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Lymphatic anatomy: lymphatics of the breast and axilla
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
The internal mammary artery medially (65%) and the lateral thoracic artery (35%) supply blood to the breast (Figure 7.1). The cephalic vein serves as a landmark separating the pectoralis major muscle from the deltoid muscle. The vein travels through the deltopectoral triangle and pierces the clavipectoral fascia, joining the axillary vein. Branches of the brachial plexus are located throughout the course of the axilla. The long thoracic nerve is located on the medial wall of the axilla, arising in the neck from the fifth, sixth, and seventh roots of the brachial plexus. It innervates the serratus anterior muscle, which permits raising the arm above the shoulder. The intercostobrachial nerve is the lateral cutaneous branch of the second intercostal nerve and the joining of the medial cutaneous nerve of the arm, supplying the skin of the floor of the axilla and the upper medial aspect of the arm.
Distal Conduction Blocks
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
Another procedure that can be used for blocking both the medial brachial cutaneous and the intercostobrachial nerves involves the installation of both an intradermal and a subcutaneous ring of local anesthesia at the inner part of the arm (Figure 1.53).85 This procedure provides consistent blockade of the intercostobrachial nerve, but relative poor blockade of the medial brachial cutaneous nerve. However, the analgesia produced is usually sufficient to permit the placement of a tourniquet on the upper part of the arm.
Breast and Endocrine Surgery
Published in Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh, 300 Essentials SBAs in Surgery, 2017
Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh
Damage to the intercostobrachial nerves causes sensation loss in the skin overlying the medial aspect of the arm. Damage to the thoracodorsal nerve leads to weakness of the latissimus dorsi muscle. Damage to the long thoracic nerve of Bell, which innervates the serratus anterior muscle, leads to winging of the scapula.
Reliability and validity of the Upper Limb Functional Test (ULIFT) for women after breast cancer surgery
Published in Disability and Rehabilitation, 2022
Clarissa Medeiros da Luz, Amably Cristiny Prim, Julia Deitos, Ailime Perito Feiber Heck, Thaís Lunardi Recchia, Anamaria Fleig Mayer
Before performing the ULIFT, the patients underwent a physical exam to investigate breast and arm sensitivity through the Semmes-Weinstein monofilament (SORRI-BAURU), assuming the violet monofilament (2.0 g) as a cut-off point, classifying the absence to responses to monofilament stimuli lower than violet as altered sensibility [37]. Ipsilateral arm lymphedema was identified and staged as the Simplified Clinical Classification for Lymphedema [38]. The paraesthesia of the region innervated by the intercostobrachial nerve was defined by the presence of burning pain, shooting pain, pressure sensation, and numbness in the lateral region of the thorax, medial region of arm and/or axilla, being assessed by inspection, palpation, and/or referenced by the patient [39,40]. Based on this evaluation, the participants were classified in presenting or not intercostobrachial nerve injury. Scapular winging was assessed by testing the serratus anterior muscle function as proposed by Hoppenfeld [41,42]. The test is considered positive (presence of winged scapula) on evidence of the medial portion of the scapula during movement [40,42].
Effect of ketamine–bupivacaine combination in multilevel ultrasound- assisted thoracic paravertebral block on acute and chronic post-mastectomy pain
Published in Egyptian Journal of Anaesthesia, 2019
Shereen Mamdouh Kamal, Badawy M Ahmed, Ahmed Refaat
Chronic pain is a well-known risk after modified radical mastectomy with axillary evacuation for breast cancer that ranges from 20 to 47% [15]. It has neuropathic characteristics and was commonly attributed to the injury to the intercostobrachial nerve (a cutaneous branch of T1-T2) during axillary evacuation [16]. Persistent pain often results from nociceptive communication from injured peripheral tissue to the central nervous system via afferent nerves in the immediate postoperative period, and it is this communication that peripheral nerve blocks can dramatically attenuate [8]. The perioperative period should be considered as a justifiable target for interventions aimed to reduce the incidence and severity of chronic pain after modified radical mastectomy. Thereby, decreasing the effort and cost spent on the management of chronic post-mastectomy pain syndromes (PMPS).
Role of the Cadaver Lab in Lymphatic Microsurgery Education: Validation of a New Training Model
Published in Journal of Investigative Surgery, 2022
Lucian P. Jiga, Corrado C. Campisi, Zaher Jandali, Melissa Ryan, Michele Maruccia, Luigino Santecchia, Mario Cherubino, Janniko Georgiadis
After marking the flap the skin was incised along the lateral margin of the pectoralis major. The dissection was deepened proximally into the axilla. After identification of the axillary vein and artery, the proximal part of the lateral thoracic pedicle was identified. The intercostobrachial nerve crossing the lateral thoracic pedicle toward the arm was identified and preserved (Figure 3C). Approximately 2-3 cm distal from the crossing of this nerve, the lateral thoracic pedicle enters the fat layer containing the 2 to 4 lateral thoracic axillary lymph nodes.