio-thoracic artery and two lateral thoracic arteries. The deep brachial artery behind the median nerve, after giving rise to the anterior circumflex humeral artery trifurcated into a branch that coursed distally, the posterior circumflex humeral artery and the subscapular artery. The latter subdivided into the circumflex scapular artery, a muscular branch for the subscapularis and the thoracodorsal artery. The continuation of the deep brachial artery divided laterally into a humeral nutrient artery and medially into a trunk which trifurcated into the profunda brachii artery, a deep muscular branch and a branch to the posterior compartment of the arm. The profunda brachii artery ended as radial and middle collateral arteries.Discussion and evaluationDeviations from the normal arterial pattern are of immense significance for anatomists, plastic, cardiovascular and orthopedic surgeons, vascular radiologists and interventional cardiologists.

Another option of perforator flap in the lateral thoracic area: lateral thoracic perforator flap.

The lateral thoracic donor site provides two types of perforator flap; the latissimus dorsi perforator flap based on the musculocutaneous perforator, and the thoracodorsal perforator flap based on the septocutaneous perforators from the thoracodorsal artery. In this article, we introduce a direct cutaneous perforator derived from the lateral thoracic artery, which provides another option for harvesting a perforator flap from the lateral thoracic region. Overall 17 patients underwent reconstructions using the lateral thoracic perforator flap for defects resulting from tumor-ablative surgery in the head and neck region, chronic osteomyelitis, and trauma or chronic wounds of the lower extremities. All flaps survived without major complications and six of the flaps were harvested in a chimeric pattern. When the latissimus dorsi and thoracodorsal perforator flaps are not suitable, the lateral thoracic perforator flap provides another option from the lateral thoracic region that is useful for a variety of reconstructions. However, anatomic variation and the shorter and smaller pedicle compared with the thoracodorsal vessels are drawbacks of the lateral thoracic perforator flap that make it difficult to approach. The combination of the versatility of the previous two perforator flaps based on the thoracodorsal system and this additional type of lateral thoracic perforator flap makes the lateral thoracic region a universal donor site.

Anatomical variations of the axilla.

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.

Lymph fasciocutaneous lateral thoracic artery flap: anatomical study and clinical use.

The lateral thoracic flap was first studied in the mid-1970s but its use has been limited because of pedicle anatomical variations. However, after the development of lymph node transfer surgery, the axilla/upper lateral thorax presented as a promising donor area. Through a detailed anatomical study, the lateral thoracic flap was evaluated regarding its vascularization and composition. Later, it was used for pedicle and free flap reconstructions. A total of 40 flaps were dissected in fresh cadavers and the characteristics of the lateral thoracic pedicle and its relationship to the upper lateral thoracic axillary lymph nodes (LTLN) were analyzed. We performed six pedicle flap reconstructions around the shoulder area and a free lymph node transfer for lower limb lymphedema. In the cadaveric dissections, the lateral thoracic pedicle branched off the axillary vessels and was found to be a primary level I axillary lymph node irrigator before reaching the skin. The cutaneous portion of the artery was present in 87.5% of the dissections. Arterial caliber was an average of 1.3 and venous, 2.6 mm. Five to seven lymph nodes were isolated with each pedicle and a lymph fasciocutaneous flap could be designed. In seven clinical cases, all of the flaps survived. Functioning lymph nodes were visualized on lymphoscintigraphy after their transfer to the ankle. Donor area had an inconspicuous evolution. Lateral thoracic flap is a feasible flap with low donor area morbidity in a concealed region that can be harvested with upper LTLN for transplantation.

An alternative contrast medium for computed tomographic angiography: gadolinium.

Sir: Computed tomography is the mainstay for perforator flap angiographic mapping. There is an increasing foundation of evidence in the literature for the use of computed tomographic angiography in the planning of free flaps, able to guide the surgical approach and improve operative outcomes. Iodinated contrast is the gold standard contrast medium for angiographic imaging. Used in either an oil- or water-soluble form, the radiopaque medium is administered intravenously to improve visibility of the vasculature on radiographic images. However, iodinated contrasts are associated with nephrotoxicity and are strongly contraindicated in patients with poor renal function.1 Magnetic resonance angiography has been suggested for use in such a scenario, when iodinated contrast media are not suitable. However, magnetic resonance angiography is also contraindicated in some settings, particularly where there are implanted metallic devices (such as some breast implants). In these cases, options for high-resolution preoperative imaging are limited. We describe the use of gadolinium as an alternative to iodinated contrast media for use in computed tomographic angiography for preoperative flap imaging. This enables the use of the gold standard modality in patients that otherwise would be unable to undergo imaging with computed tomography. Although this has not been described before, gadolinium has been tested as a contrast medium in computed tomography previously.2,3 Gadolinium, with an atomic number of 64, is a rare earth metal that, because of its paramagnetic properties, is an extremely efficacious contrast agent. In its chelated form, gadolinium has been shown to be considerably less nephrotoxic and allergenic than iodinated contrast compounds1 and is not associated, as previously thought, with any increased risk of the development of nephrogenic systemic fibrosis.4 The use of gadolinium (gadolinium diethylenetriaminepentaacetic acid)-enhanced computed tomographic angiography has been described in aortography and other large vessel angiography. The results have been verified with other forms of imaging and the conclusions have been predominantly positive. Chryssidis et al. describe the use of gadolinium for thoracic aortic aneurysm diagnosis, with vascular enhancement concluded to be sufficient for the confident exclusion of an intimal flap with confirmation of findings by magnetic resonance imaging.5 These findings are consistent across thoracic, abdominal, and cerebral vessel imaging. We have used this imaging in two patients who both required vascular mapping for preoperative flap planning, and who were both unable, for various indications, to receive either iodinated contrast or undergo magnetic resonance imaging. The images below are from a woman presenting for unilateral breast reconstruction, for whom iodinated contrast was contraindicated because of impaired renal function and for whom magnetic resonance imaging was also contraindicated because of her breast expander in situ (Mentor 550 cc Tall height model 354/6313; Mentor Corp., Santa Barbara, Calif.), which is incompatible with magnetic resonance imaging because of a magnetic port. Figures 1 and 2 clearly demonstrate the right lateral thoracic and thoracodorsal arteries, imaged for use in a breast-sharing procedure.Fig. 1: Computed tomographic angiogram, maximum-intensity projection software reconstruction, with gadolinium contrast medium, highlighting opacification of the lateral thoracic artery (blue arrow) and thoracodorsal artery (red arrow).Fig. 2: Computed tomographic angiogram, three-dimensional volume-rendered technique software reconstruction, with gadolinium contrast medium, highlighting opacification of the lateral thoracic artery (blue arrow).In both cases, accurate and relevant angiographic data were gained. Despite these being the first two scans of this type obtained, the contrast injections were able to be timed effectively and gadolinium was shown to be a valuable contrast agent when other forms of scanning are contraindicated. DISCLOSURE The authors declare that there is no source of financial or other support or any financial or professional relationship that might pose a competing interest. There was no source of funding for this article. Phaethon Karagiannis, M.B.B.S. Vachara Niumsawatt, M.B.B.S. Department of Surgery Monash University Monash Medical Centre Clayton, Victoria, Australia Warren M. Rozen, M.B.B.S., M.D., Ph.D. Department of Surgery Monash University Monash Medical Centre Clayton, Victoria, and Department of Surgery School of Medicine and Dentistry James Cook University Clinical School Townsville, Queensland, Australia [email protected]

Clinical application of single pedicle thoraco-umbilical flaps spanning chest and abdomen in the repair of upper extremity giant soft-tissue defects

Objective To introduce the surgical techniques and indications of single pedicle thoracoumbilical flaps spanning chest and abdomen in the repair of upper extremity giant soft-tissue defects.Methods From 2006 to 2012,8 cases with upper extremity giant soft-tissue defects were treated with the ultra-long thoraco-umbilical flaps spanning chest and abdomen.The blood vessel of inferior epigastric artery→superior epigastric artery→intercostal arteries or lateral thoracic artery were included in the flap to provide double blood with only one vascular anastomosis.Results All of the 8 flaps survived.Wounds at both donor and recipient sites achieved primary healing.The shape of flaps was satisfactory after 6 to 18 months' follow-up.The donor site was left with a linear scar.There were no complications.Conclusion The thoraco-umbilical flap spanning chest and abdomen with inferior epigastric artery→ superior epigastric artery→ intercostal arteries or lateral thoracic artery double chain blood supply requires only one vascular anastomosis and is an ideal option for treatment of upper extremity giant long soft-tissue defects. Key words: Transplantation; Surgical flaps; Thoraco-umbilical flaps; Upper extremity soft-tissue defects; Repair

Clinically Significant Variation in the Branching Pattern of the Human Axillary Artery – A Case Report

Axillary artery begins at the outer border of the rib, divides into 3 parts by the pectoralis major muscle. Though anomalies in the origin, course and branching pattern is not frequent with axillary artery, previous research reports shows different types of anomalies in it. We observed an unusual unilateral variation in a 55 year old male cadaver, during routine dissection, in the branching pattern of the axillary artery. The variation reported in this study is in the second part of the axillary artery where the lateral thoracic and subscapular artery arises from the common trunk which arises at the junction between the second and third part of the axillary artery. Rest of the branching pattern are standard as explained in the gross anatomy text books. As there is a high rate of rupture and damage to the axillary artery during the surgical interventions, the orientation of the axillary artery and its branches is vital for efficient clinical practice. Thus the sound knowledge about the normal, its variation is prerequisite for the clinicians [surgeon, radiologist, orthopedician, anaesthesiologist and clinical anatomist] for accurate diagnosis and surgical intervention. Keyword: Axillary artery, common trunk, lateral thoracic artery, subscapular artery.

Three-Dimensional Printing of Perforator Vascular Anatomy

Sir: The use of three-dimensional printing has increased in recent years with the advent of commercially available three-dimensional printers and lower costs. Computed tomographic data can be obtained rapidly and incorporated into three-dimensional reconstructions visualized in two dimensions. This information can be used to produce a physical object using progressive layering of different polymers or materials with a three-dimensional printer. Production of three-dimensional models allows improved visualization and manipulation of anatomical structures compared with two-dimensional representations. They can be used for surgical planning, implant design, and education.1 Three-dimensional models have also been used for training on patient-specific models to simulate surgical procedures to help understand difficult anatomy, predict complications, and potentially reduce operating time.1–41–41–41–4 We produced a three-dimensional model to facilitate understanding of the regional anatomy of the internal mammary artery. We chose the internal mammary artery perforator system, as its relationship to surrounding ribs is important in the dissection and identification of the dominant perforator while raising the internal mammary artery perforator flap. To create a three-dimensional model of the dominant internal mammary artery perforator, a fresh cadaver was injected with the modified lead oxide technique described previously.5 The cadaver was obtained through the Dalhousie University Donor Program. Plain films and computed tomographic images of the cadaver were obtained and the data were analyzed using Materialise’s Interactive Medical Image Control System program (Materialise, Leuven, Belgium). Using the program, three-dimensional images of the dominant internal mammary artery perforator and surrounding structures were created (Fig. 1).Fig. 1: Three-dimensional reconstructions of the left bony thorax, internal mammary artery, and dominant left internal mammary artery perforator and lateral thoracic artery from cadaveric computed tomographic data using Materialise’s Interactive Medical Imaging Control System. (Left) Anterior-posterior, (center) oblique, and (right) posterior-anterior views (*, second internal mammary artery perforator; •, second rib; , lateral thoracic artery).The reconstruction was printed in three dimensions using a composite powder printing process on a ProJet x60 series printer with a Z-bond 90 infiltrant (3D Systems, Rock Hill, S.C.). This produces a three-dimensional object by successively laying down the infiltrant to build the model slice by slice based on the reconstruction. We report the first use of three-dimensional printing to produce vascular perforator anatomy. The dominant internal mammary artery perforator can be seen branching off of the internal mammary artery, through the second intercostal space and anastomosing with the lateral thoracic artery (Fig. 2).Fig. 2: Anteroposterior (left) and oblique (right) views of a three-dimensional model of the left bony thorax, internal mammary artery, and internal mammary artery perforator (*, second internal mammary artery perforator; •, second rib; , lateral thoracic artery). The lateral thoracic artery was based on cadaveric data and printed using a ProJet x60 series printer with a Z-bond 90 infiltrant (3D Systems, Rock Hill, S.C.).The use of three-dimensional printing to produce physical objects is the next step from three-dimensional reconstructions visualized on two-dimensional screens. It allows rapid manipulation and understanding of an individual’s anatomy by physically holding the object and being able to visualize it in multiple planes. This can be useful for teaching learners, and can be used as a tool to better explain the proposed surgery to patients using their own anatomy. One limitation of the process is the cost associated with production of the model, which can be anywhere from $400 to $1200. Also, due to the minuteness of perforator vessels, some smaller vessels do not endure the printing process due to the resolution limitations of the three-dimensional printer. This can be ameliorated with a larger model, albeit at a higher cost. Also, the materials used to make certain models are delicate, and rough handling can cause perforator branches to crack. However, postprinting processing with materials such as wax can create a durable model that can be used in clinics and teaching sessions. DISCLOSURE The authors have no financial interest in any of the products or devices mentioned in this article. Joshua A. Gillis, B.Sc., M.D. Steven F. Morris, M.D., M.Sc. Division of Plastic Surgery Dalhousie University Halifax, Nova Scotia, Canada

Unilateral Aberrant Branch to the Thoracic Region of the Brachial Artery

The brachial artery begins at the lower margin of the tendon of the teres major muscle, and, passing down the arm, ends about 1 cm. below the bend of the elbow, where it divides into the radial and ulnar arteries. Branches of the brachial artery are the profunda brachii artery (also known as the deep brachial artery), nutrient humeral artery, superior ulnar collateral artery, inferior ulnar collateral artery, radial artery (a terminal branch) and ulnar artery (a terminal branch). Superior thoracic artery (highest thoracic artery) is a small vessel normally arising from the first division of the axillary artery and the lateral thoracic artery (or external mammary artery) is a blood vessel that supply to the upper and lateral structures of the thorax and breast. The thoracodorsal artery is a branch of the subscapular artery. It travels inferiorly with the thoracodorsal nerve and also supplies the lateral wall of thorax. We found an aberrant branch of the left brachial artery in an adult, Caucasian, male cadaver during a routine dissection. This aberrant artery originated from brachial artery, 2 cm below of the profunda brachii artery, then course to the thoracic region on the left side. This aberrant branch was divided to superficial and deep branches over the pectoralis major muscle at the lower border of fifth costa. Variations of arterial system in the upper limb are well documented. According to human anatomy text books and available literature, this aberrant branch of the brachial artery is possible very rare and there is no existing text about it. This kind or arterial variations may cause complications during axillary, thoracic or abdominal surgical operations as well as during normal life time of these individuals.

The lateral thoracic artery revisited

Although the variations in the origin of the branches of the axillary and subclavian arteries have been well documented, little information regarding the highly variable lateral thoracic artery (LTA) is available. Descriptions of the LTA variations may prove useful during procedures of the lateral aspects of the thorax such as reconstructive plastic surgery and modified radical mastectomy. The aim of this study was to examine the anatomy of the LTA and offer an accurate account of its variability. The entire course and distribution of the LTA was examined in 420 formalin-fixed adult human cadavers. The LTA was found in 96.7 % of the specimens, showing great morphological variability and classified into six types according to its origin. The most common type was where the LTA arose from the thoracoacromial artery (Type I 67.62 %). In decreasing order of incidence were origins from: the axillary artery (Type II 17.02 %), the thoracodorsal artery (Type III 5 %), and the subscapular artery (Type IV 3.93 %). Additionally, multiple LTAs were present (Type V 3.09 %) and complete absence of LTA (Type VI 3.33 %) was observed. Despite variations in origin of the vessels, our dissections demonstrated that the ultimate tissue distribution of the LTA remained typical in the vast majority of the specimens and descended on the lateral border of the pectoralis minor. Our results illustrate the need for re-evaluation of the branches of the thoracoacromial artery with possible consideration that the LTA arises from it, instead of directly from the axillary artery. We hope that the information supplied by this study will provide useful information to anatomists and surgeons alike.

Unilateral Third Head of Biceps Brachii with Associated Neurovascular Variants in both the Upper Limbs of a Single Cadaver

During routine undergraduate dissection in the upper extremities of a 65 years old male cadaver in the department of Anatomy at Dr. PSIMS &amp; RF, coexistence of muscular and neurovascular variants were identified .Muscular variations included presence of additional head(third) of biceps brachii in the left arm, accompanied with medially positioned median nerve in relation to brachial artery bilaterally . Teres minor muscle was not identified and the origin of long head of triceps brachii extended upto the lateral border of scapula on the left side. Both the medial cutaneous nerves of arm and forearm arouse from a single trunk bilaterally. In the right limb the axillary artery showed only four branches instead of six branches, with common trunk for thoraco-acromial and lateral thoracic artery and common trunk for subscapular and posterior circumflex humeral artery. Knowledge of coexistence of these variations would of profound importance surgically and clinically, especially in limb injuries and surgical repairs. DOI: http://dx.doi.org/10.3126/ajms.v5i1.7391 Asian Journal of Medical Science Vol.5(1) 2014 pp.81-85

The Lateral Thoracic Artery Revisited

Although the variations in the origin of the branches of the axillary and subclavian arteries have been documented, little information regarding the highly variable lateral thoracic artery (LTA) is available. Descriptions of the LTA variations may decrease intraoperative problems during surgery of the lateral aspects of the thorax such as reconstructive plastic surgery and modified radical mastectomy. The aim was therefore to review the anatomy of the LTA and to offer an accurate account of its variability. The entire course and distribution of the LTA was examined in 420 formalin‐fixed adult human cadavers. The LTA was found in 96.7% of our specimens, showing great morphological variability and classified the variations according to origin into 6 types. The most common was where the LTA arose from the thoracoacromial trunk (Type I, 70%). In decreasing order of incidence were origins from; the axillary artery (Type II, 17.6%), the thoracodorsal artery (Type III, 5.2%), and the subscapular artery (Type IV, 4%). Additionally, multiple LTAs were present (Type V, 3.2%) and complete absence of LTA (Type VI, 3.3%) was observed. Despite variations in the origin our dissections demonstrated that the ultimate tissue distribution of the LTA remained typical (90%) and descended on the lateral border of the pectoralis minor. Our results illustrate the need for re‐evaluation of the branches of the thoracoacromial trunk with possible consideration that the LTA arises from it instead of directly from the axillary artery. We hope that the information supplied by this study will provide useful information to anatomists and surgeons alike.Grant Funding Source: N/A

Superficial subscapular artery: Incidence in the Black South African Population

The subscapular artery, the largest branch of the axillary artery, usually arises from the third part of the axillary artery at the inferior border of subscapularis muscle. Approximately 4cm from its origin it divides into the circumflex scapular and thoracodorsal arteries. Separate origins of its terminal branches have been referred to as an absent subscapular artery. Yamada (1967) distinguished two types of subscapular artery: the first one arose from the axillary artery proximal to the point where the axillary artery passed between the lateral and medial roots of median nerve and the second type arose distal to this point. Yamada (1967) referred to the former as the superficial subscapular artery(SSA) and the later as the deep subscapular artery (DSA). This study aims to determine the incidence of SSA in the South African black population. The study comprised of bilateral dissections of 50 adult black South African cadavers (n = 100 axillary arteries). The site of origin of each vessel was recorded. Additional branches and variations were also noted. SSA was found in 47% cases. In 31.9% cases, it was bilateral. DSA was found in 42%. In 15%, subscapular artery gave rise to the posterior circumflex humeral artery; lateral thoracic artery in 30%, and to upper subscapular artery in 36% cases. It was absent in 11%. The literature review records this incidence to range between 0–16% in the following population groups: Japanese, Indians, Whites and Negroes which differ significantly to this study. The results of this study may have clinical significance as a superficial course of arteries make them vulnerable to injury during surgical procedures.