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Surgical and Radiologic Anatomy

, Volume 41, Issue 4, pp 385–392 | Cite as

Anatomical variations of the subscapular pedicle and its terminal branches: an anatomical study and a reappraisal in the light of current surgical approaches

  • Martin LhuaireEmail author
  • Mikael Hivelin
  • Mohamed Derder
  • Vincent Hunsinger
  • Vincent Delmas
  • Peter Abrahams
  • Daniele Sommacale
  • Reza Kianmanesh
  • Christian Fontaine
  • Laurent Lantieri
Original Article
  • 44 Downloads

Abstract

Purpose

While anatomical variations of the subscapular vessels are frequently encountered during axillary dissection, little is found in the literature. The aim of this cadaveric study was to define arterial and venous anatomical variations and frequencies of the subscapular vascular pedicle and its terminal/afferent vessels in women.

Methods

We performed 80 dissections of the axillary region on forty female formalin-embalmed cadavers. Each anatomical arrangement was photographed and recorded on a scheme before analysis.

Results

We propose a new classification of the subscapular pedicle variations. We observed three types of subscapular arterial variation. The type Ia was the most frequent arrangement (71% of our dissections), the type Ib was observed in 11% and the type II in 18% of cases. We observed four types of subscapular venous variation. The type Ia was observed in 63% of cases, the type Ib in 14%, the type II in 14% and the type III in 10% of cases.

Conclusions

This knowledge of the anatomical variation arrangement and frequencies of the subscapular vascular pedicle will assist the surgeon when dissecting the axillary region for malignant or reconstructive procedures.

Keywords

Subscapular pedicle Thoracodorsal pedicle Circumflex scapular pedicle Autologous microsurgical breast reconstruction Axillary lymph nodes dissection Vascular anatomy Axilla Anatomical variations 

Notes

Acknowledgements

We are grateful to the donors of the Institute of Anatomy and Organogenesis of Lille and their families without whom anatomical studies for medical research advancements and education of future healthcare providers would not be possible. We thank Pr José R. Sañudo from the Department of Human Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, for his instructive comments especially about the genesis of variations during development. We thank Pr Christian Vacher, from the Department of Anatomy, Faculté de Médecine Paris-Diderot, URDIA (EA4465), Paris, for his instructive comments to increase the relevance of the manuscript and especially the correlations between arterial and venous arrangements. We thank Maurice De Meulaere, Fabien Descamps, and Franck Stevendart from the Institute of Anatomy and Organogenesis of Lille for their assistance throughout the dissections.

Author contributions

All persons listed as authors have contributed substantially to the design, performance, analysis, and reporting of this work. ML, MH, MD, VH: collected data, analyzed data, wrote paper. VD, PH, DS, RK: analyzed data, wrote paper. ML, CF, LL: Designed study, analyzed data, wrote paper.

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Martin Lhuaire
    • 1
    • 2
    • 3
    Email author
  • Mikael Hivelin
    • 1
  • Mohamed Derder
    • 1
  • Vincent Hunsinger
    • 1
  • Vincent Delmas
    • 4
  • Peter Abrahams
    • 5
  • Daniele Sommacale
    • 3
  • Reza Kianmanesh
    • 3
  • Christian Fontaine
    • 2
  • Laurent Lantieri
    • 1
  1. 1.Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de ParisUniversité Paris Descartes, Paris VParis Cedex 15France
  2. 2.Institute of Anatomy and Organogenesis, Faculté de Médecine Henri WarembourgUniversité de Lille IILilleFrance
  3. 3.Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de ReimsUniversité de Reims Champagne-ArdenneReimsFrance
  4. 4.Institute of Anatomy, URDIA, EA4465, UFR Biomédicale des Saints-PèresUniversité Paris Descartes, Paris VParisFrance
  5. 5.Institute of Anatomy and Clinical Education, Warwick Medical SchoolUniversity of WarwickCoventryUK

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