The innervation of the axillary arch determined by surface stimulodetection electromyography

The axillary arch (AA) is a muscular anatomical variation in the fossa axillaris that has been extensively studied in cadaveric specimens. Within these dissections, different innervations of the AA have been proposed, but this has never been explored in vivo. Knowledge of the innervation of the AA is required in order to better understand its function (e.g. predisposition for certain sports and/or activities, understanding shoulder injuries in overhead sports). Here, we report on the use of surface stimulodetection electromyography (SSEMG) to resolve the innervation of the AA in 20 subjects (12 women, eight men - mean age of 21.3 ± 2.7 years) with a uni- or bilateral AA. SSEMG of each muscle [M. latissimus dorsi (MLD) and M. pectoralis major] was performed with a four-channel electrostimulation measuring system in order to determine the innervation of the AA. The results showed co-contraction of the MLD in 85% of the subjects after AA stimulation. In the remaining subjects, no specific localized response was observed due to non-specific nerve stimulation, inherent to the proximity of the brachial plexus in these individuals. Our findings demonstrate that SSEMG exploration offers a practical and reliable tool for investigating anatomical aspects of muscle innervation in vivo. Using this approach, we conclude that the AA receives the same innervation as the MLD (the N. thoracodorsalis), and may be considered a muscular extension of the latter.     

Axillopectoral muscle (Langer's muscle)

In a routine dissection of the axillary fossa, a muscle originating from the coracoid process of the scapula and extending to the long head of triceps brachii muscle was observed. The mentioned muscle was adhering to both the triceps brachii muscle and the tendinous part of the latissimus dorsi muscle. This anatomical variation is referred to as axillary arch (Langer's muscle or axillopectoral muscle). The muscle mass was measured 9.6 cm in length and 1.4 cm in width. The accessory muscle can be a reason of an axillary mass and can exert pressure on the neighboring neurovascular bundle or lymph routes; thus, exposing a wide range of symptoms. Therefore, variations of this area should be kept in mind in surgical interventions.     

Axillary arch: potential cause of neurovascular compression syndrome

During routine bilateral dissection of 64 upper limbs in 32 adult human cadavers, four cases of an axillary arch, a muscular anomaly, were found. In one case, the axillary arch presented on both sides and in two cases it presented unilaterally on the right side. The innervation and relationships of the axillary arches are reported and the surgical significance of the anomaly is discussed.     

Axillary arch (of Langer): A large-scale dissection and simulation study based on unembalmed cadavers of body donors

Connective or muscular tissue crossing the axilla is named axillary arch (of Langer). It is known to complicate axillary surgery and to compress nerves and vessels transiting from the axilla to the arm. Our study aims at systematically researching the frequency, insertions, tissue composition and dimension of axillary arches in a large cohort of individuals with regard to gender and bilaterality. In addition, it aims at evaluating the ability of axillary arches to cause compression of the axillary neurovascular bundle. Four hundred axillae from 200 unembalmed and previously unharmed cadavers were investigated by careful anatomical dissection. Identified axillary arches were examined for tissue composition and insertion. Length, width and thickness were measured. The relation of the axillary arch and the neurovascular axillary bundle was recorded after passive arm movements. Twenty-seven axillae of 18 cadavers featured axillary arches. Macroscopically, 15 solely comprised muscular tissue, six connective tissue and six both. Their average length was 79.56 mm, width 7.44 mm and thickness 2.30 mm. One to three distinct insertions were observed. After passive abduction and external rotation of the arm, 17 arches (63%) touched the neurovascular axillary bundle. According to our results, 9% of the Central European population feature an axillary arch. Approximately 50% of it bilaterally. A total of 40.74% of the arches have a thickness of 3 mm or more and 63% bear the potential of touching or compressing the neuromuscular axillary bundle upon arm movement.     

The axillary sheath and single-injection axillary block

Failure to block the terminal nerves of the brachial plexus, the circumferential type of incomplete axillary brachial plexus block, is the main problem of the single-injection technique. Two studies were carried out to observe the internal anatomy of the axillary sheath and the effect of different volumes of dye injected into the sheath in cadavers. In our first study, the internal arrangement of the axillary sheath and its septae were examined microscopically by slicing the sheath longitudinally and transversely. In the second study, boluses of 10, 20, and 40 cc of methylene-blue were injected into one of the compartments of the axillary sheath. The axillary sheath was dissected out and sliced transversely to observe the spread of the dye in the injected and in the adjacent compartments. The specimens of the axillary sheath were then opened longitudinally and the septae excised and examined at x10 magnification to see the effect of the various volumes of the injection bolus. This study shows that septae from the deep surface of the axillary sheath form compartments for each nerve. The septae function as barriers under physiologic conditions. By increasing the injected volume of solutions, bubble-like defects are produced in the septae in the compartments into which leakage was demonstrated.     

Anatomical study of the accessory axillary vein

Summary The Accessory Axillary Vein (AAV) was studied in 60 axillae of adult cadavers after fixation in 10% formaldehyde solution. The AAV had an incidence of 56.7% originating in 55.9% from the lateral brachial vein, in 32.4% from the common brachial and in 11.8% from the deep brachial vein. After running upward laterally to the axillary artery and the brachial plexus it ended usually (79.4%) in the suprapectoral portion of the AV. The tributaries of the AAV are the circumflex humeral and muscular veins and rarely the thoraco-acromial and the cephalic veins. The AAV can replace the AV in cases of obliteration of the latter.M.S. thesis in anatomy (LCB Gusmao), Department of Morphology, Escola Paulista de Medicina     

The deep axillary artery

An aberrant axillary artery running deep to the brachial plexus during its course was observed. The brachial plexus in this case was formed by the fourth cervical nerve to the first thoracic nerve and the radial nerve received a small nerve bundle (accessory radial nerve root) from the posterior aspect of the lower trunk. The axillary artery passed between the lateral and the medial cords of the brachial plexus, the same as for an ordinary axillary artery. In addition, it passed between their posterior divisions, forming the posterior cord, and further ran between the radial nerve root and the accessory radial nerve root from deep to superficial. This axillary artery was recognized as the deep axillary artery, the same as the axillary artery we have reported previously. It was thought that the branches to the subscapularis and serratus anterior muscles, nutrient branch to the radial nerve root and the subscapular artery played important roles in its formation.     

Typology of the subclavian and axillary lymphatics

Detailed dissections were performed bilaterally on 90 human adult cadavers to obtain more accurate data on the course and origin of the subclavian lymphatics and especially of the subclavian lymphatic trunk. We classified these into four types from the morphology. Type A (46.1 %): The subclavian lymphatics were located along the medial edge of the subclavian vein edge close to the lateral thoracic wall. In this type, the subclavian lymphatics consisted of the subclavian node chain, interconnecting vessels, and short lymph trunks. Type B (20.0%): A large connecting vessel ran along the lateral edge of the subclavian vein or on the subclavian artery, with the result that the trunk was located away from the thoracic wall. In the Type B configuration, the vessels originated from the nodes near the origin of the thoracoacromial artery. Type C (21.7%): The Type B large collecting vessel was observed with the Type A subclavian lymphatics. Type D (12.2%): Lymph vessels were too fine to be found and dissected in the subclavian lymphatics. These observations provide critical information for an unproved clinical examination and lymphatic resection of breast cancer. © 1994 Wiley-Liss, Inc.     

腋动脉及其分支的应用解剖学研究

目的探索国人腋动脉(AA)及其分支的类型、量化数据以及他们之间的比例关系。方法解剖观察32具成人尸体标本(男25具、女7具)的腋动脉分支类型、外径及腋动脉起始段的外径与其自身比例,腋动脉3段的长度、外径,计算三者间的自身比例。结果腋动脉分支分为7型及1个变异型。每型又分为若干亚型,以6支型(出现率30.16%)和5支型(出现率26.98%)多见;腋动脉3段长度差异较大,三者之比为1∶1.18∶1.25,外径由第一段至第三段渐细,三者之比为1∶0.89∶0.75,腋动脉的各分支依据其支数及起始位置的不同,分为若干型及亚型。腋动脉起始端与各分支起始端外径之比分别为胸上动脉(TS)1∶0.28,胸肩峰动脉(TA)1∶0.42,胸外侧动脉(TL)1∶0.31,肩胛下动脉(SS)1∶0.63,旋肱前动脉(CHA)1∶0.25,旋肱后动脉(CHP)1∶0.46。结论腋动脉及其分支的变异较大,临床介入放射学及血管外科学对血管处理或选择时,应以出现率高、类型恒定、管径允许者作为应用对象。     

一站式杂交手术与全弓置换治疗主动脉弓病变的疗效分析

目的探讨一站式杂交手术与全弓置换处理主动脉弓部病变的疗效。方法回顾性分析2017年1月至2019年4月我院收治的29例累及主动脉弓部病变患者的临床资料,将13例行一站式杂交手术的患者纳入杂交手术组,16例行全弓置换联合支架象鼻的患者纳入全弓置换组。比较2组患者肺部感染、胸腔积液、肾损伤、神经系统损伤、心功能不全、截瘫、切口感染、用血量和住院时间等情况。结果所有患者均成功完成手术。术后2组患者肺部感染、胸腔积液、一过性肾功能损伤、切口感染、一过性意识障碍、截瘫、脑梗死/脑出血、心功能不全、移植旁路血管再发狭窄、再发主动脉夹层等术后并发症发生率比较,差异无统计学意义(P>0.05);2组患者住院时间比较,差异无统计学意义(P>0.05);杂交手术组患者用血量平均(3.69±2.89)U,全弓置换组平均(12.38±3.14)U,组间比较差异有统计学意义(P<0.05)。杂交手术组围手术期因突发心跳骤停,成功复苏后脑死亡1例,全弓置换组无围手术期死亡病例。随访1~26个月,随访期间杂交手术组出现1例覆膜支架远端夹层扩张破裂死亡病例,全弓置换组出现1例脑血管意外导致呼吸功能衰竭死亡病例,其余患者恢复良好。结论一站式杂交手术与全弓置换治疗弓部病变效果均满意,其中一站式杂交手术用血量较全弓置换组明显减少,无需深低温停循环,对年龄大、一般情况差的患者更为有利;而全弓置换组用血量更大,需要停循环、创伤大,但象鼻支架材料利于二次手术根治远端病变,适用于年轻、术前一般情况良好的患者。     

Benign axillary epithelial lymph node inclusions—a histological pitfal

We present two cases of axillary epithelial lymph node inclusions in the presence of benign and malignant breast disease. Although the presence of lymph node inclusions is well recognized at other sites in the body, their presence in the axillary nodes of women with breast disease necessitates close attention. This is particularly true in women with malignant breast disease as misinterpretation may lead to inappropriate treatment.     

掌浅弓的应用解剖

ObjectiveTo provide anatomical basis for repair of the superficial palmar arch with transplanted superficial vein when the operations of vessel repair and replantation of severed palm are performed.MethodsThe origin and branches of ulnar of superficial palmar arch were observed and measured on 30 cases of hand specimens.ResultsThere were 4 types of branches arising from the ulnar side of superficial palmar arch.If the center of pisiform bone was regarded as point O,the origin of the proper palmar digital artery of little finger as point A,the origin of common palmar digital arteries of the 3rd、2nd、1st fingers were regarded as point B,C,D respectively;then the distance was as followO-A 30.1±5.6 mm;A-B 8.1±4.7 mm;B-C 9.2±6.0 mm;C-D 6.2±3.9 mm.The diameters of the origins of branches followedA1.24±0.34 mm;B1.50±0.34 mm;C1.78±0.42 mm;D1.54±0.38 mm.ConclusionsThe branches of superficial palmar arch on ulnar side are constant.The anatomical data will benefit the repair the repair of superficial palmar arch.     

不同手术方法治疗腋臭临床疗效分析

目的观察不同手术术式治疗腋臭的临床疗效,探讨和寻求疗效最佳的手术方法。方法对我院2011年1月至2013年7月收治的200例腋臭患者的临床资料进行回顾性分析,观察不同手术方法的远期疗效。手术方法分为传统腋臭切除术、微创刮除术、射频笔触式电针烧灼术和改良式切刮术,对观察数据进行统计学分析。结果传统切除术80例,手术切口平均愈合时间为18.7 d,远期疗效治愈78例(97.5%),显效2例(2.5%)。微创刮除术60例中,切口平均愈合时间为8.6 d;远期疗效治愈3例(5.0%),显效8例(13.3%),好转16例(26.7%),弱效4例(6.7%),无效29例(48.3%)。射频笔触式电针烧灼术30例,显效5例(16.7%),好转8例(26.7%),无效17例(56.6%)。改良式切刮术30例,伤口平均愈合时间为9.8 d,远期疗效治愈28例(93.3%),显效2例(6.7%)。结论传统切除术疗效好,但是伤口瘢痕大,恢复期长;微创刮除术和射频笔触式电针烧灼术恢复快,但是复发率高;改良式刮除术吸收了传统和微创手术的优点,恢复快,疗效肯定,缺点是伤口瘢痕较大,但是总体疗效令人满意,可以作为治疗腋臭的首选手术方法。     

Gigantomastia in pregnancy with an accessory axillary mass masquerading as inflammatory carcinoma

Giagantomastia is a rare disorder known to occur in pregnancy, causing enlargement of the breasts greater than that of gravid enlargement. The histological features of gigantomastia are glandular hyperplasia and an increase of stromal tissue. Illustrated by one documented case, cytomorphology of gigantomastia was misdiagnosed as a phyllodes tumor. We document the cytomorphology of an axillary mass in a gravid woman of 24 years with gigantomastia. She presented in her first trimester with bilateral mastalgia and swelling, nonresponsive to antibiotics. Imaging excluded mass breast lesions and a pituitary prolactinoma. The breasts progressively enlarged, became warm, tender, and developed skin ulcerations and a peau d'orange appearance. Subsequently she developed a mass in her left axilla. On aspiration of the mass, some of the cytomorphological features were suspicious for a metastasis, which correlated well with her clinical features. Careful evaluation suggested cytomorphology to be compatible with benign accessory breast tissue with possible hormone related changes of pregnancy. Histology of the excised axillary mass confirmed this diagnosis. Thus, awareness of this rare condition and careful evaluation is mandatory to avoid misdiagnosis in a similar clinical context.     

Cotton-ball granuloma mimicking axillary lymphadenopathy in a breast cancer patient

Foreign body granuloma is a reaction to either a biodegradable substance or inert material. In a breast cancer patient who had undergone an excision or mastectomy with axillary clearance, a foreign body granuloma in the axilla may be misinterpreted as an axillary lymph node. We report our experience with a case of cotton-ball granuloma of the axilla in a breast cancer patient, which mimics a lymph node radiologically from the CT scan, mammogram and ultrasonography. Following biopsy and excision, the mass was diagnosed histologically as a foreign body granuloma.     

Accuracy of axillary staging using sentinel node biopsy or diagnostic axillary lymph node dissection--a case-control study

We aimed to compare the accuracy of axillary staging in breast cancer between sentinel node biopsy (SNB) and axillary lymph node dissection (ALND). The prevalence of axillary metastases was studied in 166 breast cancer patients with SNB and pair-matched control patients with ALND. The matching factors included age of the patient and grade, histological type and histological size of the tumour. There were 37% of patients with axillary metastases in the SNB group and 31% in the ALND group. Altogether, 57 pairs were discordant in relation to axillary metastases. In 34 discordant pairs the SNB patient and in 23 the ALND patient had axillary metastases, p=ns. Among the 36 discordant pairs with invasive ductal carcinoma (IDC), axillary metastases were detected as often in the SNB and the ALND patients. In the 21 discordant pairs with other histological types, the SNB patient had axillary metastases in 16 pairs and the ALND patient in 5 pairs, p<0.03. SNB seems to be as accurate a method for axillary staging as ALND. However, SNB generated no upstaging effect in IDC, only in other histological tumour types.     

The lateral thoracic artery passing through duplicated axillary vein: A case report

The axillary vein is a large‐blood vessel that lies on the medial side to the axillary artery. The veins of the axilla are more abundant than the arteries and their variations were extremely common. During educational dissection, a rare form of the axillary vein accompanying arterial variation was founded in left arm of 70‐year‐old female cadaver. The axillary vein was divided into two large veins, anterior and posterior axillary veins according to their anatomical position. The lateral‐thoracic artery arose from the second part of the axillary artery and passed through the gap of duplicated axillary vein. Before the lateral‐thoracic artery passed through the gap of duplicated axillary vein, the lateral‐thoracic artery gave‐off an additional branch, which descended superficial to the anterior axillary vein. It surrounded the anterior axillary vein as annular form and the diameter of surrounded part of the anterior axillary vein became narrow. This novel case was reported and its clinical implications of such a variant were discussed. Clin. Anat. 26:1014–1016, 2013. © 2012 Wiley Periodicals, Inc.     

超声对乳腺癌腋下淋巴结转移状态评估价值的研究进展

超声技术作为术前评估乳腺癌腋下淋巴结转移(axillary lymph node metastasis,ALNM)状态最常用的方法,可通过二维灰阶图像、血流表现、弹性成像、超声造影等手段根据淋巴结的形态、纵横比、皮质状态、淋巴门表现、血流情况等指标预测淋巴结转移与否.但超声技术受众多影响因素如腋下淋巴结的大小、位置、腋窝深度、医师经验、超声仪器分辨率不同等的限制,其检出率及准确率仍未达到令人满意的水平.因此,如何提高超声对乳腺癌ALNM的评估效能成为亟需解决的问题.