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Markou MA, Kakagia DD, Effraimidou EI, Fiska AT. Anatomical Variations of the Axillary Arch and Implications in Breast Surgery. J Surg Res 2023; 281:176-184. [PMID: 36179595 DOI: 10.1016/j.jss.2022.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/25/2022] [Accepted: 08/15/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Langer's axillary arch (AA), the most common anatomical variant in the axillary area of definite clinical significance. This is an updated review of the reported variations in the structure, highlighting its morphological diversity and its potential in complicating axillary lymph node biopsy, lymphadenectomy, or breast reconstruction. METHODS A review of the literature concerning the AA published between 1812 and 2020 was performed using the PubMed, Scopus, Embase, and Cochrane medical databases. The frequency, laterality, morphology, origin, lateral attachment points, vascularization, and neurosis of the AA were the parameters retrieved from the collected data. RESULTS The prevalence of AA ranged from 0.8% to 37.5%. It is more often unilateral, muscular in nature, and extending from the latissimus dorsi to the pectoralis major. It is vascularized by the lateral thoracic vessels or the subscapular artery and innervated by the thoracodorsal nerve. CONCLUSIONS Langer's AA, when present, may complicate surgical procedures in the area; therefore, every surgeon performing breast or axillary surgery should be aware of this entity and its variations to ensure maximal effectiveness and safety in the management of patients.
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Affiliation(s)
- Markos A Markou
- Department of Plastic Surgery & Burns, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece; 1st Department of Surgery, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Despoina D Kakagia
- Department of Plastic Surgery & Burns, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Eleni I Effraimidou
- 1st Department of Surgery, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Aliki T Fiska
- Laboratory of Anatomy, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Lhuaire M, Wehbe K, Garrido I, Hunsinger V, Derder M, Balaya V, Delmas V, Abrahams P, Sommacale D, Kianmanesh R, Fontaine C, Lantieri L. Anatomy of the axillary arch: from its incidence in human to an embryologic and a phylogenetic explanation of its origins. Surg Radiol Anat 2021; 43:619-30. [PMID: 33136183 DOI: 10.1007/s00276-020-02605-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Typically, the axillary arch is defined as a fleshy slip running from latissimus dorsi to the anterior aspect of the humerus. Phylogeny seems to give the most relevant and plausible explanation of this anatomical variant as a remnant of the panniculus carnosus. However, authors are not unanimous about its origin. We report herein the incidence of axillary arch in a series of 40 human female dissections and present an embryologic and a comparative study in three domestic mammals. MATERIALS AND METHODS Forty formalin-preserved Caucasian human female cadavers, one rat (Rattus norvegicus), one rabbit (Oryctolagus cuniculus) and one pig (Sus scrofa domesticus) cadavers were dissected bilaterally. A comparative, analytical and a descriptive studies of serial human embryological sections were carried out. RESULTS We found an incidence of axillary arch of 2.5% (n = 1 subject of 40) in Humans. We found a panniculus carnosus inserted on the anterior aspect of the humerus only in the rat and the rabbit but not in the pig. The development of the latissimus dorsi takes place between Carnegie stage 16-23, but the embryological study failed to explain the genesis of the axillary arch variation. However, comparative anatomy argues in favour of a panniculus carnosus origin of the axillary arch. CONCLUSIONS With an incidence of 2.5% of cases, the axillary arch is a relatively frequent variant that should be known by clinician and especially surgeons. Moreover, while embryology seems to fail to explain the genesis of this variation, comparative study gives additional arguments which suggest a possible origin from the panniculus carnosus.
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Sang Y, Kong X, Li X, Jiang L, Ma T, Zhao W, Yang Q. Langer's axillary arch lymph node metastasis in breast cancer patients: A prospective clinical study. Surg Oncol 2019; 29:48-52. [DOI: 10.1016/j.suronc.2019.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/11/2019] [Accepted: 03/02/2019] [Indexed: 12/20/2022]
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Nair AS, Vanzar P, Rayani BK. Implications of accessory pectoral muscles for ultrasound-guided thoracic wall blocks. Indian J Anaesth 2018; 62:824-825. [PMID: 30443072 PMCID: PMC6190413 DOI: 10.4103/ija.ija_260_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Abhijit S Nair
- Department of Anesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Prashant Vanzar
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Basanth Kumar Rayani
- Department of Anesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
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Taterra D, Henry BM, Zarzecki MP, Sanna B, Pękala PA, Cirocchi R, Walocha JA, Tubbs RS, Tomaszewski KA. Prevalence and anatomy of the axillary arch and its implications in surgical practice: A meta-analysis. Surgeon 2018; 17:43-51. [PMID: 29801707 DOI: 10.1016/j.surge.2018.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/11/2018] [Accepted: 04/18/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE The following research aimed to investigate the prevalence and anatomical features of the axillary arch (AA) - a muscular, tendinous or musculotendinous slip arising from the latissimus dorsi and that terminates in various structures around the shoulder girdle. The AA may complicate axillary lymph node biopsy or breast reconstruction surgery and may cause thoracic outlet syndrome. METHODS Major electronic databases were thoroughly searched for studies on the AA and its variations. Data regarding the prevalence, morphology, laterality, origin, insertion and innervation of the AA was extracted and included in this meta-analysis. The AQUA tool was used in order to assess potential risk of bias within the included studies. RESULTS The AA was reported in 29 studies (10,222 axillas), and its pooled prevalence estimate in this meta-analysis was found to be 5.3% of the axillas: unilaterally (61.6%) and bilaterally (38.4%). It was predominantly muscular (55.1% of the patients with the AA), originated from the latissimus dorsi muscle or tendon (87.3% of the patients with the AA), inserted into the pectoralis major muscle or fascia (35.2% of the patients with the AA), and was most commonly innervated by the thoracodorsal nerve (39.9% of the patients with the AA). CONCLUSION The AA is a relatively common variant, hence it should not be neglected. Oncologists and surgeons should consider this variant while diagnosing an unknown palpable mass in the axilla, as the arch might mimic a neoplasm or enlarged lymph nodes.
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Affiliation(s)
- Dominik Taterra
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Michał P Zarzecki
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Beatrice Sanna
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Faculty of Medicine and Surgery, University of Cagliari, Monserrato, Italy
| | - Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Roberto Cirocchi
- Department of Surgical Sciences, Radiology and Dentistry, University of Perugia, Italy
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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Hong HJ, Choi NJ, Han DH, Ahn MI. Axillary arch: detailed ultrasonographic images with multiplanar CT correlation. J Med Ultrason (2001) 2015; 42:121-5. [DOI: 10.1007/s10396-014-0563-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 06/23/2014] [Indexed: 10/24/2022]
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Snoeck T, Balestra C, Calberson F, Pouders C, Provyn S. The innervation of the axillary arch determined by surface stimulodetection electromyography. J Anat 2012; 221:275-8. [PMID: 22747747 DOI: 10.1111/j.1469-7580.2012.01539.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
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.
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Affiliation(s)
- Thyl Snoeck
- Department of Anatomy, Morphology and Biomechanics - Haute Ecole Paul Henri Spaak, Brussels, Belgium.
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Magee C, Jones C, McIntosh S, Harkin DW. Upper limb deep vein thrombosis due to Langer's axillary arch. J Vasc Surg 2011; 55:234-6. [PMID: 21924577 DOI: 10.1016/j.jvs.2011.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 01/27/2011] [Indexed: 11/28/2022]
Abstract
Langer's axillary arch is a recognized muscular anomaly characterized by an accessory muscular band crossing the axilla that rarely causes symptoms. We describe a patient who presented with an upper limb deep vein thrombosis caused by this aberrant muscle, which we believe is the first reported case. Axillary surgery with division of the aberrant muscle relieved upper limb venous obstruction in this patient.
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Affiliation(s)
- Claire Magee
- Regional Vascular Surgery Unit, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
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9
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Provyn S, Balestra C, Delobel A, Wilputte F, Leduc O, Pouders C, Snoeck T. Are there hemodynamic implications related to an axillary arch? Clin Anat 2011; 24:964-7. [DOI: 10.1002/ca.21259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 07/15/2011] [Accepted: 07/23/2011] [Indexed: 11/10/2022]
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10
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Ridgway PF, Collins AM, Mccready DR. The surgical importance of an axillary arch in sentinel node biopsy. Surg Radiol Anat 2011; 33:147-9. [DOI: 10.1007/s00276-010-0724-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Accepted: 08/21/2010] [Indexed: 11/25/2022]
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Uzmansel D, Kurtoğlu Z, Kara A, Öztürk NC. Frequency, anatomical properties and innervation of axillary arch and its relation to the brachial plexus in human fetuses. Surg Radiol Anat 2010; 32:859-63. [DOI: 10.1007/s00276-010-0687-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 06/16/2010] [Indexed: 10/19/2022]
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12
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Ando J, Kitamura T, Kuroki Y, Igarashi S. Preoperative diagnosis of the axillary arch with multidetector row computed tomography and the axillary arch in association with anatomical problems of sentinel lymph node biopsy. Breast Cancer 2009; 17:3-8. [PMID: 19585215 DOI: 10.1007/s12282-009-0138-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Accepted: 04/30/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to describe the preoperative diagnosis of the axillary arch with multidetector row computed tomography (MDCT) in patients who underwent sentinel lymph node (SLN) biopsy. In addition, we investigated anatomical problems of SLN biopsy in the cases that diagnosed this anomaly. METHODS From 2003 to 2008, combined procedures with blue dye SLN biopsy and MDCT-assisted axillary node sampling were performed in 550 clinically axilla-negative patients with primary operable breast cancer. We use MDCT for not only the diagnosis of the axillary arch, but also the planning and navigation of SLN biopsy. RESULTS The axillary arches were preoperatively diagnosed with MDCT in 59 patients (10.8%) as follows: a single ordinary axillary arch (n = 44), another anomalous muscle besides the ordinary axillary arch (n = 13), and other rare axillary arches (n = 2). The SLN identification failure rate was 1.8% (9/491) for patients without the axillary arch and 5.1% (3/59) for patients with the axillary arch (chi-square test, P = 0.11). Three patients with an axillary arch in whom a SLN could not be identified were observed in 13 patients who had another anomalous muscle besides the ordinary axillary arch (3/13, 23.1%). In the examination of 56 patients with an axillary arch in whom a SLN was identified, variations of the SLN location and/or anomalous muscles covering a SLN were observed in 16 patients (28.5%). CONCLUSIONS MDCT is useful for a diagnosis of the axillary arch. The axillary arch should be kept in mind during SLN biopsy because this anomaly would be related to anatomical variations that affect SLN biopsy.
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Affiliation(s)
- Jiro Ando
- Department of Surgery, Tochigi Cancer Center Hospital, Yohnan, Utsunomiya, Japan.
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13
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Abstract
Abstract
Objective:
The muscular axillary arch is a musculotendinous structure that arises from the latissimus dorsi muscle and crosses the axilla before inserting to the humerus, brachial fascia, or coracoid process. Case reports have described the neurovascular compression symptoms caused by this anatomic variant and have reported that the symptoms can be relieved by division of the muscle. However, there has been little information published regarding this topic in the neurosurgical literature.
Methods:
We evaluated 70 axillary dissections in 35 cadavers to assess for the presence of this anomaly.
Results:
The muscular axillary arch was identified unilaterally in 3 (8.6%) of the 35 cadavers. All 3 arches arose from the anterior border of the latissimus dorsi muscle and inserted at a point along a line extending from the coracoid process to the intertubercular groove deep to the insertion of the pectoralis major muscle. All 3 arches crossed over the neurovascular bundle in the axilla.
Conclusion:
Compression by the muscular axillary arch should be considered in the differential diagnosis of patients with thoracic outlet and hyperabduction syndromes.
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Affiliation(s)
- Elias Rizk
- Department of Neurosurgery, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Kimberly Harbaugh
- Department of Neurosurgery, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Van Hoof T, Vangestel C, Forward M, Verhaeghe B, Van Thilborgh L, Plasschaert F, De Muynck M, Vanderstraeten G, D'Herde K. The Impact of Muscular Variation on the Neurodynamic Test for the Median Nerve in a Healthy Population With Langer's Axillary Arch. J Manipulative Physiol Ther 2008; 31:474-83. [DOI: 10.1016/j.jmpt.2008.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 03/22/2008] [Accepted: 03/30/2008] [Indexed: 10/21/2022]
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15
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Kim KS, Han SA, Kim S, Lim JY, Kim SM, Jang M, Han W, Noh DY, Kim SW. The Axillary Arch of Langer (Axillopectoral Muscle): A Case Report. J Breast Cancer 2008. [DOI: 10.4048/jbc.2008.11.2.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ku Sang Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Ah Han
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sairhee Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sun Mi Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mijung Jang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Wonshik Han
- Department of Surgery, College of Medicine, Seoul National University, Seoul, Korea
| | - Dong-Young Noh
- Department of Surgery, College of Medicine, Seoul National University, Seoul, Korea
| | - Sung-Won Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Surgery, College of Medicine, Seoul National University, Seoul, Korea
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Abstract
In this work the authors summarize the extensive information available concerning the best-known variant muscular structure in the region of the human axilla--the axillary arch. Emphasis has been placed on the common morphology and variety of the axillary arches. From the anatomical descriptions, the authors extract the characteristics of a group of "typical" axillary arches and also noted the descriptions of a group of "unusual" axillary arches found in the recent literature. The axillary arch terminology, incidence in human population, innervation and origin are discussed. The clinical significance of the axillary arch is presented briefly and the need of a new concept for the axillary arch is stated. In conclusion, for the purpose of clinical practice, a new term--"clinical" axillary arch is defined, and its proper clinically oriented classification is presented.
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Affiliation(s)
- L Jelev
- Department of Anatomy, Histology and Embryology, Medical University Sofia, blvd. Sv. Georgi Sofiiski 1, BG-1431 Sofia, Bulgaria
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17
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Abstract
In order to study the incidence of the axillary arch in the Bulgarian population, we examined the axillary regions of 56 formol-carbol fixed human cadavers and observed two cases with a unilateral axillary arch. In the first case, the variant structure was situated on the right side of a 58-year-old female cadaver. The axillary arch extended from the lateral border of the latissimus dorsi to the posterior layer of the pectoralis major tendon. In the second case, the axillary arch was found on the left side of a 63-year-old male cadaver and had the same attachment points as in the first case. The innervation and blood supply of the arches are discussed. We have also reviewed extensive information concerning the clinical importance of the axillary arch, and for the first time, it was summarized clearly for clinicians. The summary consists of three parts: "diagnosis" of the axillary arch by physical investigation or imaging techniques; the axillary arch and surgical interventions in the region of the axilla; the axillary arch as an entrapment site for the axillary vessels and nerves.
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Affiliation(s)
- G P Georgiev
- Department of Anatomy, Histology and Embryology, Medical University Sofia, Sofia, Bulgaria
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18
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Chêne G, Le Bouëdec G, Dauplat J. L'arche et la sentinelle: techniques chirurgicales de la lymphadénectomie axillaire sentinelle en présence du muscle pectoro-axillaire. ACTA ACUST UNITED AC 2007; 35:25-9. [PMID: 17218142 DOI: 10.1016/j.gyobfe.2006.10.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2006] [Accepted: 10/26/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Identify the axillopectoral muscle (usually called Langer's axillary arch) and know the main surgical techniques of axillary sentinel node biopsies. PATIENTS AND METHODS We present the results of our five-year clinical prospective study: the presence of this anomaly is diagnosed peroperatively during a sentinel node biopsy. RESULTS Langer's arch is identified in 1,7%, often with an unilateral distribution. Lymph nodes are just near or behind the muscle. Sentinel node biopsy dissection is difficult in about 40%. DISCUSSION AND CONCLUSION The embryological derivation and anatomical features of this muscle are described, with emphasis on the surgical applications. Its presence or absence should be ascertained in every sentinel node biopsy because of the risks of axillary dissection complications by this ectopic muscle.
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Affiliation(s)
- G Chêne
- Service de chirurgie oncologique, centre Jean-Perrin, 38, rue Montalembert, 63000 Clermont-Ferrand, France.
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Ko K, Han BK, Shin JH, Choe YH, Chung HW, Lee EH, Choi SJ. The axillopectoral muscle seen on mammography. Clin Radiol 2006; 61:625-9. [PMID: 16784950 DOI: 10.1016/j.crad.2006.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 03/06/2006] [Indexed: 11/30/2022]
Affiliation(s)
- K Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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21
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Abstract
Langer's arch is identified in up to 7% of axillary explorations; in a three-month period we identified three individuals among forty-six patients undergoing axillary surgery with this abnormality. Langer's arch is a muscular-tendinous structure that usually extends from latissimus dorsi to pectoralis major muscle. The purpose of this article is to describe the embryological derivation of this muscular variant from the panniculus carnosus and to define its anatomical features. The clinical implications both symptomatically and as an unexpected finding during axillary dissection, are also discussed.
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Affiliation(s)
- I Besana-Ciani
- Department of Surgery, Oxford Radcliffe NHS Trust, Oxford, UK
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22
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Abstract
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.
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Affiliation(s)
- Hasan Basri Turgut
- Department of Anatomy, Faculty of Medicine, Gazi University, Ankara, Turkey.
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Pouliart N, Gagey O. Significance of the latissimus dorsi for shoulder instability. I. Variations in its anatomy around the humerus and scapula. Clin Anat 2005; 18:493-9. [PMID: 16092134 DOI: 10.1002/ca.20185] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In a cadaveric instability model that leaves all muscles intact initially, we studied anteroinferior glenohumeral dislocation behavior after section of the ligaments on the humeral side of the joint. In this study, the latissimus dorsi seemed to play a role when complete section did not result in a locked anteroinferior dislocation. We therefore initiated a study to test the hypothesis that the latissimus dorsi may, in certain circumstances, depending on variations in its anatomy, influence dislocation behavior. Here, in Part I, we present the results of the anatomic study of latissimus dorsi and its tendons. The anatomy of the latissimus dorsi pertaining to the scapula and humerus was studied in 100 cadaver specimens. The distance between the uppermost part of the tendon of both the latissimus dorsi and the teres major and the edge of the articular cartilage of the humeral head (tendon-cartilage distance, TCD) as well as the width and length of the tendons were measured. Furthermore, the relationship between latissimus dorsi and the inferior angle of the scapula was studied. The tendon of the latissimus dorsi inserted at a variable distance from the cartilage of the humeral head: the TCD ranged from 12.6 to 31.6 mm (mean 21.06 mm+/-5.11 mm). The latissimus dorsi can have muscular fibers arising from the inferior angle of the scapula (type 1 scapular connection, 43%). Alternatively, there may be only a few fibrous strands between the muscle and the scapula or there may be an intervening bursa (type 2 scapular connection, 57%). This variability in the morphology of the latissimus dorsi may be a factor explaining the differences observed in a study of humerus-based sequential cutting of the glenohumeral capsule. This possibility is explored in Part II of the study. The latissimus dorsi may also complete the tendinous protection of the humeral side of the capsule generally provided by the rotator cuff.
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Affiliation(s)
- N Pouliart
- Department of Orthopaedics and Traumatology, Academic Hospital Vrije Universiteit Brussel, Brussels, Belgium.
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