Axillary Fossa Variations

Knowledge of muscular, vascular, and neural variations in the axilla is of great clinical importance, especially in mastectomies, breast reconstruction, and axillary bypass operations. The aim of our study is to emphasize on multiple variability of the axillary structures and its clinical importance. In this paper we report some varieties of the axilla, found in two cadavers, including: the axillary arch muscle of Langer; atypical inflow of cephalic vein into external jugular vein; variations in branching of brachial plexus. In one of the axillae we discover an availability of muscular fibers bridging between pectoralis major and latissimus dorsi muscles. The second finding though more rare than the first one is of particular importance for cardiac implant techniques still treating the cephalic vein as a target for venesection. The branching varieties of the nerves in the axilla are presented by musculocutaneus nerve starting from median nerve. Identification of the axillary arch and its variations may help avoid accidental injury to axillary vessels and the brachial plexus during surgical procedures. Some device implanters still prefer to cut down the cephalic vein as the initial approach to venous access for transvenous placement of pacemaker or defibrillator leads out of concern for the risk of pneumothorax, subclavian crush, and other possible complications. Anesthesiologists administering local anesthetic blocks and surgeons operating in the axilla should be aware of nerve varieties to avoid iatrogenic injury. We conclude that more wide concern of the pattern of the axillary fossa structures is necessary to escape inadvertent accidents.