Significance of 'Langer's axillary arch' in axillary dissection

The axillary arch is reported to occur in 7% of the population, but in our experience has only been observed in 0.25%. The anatomical features are described and its importance in axillary dissection is indicated. In addition, its relevance to the prevention of lymphoedema and to the construction of latissimus dorsi flaps is discussed. The axillary arch should be considered in the differential diagnosis of axillary swellings.     

Obliteration of the axillary artery after axillary block

A case of total obliteration of the axillary artery after axillary block is presented. This resulted from an accidental intramural injection of local anaesthetic (mepivacaine 1%, 40 ml, with adrenaline 1:200,000). Axillary block was performed using the loss of resistance technique with a blunt needle (45 degrees bevel). The diagnosis was made by palpation of the peripheral pulse and by comparison between the skin temperatures of each arm. The thrombosed part of the artery was successfully reconstructed with an autologous saphenous vein graft.     

Radiotherapy-related axillary arteriopathy

Treatment of breast cancer involves surgery, then perhaps radiation, hormonal or chemotherapy. Radiation-induced arterial injury is a well-known entity that represents a rare cause of arterial occlusion. We present the case of a 76-year old woman who complained of a severe intermittent claudication of the right upper limb. Twenty years before, she underwent a right-sided radical mastectomy followed by intense radiation therapy for several weeks. The patient was found to suffer of a radiotherapy-related axillary artery thrombosis and was successfully treated by angioplasty and stenting.     

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目的探讨乳腔镜腋窝淋巴结切除手术的解剖与技术。方法自2001年始借助乳腔镜完成291例次腋窝淋巴结切除术。结果平均手术时间47．2min，术中出血很少，所有病例术中、术后均未出现任何手术并发症，平均每例取出淋巴结17．4个。术后平均随访14个月，随访期间无腋窝复发或trocar处种植转移。结论乳腔镜腋窝淋巴结切除手术解剖清晰、安全易行。     

Transcutaneous axillary artery cannulation

The axillary artery may be an alternative cannulation site for patients with diffused atherosclerosis, aortic dissection, and aneurysm. There are different techniques for axillary artery cannulation that can be performed easily with a transcutaneous approach. Small incision necessity, less dissection, and good wound healing are other advantages of this technique.     

Evaluation of axillary lymphadenectomy without axillary drainage for patients undergoing breast-conserving therapy

Background: The routine use of drainage after axillary node dissection in patients undergoing breast-conserving therapy (BCT) is being questioned. To determine the value of routine drainage, we evaluated the postoperative course of patients with primary breast carcinoma who underwent axillary dissection with or without axillary drainage. Methods: A retrospective review of 69 patients prompted a prospective randomized trial of 46 patients undergoing BCT at our tertiary cancer center. Variables studied were age, treatment (drain or no drain), number and tumor status of excised lymph nodes, size of primary tumor, duration of drainage or aspiration, number and volume of aspirations, number of office visits, incidence of complications and degree of pain, change in arm or forearm circumference, and body mass index (BMI). Data from prospective and retrospective studies were pooled for analysis. Results: Of 115 patients, 72 were treated with a drain (Drain group) and 43 were not (No-drain group). Overall there was no difference in the number or tumor status of excised nodes, the size of the primary tumor, or the incidence of complications between the two groups. Aspiration was required in 50% of the No-drain patients and 8.3% of the Drain patients. The incidence of drain placement or replacement postoperatively was 9.3% for the No-drain patients and 4.2% for the Drain patients. The No-drain patients had more office visits (5.1±0.4 vs. 3.6±0.1;P=.0002) and a longer interval between operation and last aspiration or drain removal (16.2±1.4 days vs. 11.3±0.6 days;P=.0040). Findings were similar in the subgroup of 46 prospectively studied patients, who included 24 Drain patients and 22 No-drain patients. In this group, pain evaluation using a scale of 0 to 10 showed a mean rating of 4.2±2.6 in Drain patients and 2.7±0.4 in No-drain patients (P=.0062). Conclusions: Axillary node dissection can be managed with or without a drain. More office visits but less pain can be expected if a drain is not used.Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, IL, March 20–23, 1997.The views expressed herein are those of the authors and do not necessarily reflect the views of the United States Army, United States Navy, Uniformed Services University of the Health Sciences, or the Department of Defense.     

Atherosclerotic axillary artery aneurysm

True aneurysms of the axillary artery are rare, most pulsatile masses in the region being pseudoaneurysms. The present study reports a case of a true atherosclerotic axillary artery aneurysm arising in a 65 year old lady which presented with a short history of a painless pulsatile mass and sensory defecit in the hand in the absence of limb trauma. Following preoperative imaging to determine the anatomic details, she underwent repair of the aneurysm and made an excellent symptomatic recovery.     

Primary axillary hydatid cyst

Echinococcosis is a zoonotic infection, affecting humans in a characteristic geographic distribution. The disease generally involves the liver, the lung and sometimes an axillary location. We reported a case of 43-year-old man, who was diagnosed with a cystic lesion of the left axilla, which was presumed to be a hydatid cyst or a vascular malformation by ultrasound and computed tomography. Surgical excision of the lesion was performed confirming the hydatid cyst diagnosis by histological studies.     

Videoendoscopic single-port axillary dissection

Videoendoscopy is newly used in breast and axillary surgery. Single-port surgery is one of the newest methods of minimally invasive surgery. This report describes the first case of videoendoscopic single-port axillary dissection. In histopathological evaluation, 24 lymph nodes were identified and one node was infiltrated by the cancer cells. Videoendoscopic single-port axillary dissection is a precise and improvable technique. Single-port videoendoscopic axillary dissection could be more feasible with individual tools that will be designed for minimally invasive breast surgery.     

The surgical and oncologic significance of the axillary arch during axillary lymphadenectomy

An uncommon and often-overlooked anatomic variation of the latissimus dorsi muscle is the axillary arch. It is formed by an anomalous slip of the muscle that arises from the body of the latissimus dorsi but then inserts along with the pectoralis major muscle anterior to the axillary vein and neurovascular bundle. If an axillary arch is encountered during axillary lymphadenectomy, the lymph nodes posterior and lateral to the arch should be excised. Experience with a number of cases is used to consider local therapeutic and staging factors.     

The bifid axillary artery

The anesthetic of a patient who presented for vascular access under axillary block is described. After physical examination and ultrasound study, the patient was found to have a bifid axillary artery. Because of neurologic anomalies associated with this vascular variation, an interscalene block was chosen for the procedure. The clinical implications of a bifid axillary artery when an axillary block is contemplated are discussed.     

A case of axillary web syndrome with subcutaneous nodules following axillary surgery

Axillary web syndrome (AWS) is a cause of morbidity in the early postoperative period following axillary surgery, which is characterized by cords of subcutaneous tissue extending from the axilla into the medial arm. Few reports have been published describing this entity, which results in pain and a limitation of shoulder abduction. Here, we report a case of AWS that was accompanied with sub-cutaneous nodules mimicking recurrence of breast cancer.