RESUMEN

Variants of the axillary artery and brachial plexus were found bilaterally in the axilla of an 86-year-old Asian female. On the left, the cadaver donor had a high bifurcation of the second part of the axillary artery, creating a superficial brachial artery. Meanwhile, the right axilla presented with root, trunk, and cord variations in the formation of the brachial plexus, the most interesting feature being a single, unified cord. Presented in this case report are the structural relationships of the variants with considerations regarding anatomy, embryology, prevalence, and clinical importance.

Asunto(s)

RESUMEN

INTRODUCTION: Adequate knowledge on variant morphology of brachial plexus and its branches are important in clinical applications pertaining to trauma and surgical procedures of the upper extremity. AIM: Current study was aimed to report variations of the branches of the lateral cord of brachial plexus in the axilla and their possible clinical complications. MATERIALS AND METHODS: Total number of 82 upper limbs from 41 formalin embalmed cadavers was dissected. Careful observation was made to note the formation and branching pattern of lateral cord. Meticulous inspection for absence of branches, presence of additional or variant branches and presence of abnormal communications between its branches or with branches of other cords was carried out. RESULTS: In the present study, we noted varied branching pattern of lateral cord in 6 out of 82 limbs (7%). In one of the limb, the median nerve was formed by three roots; two from lateral cord and one from medial cord. Two limbs had absence of lateral pectoral nerve supplemented by medial pectoral nerves. One of which had an atypical ansa pectoralis. In 2 upper limbs, musculocutaneous nerve was absent and in both cases it was supplemented by median nerve. In one of the limb, coracobrachialis had dual nerve supply by musculocutaneous nerve and by an additional branch from the lateral cord. CONCLUSION: Variations of brachial plexus and its branches could pose both intraoperative and postoperative complications which eventually affect the normal sensory and motor functions of the upper limb.

RESUMEN

The knowledge of innervation of pectoral muscles is important to surgeons performing breast surgeries, axillary lymph node dissection, harvesting pectoralis major/minor for flaps, and during neurotization procedures where the pectoral nerves are particularly at risk. The present case describes the innervation of the pectoral muscles solely by a nerve trunk arising from the ansa pectoralis (AP) - the loop of medial and lateral pectoral nerves. Interestingly, there was also a communication between the AP and roots forming the median nerve. It is imperative for the operating surgeons to be aware of these rare variations in order to prevent denervation and subsequent atrophy of the pectoral musculature.