肋间臂神经在腋窝区域的走行及其与经腋窝隆胸术的关系。

The course of the intercostobrachial nerve in the axillary region and as it is related to transaxillary breast augmentation.

作者信息

Hwang Kun, Huan Fan, Hwang Se Won, Kim Sang Hyun, Han Seung Ho

机构信息

From the *Department of Plastic Surgery and †Center for Advanced Medical Education by BK21 project, Inha University School of Medicine, Incheon, Korea; and ‡Department of Anatomy and § Institute for Applied Anatomy, Catholic University of Korea, Seoul, South Korea.

出版信息

Ann Plast Surg. 2014 Mar;72(3):337-9. doi: 10.1097/SAP.0b013e31825c07ba.

DOI:10.1097/SAP.0b013e31825c07ba

PMID:23364676

Abstract

PURPOSE

The aim of this study was to precisely determine the course of the intercostobrachial nerve (ICBN) in the axillary region and as it is related to bony landmarks, and all of this might be of use for transaxillary breast augmentation.

METHODS

Thirty hemithoraxes of 15 fresh cadavers of Korean adults were dissected. After removal of the skin, the ICBN from its origin was identified. The point of emergence (EP) and the branching point (BP) were marked on translucent paper.

RESULTS

The ICBN appeared at the second intercostal space approximately (mean ± SD; 33.4 ± 12.7) mm lateral to the midclavicular line and 9.8 ± 6.4 mm medial to the lateral border of the pectoralis minor (P minor) muscle. The mean (SD) distance from the lower border of the second rib to the EP was 5.2 ± 2.0 mm. The mean ± SD distance from the upper border of the third rib to the EP was 12.7 ± 3.3 mm. It traveled inferolaterally (mean ± SD) 15.1 ± 10.4 degrees from the horizontal plane) 39.4 ± 19.2 mm to reach to the BP. The BP was located at the second intercostal space approximately (mean ± SD) 59.4 ± 21.2 mm lateral to the midclavicular line and 28.5 ± 18.2 mm lateral to the lateral border of the P minor muscle. The mean ± SD distance from the lower border of the second rib to the BP was 11.3 ± 5.4 mm. The mean ± SD distance from the upper border of the third rib to the BP was 6.3 ± 7.1 mm. At the BP, the ICBN gave off a medial brachial cutaneous nerve, and this coursed superolaterally [mean (mean ± SD, 50.7 ± 15.1 degrees from the horizontal plane) toward the medial surface of the upper arm. The mean ± SD depth of the ICBN from the superficial surface of the pectoralis major and P minor was 22.7 ± 5.7 mm and 15.0 ± 5.2 mm, respectively.

CONCLUSION

When performing mammary augmentation, care should be taken not to dissect the undersurface of the P minor at the second intercostal space to avoid injury to the ICBN.

摘要

目的

本研究旨在精确确定肋间臂神经（ICBN）在腋窝区域的走行及其与骨性标志的关系，所有这些对于经腋窝隆胸术可能有用。

方法

解剖了15具韩国成年新鲜尸体的30个半胸。去除皮肤后，从其起始处识别出ICBN。在半透明纸上标记出穿出点（EP）和分支点（BP）。

结果

ICBN出现在锁骨中线外侧约（均值±标准差；33.4±12.7）mm、胸小肌（P小肌）外侧缘内侧9.8±6.4mm处的第二肋间间隙。从第二肋下缘到EP的平均（标准差）距离为5.2±2.0mm。从第三肋上缘到EP的平均±标准差距离为12.7±3.3mm。它向外侧下方走行（平均±标准差，与水平面成15.1±10.4度角）39.4±19.2mm到达BP。BP位于锁骨中线外侧约（均值±标准差）59.4±21.2mm、P小肌外侧缘外侧28.5±18.2mm处的第二肋间间隙。从第二肋下缘到BP的平均±标准差距离为11.3±5.4mm。从第三肋上缘到BP的平均±标准差距离为6.3±7.1mm。在BP处，ICBN发出臂内侧皮神经，该神经向上外侧走行[平均（平均±标准差，与水平面成50.7±15.1度角）]朝向肱骨内侧面。ICBN距胸大肌和P小肌表面的平均±标准差深度分别为22.7±5.7mm和15.0±5.2mm。