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Review article
peer-reviewed

Origin, Branching, and Communications of the Intercostobrachial Nerve: a Meta-Analysis with Implications for Mastectomy and Axillary Lymph Node Dissection in Breast Cancer



Abstract

The intercostobrachial nerve (ICBN), which usually originates from the lateral cutaneous branch of the second intercostal nerve, innervates areas of the axilla, lateral chest, and medial arm. It is at risk for injury during operative procedures that are often used in the management of breast cancer and such injury has been associated with postoperative sensory loss and neuropathic pain, decreasing the quality of life.

PubMed, Excerpta Medica Database (EMBASE), ScienceDirect, Google Scholar, China National Knowledge Infrastructure (CNKI), Scientific Electronic Library Online (SciELO), Biosciences Information Service (BIOSIS), and Web of Science were searched comprehensively. Data concerning the prevalence, branching, origin and communications of the ICBN were extracted and pooled into a meta-analysis.

A total of 16 studies (1,567 axillas) reported data indicating that the ICBN was present in 98.4% of person. It most often (90.6%) originated from fibers at the T2 spinal level and commonly coursed in two branching patterns: as a single trunk in 47.0% of cases and as a bifurcating pattern in 42.2%. In the latter cases, the bifurcation was usually unequal (63.4%). Additionally, the ICBN presented with anastomosing communication to the brachial plexus in 41.3% of cases.

The ICBN is a prevalent and variable structure at significant risk for injury during operative procedures of the axilla. In view of the postoperative pain and paresthesia experienced by patients following injury, surgeons need to exercise caution and aim to preserve the ICBN when possible. Ultimately, careful dissection and knowledge of ICBN anatomy could allow postoperative complications to be reduced and patient's quality of life increased.



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Review article
peer-reviewed

Origin, Branching, and Communications of the Intercostobrachial Nerve: a Meta-Analysis with Implications for Mastectomy and Axillary Lymph Node Dissection in Breast Cancer


Author Information

Brandon Michael Henry Corresponding Author

Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

Matthew J. Graves

Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

Jakub R. Pękala

Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

Beatrice Sanna

Faculty of Medicine & Surgery, University of Cagliari

Wan Chin Hsieh

First Faculty of Medicine, Charles University

R. Shane Tubbs

Neurosurgery, Seattle Science Foundation

Jerzy A. Walocha

Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

Krzysztof A. Tomaszewski

Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland


Ethics Statement and Conflict of Interest Disclosures

Conflicts of interest: The authors have declared that no conflicts of interest exist.

Acknowledgements

Krzysztof A. Tomaszewski was supported by the Foundation for Polish Science (FNP).


Review article
peer-reviewed

Origin, Branching, and Communications of the Intercostobrachial Nerve: a Meta-Analysis with Implications for Mastectomy and Axillary Lymph Node Dissection in Breast Cancer


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Review article
peer-reviewed

Origin, Branching, and Communications of the Intercostobrachial Nerve: a Meta-Analysis with Implications for Mastectomy and Axillary Lymph Node Dissection in Breast Cancer

  • Author Information
    Brandon Michael Henry Corresponding Author

    Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

    Matthew J. Graves

    Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

    Jakub R. Pękala

    Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

    Beatrice Sanna

    Faculty of Medicine & Surgery, University of Cagliari

    Wan Chin Hsieh

    First Faculty of Medicine, Charles University

    R. Shane Tubbs

    Neurosurgery, Seattle Science Foundation

    Jerzy A. Walocha

    Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

    Krzysztof A. Tomaszewski

    Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland


    Ethics Statement and Conflict of Interest Disclosures

    Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements

    Krzysztof A. Tomaszewski was supported by the Foundation for Polish Science (FNP).


    Article Information

    Published: March 17, 2017

    DOI

    10.7759/cureus.1101

    Cite this article as:

    Henry B, Graves M J, Pękala J R, et al. (March 17, 2017) Origin, Branching, and Communications of the Intercostobrachial Nerve: a Meta-Analysis with Implications for Mastectomy and Axillary Lymph Node Dissection in Breast Cancer. Cureus 9(3): e1101. doi:10.7759/cureus.1101

    Publication history

    Received by Cureus: February 14, 2017
    Peer review began: March 07, 2017
    Peer review concluded: March 13, 2017
    Published: March 17, 2017

    Copyright

    © Copyright 2017
    Henry et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

The intercostobrachial nerve (ICBN), which usually originates from the lateral cutaneous branch of the second intercostal nerve, innervates areas of the axilla, lateral chest, and medial arm. It is at risk for injury during operative procedures that are often used in the management of breast cancer and such injury has been associated with postoperative sensory loss and neuropathic pain, decreasing the quality of life.

PubMed, Excerpta Medica Database (EMBASE), ScienceDirect, Google Scholar, China National Knowledge Infrastructure (CNKI), Scientific Electronic Library Online (SciELO), Biosciences Information Service (BIOSIS), and Web of Science were searched comprehensively. Data concerning the prevalence, branching, origin and communications of the ICBN were extracted and pooled into a meta-analysis.

A total of 16 studies (1,567 axillas) reported data indicating that the ICBN was present in 98.4% of person. It most often (90.6%) originated from fibers at the T2 spinal level and commonly coursed in two branching patterns: as a single trunk in 47.0% of cases and as a bifurcating pattern in 42.2%. In the latter cases, the bifurcation was usually unequal (63.4%). Additionally, the ICBN presented with anastomosing communication to the brachial plexus in 41.3% of cases.

The ICBN is a prevalent and variable structure at significant risk for injury during operative procedures of the axilla. In view of the postoperative pain and paresthesia experienced by patients following injury, surgeons need to exercise caution and aim to preserve the ICBN when possible. Ultimately, careful dissection and knowledge of ICBN anatomy could allow postoperative complications to be reduced and patient's quality of life increased.



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Create a free account to continue reading this article.

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Brandon Michael Henry

Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

For correspondence:
bmhenry55@gmail.com

Matthew J. Graves

Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

Jakub R. Pękala

Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

Beatrice Sanna

Faculty of Medicine & Surgery, University of Cagliari

Wan Chin Hsieh

First Faculty of Medicine, Charles University

R. Shane Tubbs, Ph.D., Professor

Neurosurgery, Seattle Science Foundation

Jerzy A. Walocha

Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

Krzysztof A. Tomaszewski

Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

Brandon Michael Henry

Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

For correspondence:
bmhenry55@gmail.com

Matthew J. Graves

Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

Jakub R. Pękala

Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

Beatrice Sanna

Faculty of Medicine & Surgery, University of Cagliari

Wan Chin Hsieh

First Faculty of Medicine, Charles University

R. Shane Tubbs, Ph.D., Professor

Neurosurgery, Seattle Science Foundation

Jerzy A. Walocha

Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

Krzysztof A. Tomaszewski

Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland