From Cadaveric Dissection to the Operating Room: A Unilateral Double Intercostobrachial Nerve and the Implications in Axillary Lymph Node Dissection

There are multiple treatment options for breast cancer (BC), including lumpectomy, chemo- and radiotherapy, complete mastectomy, and, when indicated, an axillary lymph node dissection. Such node dissections commonly lead the surgeon to encounter the intercostobrachial nerve (ICBN), which, if injured...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2023-03, Vol.15 (3), p.e36647
Main Authors: Olivencia-Delgado, Mariana N, Jusino-Álamo, Javier F, De Miranda-Sánchez, Emanuel, Quiñones-Rodríguez, Jailenne I
Format: Article
Language:English
Subjects:
Anatomy
Brachial plexus
Breast cancer
Cadavers
Cell adhesion & migration
Dissection
General Surgery
Iatrogenesis
Injuries
Lymphatic system
Nervous system
Pain
Plastic Surgery
Radiation therapy
Surgeons
Surgery
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Summary:There are multiple treatment options for breast cancer (BC), including lumpectomy, chemo- and radiotherapy, complete mastectomy, and, when indicated, an axillary lymph node dissection. Such node dissections commonly lead the surgeon to encounter the intercostobrachial nerve (ICBN), which, if injured, leads to significant postoperative numbness of the upper arm. To assist in identifying the ICBN, we report a unilateral variation of a dual ICBN. The first ICBN (ICBN I) originates from the second intercostal space, as classically described in human anatomy. On the contrary, the second ICBN (ICBN II) originates from the second and third intercostal spaces. The anatomical knowledge of ICBN origin and its variations are crucial for axillary lymph node dissection in BC and other surgical interventions that involve the axillary region (e.g., regional nerve blocks). An iatrogenic injury of the ICBN has been associated with postoperative pain, paresthesia, and loss of upper extremity sensation in the dermatome supplied by this nerve. Therefore, maintaining the integrity of the ICBN is a worthy goal during axillary dissections in BC patients. Increasing the awareness of ICBN variants among surgeons reduces potential injuries, which would contribute to the BC patient's quality of life.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.36647