Peripheral communications of intercostobrachial nerve Peripheral communications of the intercostobrachial nerve in relation to the alar thoracic artery


Department of Anatomy, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India


The intercostobrachial nerve (ICBN) is often encountered during axillary dissection for axillary lymph node dissection (ALND) for diagnostic and therapeutic surgery for mastectomy. The present report is a case observed in the Department of Anatomy at Vardhman Mahavir Medical College, Delhi during routine dissection of the upper extremity of a male cadaver for first year undergraduate medical students. On the right side , the medial cord of brachial plexus gave two medial cutaneous nerves of arm. Both the nerves were seen communicating with the branches of the ICBN. The ICBN and one of its branches were surrounding the termination of an alar thoracic artery. These peripheral neural connections of the ICBN with the branches of the medial cord can be a cause of sensory impairment during axillary procedures done for mastectomy or exploration of long thoracic nerves. The alar thoracic artery found in relation to the ICBN could further be a cause of vascular complications during such procedures.


Clemente CD. Ventral primarydivisions of the spinal nerves. In: Clemente CD, editor. Gray's Anatomy. 30 th ed. Baltimore: William and Wilkins; 1985. p. 1223-5.  Back to cited text no. 1
McMinn RM. Upper limb. In: McMinn RM, editor. Last's Anatomy Regional and Applied. 9 th ed. Edinburgh: Churchill Livingstone; 1994. p. 82.  Back to cited text no. 2
Williams PL, Warwick R, Dyson M. Bannister LH. Gray's Anatomy. 37 th ed. London: Churchill Livingstone; 1989. p. 756-8.  Back to cited text no. 3
Baker RJ, Fischer JE. Segmental mastectomy and axillary dissection. In: Baker RJ, Fischer JE, editors. Master of Surgery. 4 th ed. Vol. 1. Philadelphia: Lippincott, William and Wilkins; 2001. p. 591-3.  Back to cited text no. 4
Cunnick GH, Upponi S, Wishart GC. Anatomical variants of the intercostobrachial nerve encountered during axillary dissection. Breast 2001;10:160-2.  Back to cited text no. 5
Loukas M, Louis RG Jr, Fogg QA, Hallner B, Gupta AA. An unusual innervation of pectoralis minor and major muscles from a branch of the intercostobrachial nerve. Clin Anat 2006;19:347-9.  Back to cited text no. 6
Abdullah TI, Iddon J, Barr L, Baildam AD, Bundred NJ. Prospective randomized controlled trial of preservation of the intercostobrachial nerve during axillary node clearance for breast cancer. Br J Surg 1998;85:1443-5.  Back to cited text no. 7
Carpenter JS, Sloan P, Andrykowski MA, McGrath P, Sloan D, Rexford T, et al. Risk factors for pain after mastectomy/lumpectomy. Cancer Pract 1999;7:66-70.  Back to cited text no. 8
Vecht CJ, Van de Brand HJ, Wajer OJ. Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve. Pain 1989;38:171-6.  Back to cited text no. 9
Paredes JP, Puente JL, Potel J. Variations in sensitivity after sectioning the intercostobrachial nerve. Am J Surg 1990;160:525-8.  Back to cited text no. 10
Williams PL, Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE, et al. Gray's anatomy. In: Gabella G, editor. Arteries of the Limbs and Cardiovascular System. 38 th ed. London: Churchill Livingstone; 1999. p. 1537-9.  Back to cited text no. 11
Rusu MC. Bilateral alar thoracic artery. Folia Morphol (Warsz) 2005;64:59-64.  Back to cited text no. 12
Patnaik VV, Kalsey G, Singla Rajan K. Branching pattern of axillary artery- A morphological study. J Anat Soc India 2000;49:127-32.  Back to cited text no. 13
Li J, Jia S, Zhang W, Zhang Y, Qiu F, Xue J, et al. A new technique that complements sentinel lymph node biopsy: Lymph node dissection under the intercostobrachial nerves in early-stage breast cancer. Clin Breast Cancer 2013;13:212-8.  Back to cited text no. 14
Freeman SR, Washington SJ, Pritchard T, Barr L, Baildam AD, Bundred NJ. Long term results of a randomized prospective study of preservation of the intercostobrachial nerve. Eur J Surg Oncol 2003;29:213-5.  Back to cited text no. 15
Torresan RZ, Cabello C, Conde DM, Brenelli HB. Impact of the preservation of the intercostobrachial nerve in axillary lymphadenectomy due to breast cancer. Breast J 2003;9:389-92.  Back to cited text no. 16
O′Rourke MG, Tang TS, Allison SI, Wood W. The anatomy of the extrathoracic intercostobrachial nerve. ANZ J Surg 1999;69:860-4.  Back to cited text no. 17
Loukas M, Hullett J, Louis RG Jr, Holdman S, Holdman D. The gross anatomy of the extrathoracic course of the intercostobrachial nerve. Clin Anat 2006;19:106-11.  Back to cited text no. 18
Kogan I, Lewinson D. Variation in the branching pattern of the axillary artery. A description of a rare case. Acta Anat (Basel) 1998;162:238-40.  Back to cited text no. 19
Majumdar S, Bhattacharya S, Chatterjee A, Dasgupta H, Bhattacharya K. A study on axillary artery and its branching pattern among the population of West Bengal, India. Ital J Anat Embryol 2013;118:159-71.  Back to cited text no. 20
Reddy MR, Jena SK, Vamsi A, Sharma MV. A case report on alar thoracic artery seen in a cadaver of a medical college of coastal Andhra Pradesh. Int J Contemp Med 2014;2:188-90.  Back to cited text no. 21