The existence of axillary arch in human fetus and applied importance and clinical implications in the axillary brachial plexus blocks / La existencia de arco axilar en el feto humano y la importancia aplicadae implicancias clínicas en los bloques de plexo braquial

Axillary arch is the most common muscle variation of axillary fossa that gains importance for regional interventional procedures, screening methods and physical examination. In order to avoid malpractice the variations must be borne in mind. This study has been planned to research the frequency and the features of the axillary arch in human fetus, to mention the potential clinical and functional significance of axillary arch while applying axillary brachial plexus block and reflect on possible complications. Axillary fossa was examined with a stereomicroscope in 20 upper extremities of ten human fetuses. The gestation ages ranged from 16 to 36 weeks. Axillary arch was determined in 2/20 specimen unilaterally. In both specimen, muscular slip detached from latissimus dorsi, passed anterior neurovascular bundle and ended posterior pectoralis major tendon and lateral border of intertubercular groove. In one specimen axillary arch was innervated with medial pectoral nerve whereas the other one did not have a particular innervating nerve branch. The possible effects of axillary arch in the axillary brachial plexus block applications are discussed. Arcus axillaris may have a potential clinical and functional significance with regard the axillary brachial plexus block applications and may have possible effects on failure rate and acute complications. Also, we think that this fetus study which the pure structure of the muscles without any usage effect can be observed will be beneficial regarding this topic.

El arco axilar es la variación muscular más común de la fosa axilar, siendo de importancia para la región en los procedimientos de intervención, los métodos de selección y el examen físico. Con el fin de evitar las negligencias se debe tener en cuenta las variaciones. El objetivo de este estudio fue determinar la frecuencia y las características del arco axilar en el feto humano. Es necesario mencionar la importancia del potencial clínico y funcional del arco axilar en la aplicación de bloqueo axilar del plexo braquial y sus posibles complicaciones. La fosa axilar fue examinada bajo microscopio estereoscópico en 20 miembros superiores de diez fetos humanos. La edad de gestación varió de 16 a 36 semanas. El arco axilar se observó unilateralmente en 2/20 especímenes. En ambos especímenes el músculo cruzó anteriormente el paquete neurovascular y terminó en el tendón del músculo pectoral mayor y en el margen lateral del surco intertubercular. En un especimen el arco axilar se encontraba inervado por el nervio pectoral medial, mientras que en el otro no existía una determinado ramo del nervio. Se discuten los posibles efectos del arco axilar en las aplicaciones de bloqueo axilar del plexo braquial. Puede tener un significado potencial clínico y funcional, en lo que se refiere a la aplicación de bloqueo axilar del plexo braquial y aademás producir efectos de complicaciones agudas.

Anatomy and histopathology of apocrine sweat glands in axillary fossa / 中华医学美学美容杂志

Objective To investigate the distribution range and depth of the apocrine sweat glands of the axillary fossa,in order to supply with anatomic and histopathologic basis in the treatment on axillarv osmidrosis.Methods From December 2008 to ()ctober 2010,2 biopsy samples(with axillary osmidrosis),8 biopsy samples(normal,without axillary osmidrosis),were employed into the axillarv anatomy study. 25 patients with severe axillary osmidrosis were observed both maerographicallv and microscopically by using of operation and histopathological methods.Results Secretory portion of apocrine sweat glands was seen clearly,it was pitchy millet-like granules on axillary osmidrosis corpse,and pink millet-like granules in vivo.Secretory portions distributed most within the armpit hair area,exceeded the edge of armpit hair line,but not surpassed the edge of armpit hair line 1.0 cm.The depth of the apocrine sweat glands located vertically at superficial fat tissues between the dermal reticular 1aver and superficial fascia layers which were dissected away easily.Trimming with scissors under dermaIlayer,the secretory portion of apocrine sweat glands was removed cleanly without harms to reticular laver of dermas.Secretory portions became ducts under reticular layer of dermas.White Drominence-like granules were proved to be the compomers of hair follicle and sebaceous glands through Dathological section.Conclusions In order to treat axillary osmidrosis effectively,the secretary portion should be removed away through cutting off the tissues between the dermal reticular layer and suDerficial fastia layers;the ducts of apocrine sweat glands should be handled with removing hair follicle under the reticular layer of dermas．0peration area should not exceed 1.0 cm off the edge.

Island scapular flap based on transverse branch of circumflex scapular artery for axillary burn scar contracture / 中华医学美学美容杂志

Objective Island scapular flap (ISF) based on transverse branch of circumflex scapular artery is less reported than ISF based on ascending or descending branch. This article presented authors' experiences in correction of severe axillary burn scar contracture with ISF based transverse branch of circumflex scapular artery. Methods ISFs based transverse branch was harvested in 12 patients with 15 severe axillary burn scar contracture, rotating an arc of about 180°. Flap size was between 12 cm× 5cm to 20 cm × 10 cm. The donor site was closed primarily. Results All 15 flaps survived completely and axillary burn scar contracture was corrected successfully. 8 patients were satisfied with both the functional and aesthetic results after 1-3 years' follow-up. Conclusion ISF based transverse branch of circumflex scapular artery is a good choice for reconstruction of severe axillary burn scar contracture, especially for female patients or ones whose ISF based on ascending or descending branch could not be harvested because of formation of hypertrophic scar in donor site.

Metastasis of axillary node in clinical T1 -T2 N0M0 breast cancer patients / 国际外科学杂志

Objective To study the metastasis of lymph node of breast cancer patients in clinical T1-T2 N0 M0 and its clinical significance in (sentinel lymph node biopsy, SLNB). Methods A total of 276 pa-tients of breast cancer were enrolled in the study (T1 N0M0 cases =115 ; T2N0M0 cases = 161 ). The metas-tasis and distribution of axillary node by virtue of the location of primary tumor, ages and pathologic status were analyzed. Results The metastasis rate of axillary node in T1 N0M0 patients was less than T2 N0 M0 (P =0.027), while that in the central and lower outer quadrant's was higher than in other' s parts(P =0.004).When the tumor located in outer quadrant, the axillary node metastasis rate of Berg I was highest in the cen-tral, outer and inner quadrant(P =0.000). But the metastasis rate of Berg Ⅲ was lowest in the three quad-rants (P = 0. 000). For the pathologic status, the metastasis rate of invasive carcinoma-not otherwise speci-fied(NOS) was higher than early breast carcinoma and other pathologic categories (P =0.000). More than 2 groups axillary node metastasis was found in 6 of 9 patients with carcinoma simplex. The 90 cases with axilla-ry node metastasis were analyzed by age. Axillary node was easier for metastasis in those cases aged above 50years than those below 50 years(68.9% vs 31.1% )(P =0. 000). Two eases with skip metastasis were in T2 No Mo (invasive ductal carcinoma disease = 1, carcinoma simplex disease = 1 ). Conclusion The distri-bution of the metastasis of lymph node in clinical T1 ,T2 N0M0 breast cancer plays an important role in SLNB and formulating reasonable treatment protocols.