Anatomic-surgical study of intercostobrachial nerve (ICBN) course in axilla during I. and II. level of axilla clearance in breast cancer and malignant melanoma


Authors: O. Kubala 1;  J. Prokop 1;  P. Jelínek 1;  P. Ostruszka 1;  J. Tošenovský 2;  P. Ihnát 1;  P. Zonča 1
Authors‘ workplace: Chirurgická klinika LF Ostravské univerzity a FN Ostrava přednosta: Doc. MUDr. P. Zonča, Ph. D. FRCS 1;  Fakulta metalurgie a materiálového inženýrství, Katedra kontroly a řízení jakosti VŠB – Technická univerzita Ostrava, vedoucí katedry: Prof. Ing. J. Plura, CSc. 2
Published in: Rozhl. Chir., 2013, roč. 92, č. 6, s. 320-329.
Category: Original articles

Overview

Introduction:
The aim of this paper is to offer results of anatomic study of axillary course of intercostobrachial nerve (ICBN) and the effort of its saving in primary axilla clearance (PE), secondary clearance (SE) after previous positive sentinel nodes detection (SLN) and in re-clearance (RE) after previous axilla clearance in breast cancer and malignant melanoma. The correlation between possibility of ICBN saving and anatomic variant of ICBN and type of previous surgery was observed.

Material and methods:
A total of 113 surgeries with the effort of description and preservation of ICBN were done between September 2007 and August 2011. Patients were divided into three groups according to type of surgery: primary clearance (PE), secondary clearance (SE) and re-clearance (RE). Results have been statistically tested using licensed statistical software Statgraphics.

Results:
ICBN was found in 107 patients (94.7%), it wasn’t found in six cases. There were eight different types of ICBN branching. Two most frequent variants formed majority of cases – 87 out of 107 (81.3%). The successful preservation of intact ICBN was in 86 patients (76.1%). ICBN was interrupted or not found in 10 patients (8.8%), partial injury of ICBN branches was detected in 17 cases (15.0%). If the most frequent variant of ICBN branching was present, the nerve was not injured in 42 out of 45 cases (93.3%). Statistical testing showed that non-standard anatomical branches are associated with higher risk of perioperative injury. The risk of injury was lowest in PE (21.6%) and the highest in RE (42.9%). The difference wasn’t statistically significant because of low number of re-clearance cases in our study.

Conclusion:
The anatomy of ICBN in axilla is variable. The standard variant of ICBN course is the most frequent (the trunk coming out of second intercostal space; no branches in axillary course). If other variants are present, there is significantly higher risk of perioperative injury. ICBN preservation is possible also after previous axilla clearance. Preparation is more difficult and the risk of injury is increasing with the degree of previous surgery radicality.

Key words:
intercostobrachial nerve (ICBN) – anatomy – injury


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