Abnormal muscles that may affect axillary lymphadenectomy: surgical anatomy |
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Authors: | K Natsis K Vlasis T Totlis G Paraskevas G Noussios P Skandalakis J Koebke |
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Institution: | (1) Department of Anatomy, Medical School, Aristotle University of Thessaloniki, P.O. Box 300, 541 24 Thessaloniki, Greece;(2) Department of Anatomy, Medical School, University of Athens, Athens, Greece;(3) Center for Surgical Anatomy and Technique, School of Medicine, Emory University, Atlanta, GA, USA;(4) Department of Anatomy, University of Cologne, Cologne, Germany |
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Abstract: | Purpose The present study aimed at summarizing and presenting the anomalous muscles that a surgeon might encounter during axillary
lymphadenectomy (AL). Methods For this purpose, both the anatomical and surgical literature was reviewed and an anatomical study on 107 cadavers was carried
out. Furthermore, based on the anatomical features of the anomalous muscles that came up during our study and taking into
consideration the landmarks of the AL, we further analyzed the complications that may arise from each of these muscles, along
with their preoperative and intraoperative recognition and management. Results The literature review revealed that there are three supernumerary muscles that may affect the AL, namely the Langer’s axillary
arch, the pectoralis quartus and the chondroepitrochlearis muscles, as well as the aplasia of the lower part of the pectoralis
major muscle. Eight out of the 107 (7.48%) cadavers that we dissected had such an abnormal muscle in the axilla. Specifically,
the axillary arch was found unilaterally in five cadavers (4.67%) and the pectoralis quartus muscle was present unilaterally
in three cadavers (2.8%). One cadaver had both an axillary arch and a pectoralis quartus muscle in the right side. The abdominal
and almost the whole sternocostal portion of the pectoralis major as well the pectoralis minor muscle were absent in one cadaver
(0.93%). The chondroepitrochlearis muscle was not found in any of the cadavers that we dissected. Conclusions The present study offers the necessary preoperative knowledge for recognizing these muscles during AL, avoiding thus the
complications that may arise from them. |
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