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

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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.

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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.

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Authors and Affiliations

  1. Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, Paris V, 20 rue Leblanc, 75908, Paris Cedex 15, France

    Martin Lhuaire, Mikael Hivelin, Mohamed Derder, Vincent Hunsinger & Laurent Lantieri

  2. Institute of Anatomy and Organogenesis, Faculté de Médecine Henri Warembourg, Université de Lille II, Lille, France

    Martin Lhuaire & Christian Fontaine

  3. Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France

    Martin Lhuaire, Daniele Sommacale & Reza Kianmanesh

  4. Institute of Anatomy, URDIA, EA4465, UFR Biomédicale des Saints-Pères, Université Paris Descartes, Paris V, Paris, France

    Vincent Delmas

  5. Institute of Anatomy and Clinical Education, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK

    Peter Abrahams

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  1. Martin Lhuaire
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  2. Mikael Hivelin
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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.

Corresponding author

Correspondence to Martin Lhuaire.

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Conflict of interest

The authors declare that they have no competing interests.

Additional information

This work was a part of: Lhuaire, Martin. Étude anatomique des pédicules épigastriques inférieurs, subscapulaire et thoracique interne: Applications chirurgicales. Thèse de Doctorat en Médecine presented and publicly supported on December 2, 2016. No. 2016REIMM136, 2016, Reims, France.

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Lhuaire, M., Hivelin, M., Derder, M. et al. Anatomical variations of the subscapular pedicle and its terminal branches: an anatomical study and a reappraisal in the light of current surgical approaches. Surg Radiol Anat 41, 385–392 (2019). https://doi.org/10.1007/s00276-018-2161-7

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