AXILLA (Boundaries & Content)

By

Dr Raza Younus
General Surgeon Assistant Professor Department of Anatomy Avicenna Medical College

AXILLA
Axilla

The axilla is the pyramidal space inferior to the Glenohumeral joint superior to the Axillary fascia at the junction of the arm and thorax
The axilla provides a passageway or distribution center, usually protected by the adducted upper limb, for the neurovascular structures that serve the upper limb.

Axilla
Axilla
From this distribution center, neurovascular structures pass (1) superiorly via the cervicoaxillary canal to (or from) the root of the neck,

(2) anteriorly via the clavipectoral triangle to the pectoral region,

(3) inferiorly and laterally into the limb itself,

(4) posteriorly via the quadrangular space to the scapular region (5) inferiorly and medially along the thoracic wall to the inferiorly placed axioappendicular muscles (serratus anterior and latissimus dorsi).

AXILLA
The axilla has an apex, a base, and four walls, three of which are muscular: APEX: The apex of axilla is the cervicoaxillary canal, the passageway between the neck and the axilla, bounded by the 1st rib, clavicle, and superior edge of the scapula. The arteries, veins, lymphatics, and nerves traverse this superior opening of the axilla to pass to or from the arm

AXILLA
BASE: The base of axilla is formed by the concave skin, subcutaneous tissue, and axillary (deep) fascia extending from the arm to the thoracic wall (approximately the 4th rib level), forming the axillary fossa (arm pit). The base of the axilla or axillary fossa is bounded by the -- anterior and posterior axillary folds, -- thoracic wall, -- medial aspect of the arm

AXILLA
ANTERIOR WALL: Has two layers, formed by the -- pectoralis major -- pectoralis minor -- pectoral and clavicopectoral fascia associated with them Anterior axillary fold is the inferiormost part of the anterior wall that may be grasped between the fingers; it is formed by the pectoralis major, as it bridges from thoracic wall to humerus, and the overlying integument

AXILLA
POSTERIOR WALL: is formed chiefly by the -- scapula and subscapularis on its anterior surface -- inferiorly by the teres major and latissimus dorsi Posterior axillary fold is the inferior most part of the posterior wall that may be grasped. It extends farther inferiorly than the anterior wall and is formed by -- latissimus dorsi, teres major, and overlying integument.

AXILLA
MEDIAL WALL: is formed by the -- thoracic wall 1st - 4th ribs -- intercostal muscles -- overlying serratus anterior LATERAL WALL: is a narrow bony wall formed by the -- intertubercular groove in the humerus.

CONTENTS OF AXILLA
CONTENTS OF AXILLA: axillary blood vessels (axillary artery and its branches, axillary vein and its tributaries), lymphatic vessels, and several groups of axillary lymph nodes,

all embedded in a matrix of axillary fat

large nerves that make up the cords and branches of the brachial plexus, a network of interjoining nerves that pass from the neck to the upper limb. Proximally, these neurovascular structures are ensheathed in a sleeve-like extension of the cervical fascia, the axillary sheath

Axillary Artery
Axillary Artery
begins at the lateral border of the 1st rib as the continuation of the Subclavian artery ends

at the inferior border of the teres major It passes posterior to the pectoralis minor into the arm and
becomes Brachial artery (when it passes the inferior border of the teres major at which point it usually has reached the humerus).

Axillary Artery
Axillary artery is divided into three parts by the pectoralis minor (the part number also indicates the number of its branches): First part of the axillary artery is located between the lateral border of the 1st rib and the medial border of the pectoralis minor; it is enclosed in the axillary sheath has one branch the 1) superior thoracic artery.

Axillary Artery
The second part of the axillary artery lies posterior to pectoralis minor and has two branches: 1) Thoracoacromial 2) Lateral thoracic arteries

Axillary Artery
The third part of the axillary artery extends from the lateral border of pectoralis minor to the inferior border of teres major has three branches. 1. The subscapular artery is the largest branch of the axillary artery. 2. Anterior circumflex humeral 3. Posterior circumflex humeral arteries arise sometimes by means of a common trunk.

Axillary Artery
The superior thoracic artery is a small, highly variable vessel that arises just inferior to the subclavius. It commonly runs inferomedially posterior to the axillary vein and supplies the subclavius, muscles in the 1st and 2nd intercostal spaces, superior slips of the serratus anterior, and overlying pectoral muscles. It anastomoses with the intercostal and/or internal thoracic arteries.

Axillary Artery
The thoracoacromial artery, a short wide trunk, pierces the costocoracoid membrane

divides into four branches, deep to the clavicular head of the pectoralis major acromial, deltoid, pectoral, and clavicular
Lateral thoracic artery has a variable origin. It usually arises as the second branch of the second part of the axillary artery and descends along the lateral border of the pectoralis minor, following it onto the thoracic wall it may arise instead from the thoracoacromial, suprascapular, or subscapular arteries. The lateral thoracic artery supplies the pectoral, serratus anterior, and intercostal muscles, the axillary lymph nodes, and the lateral aspect of the breast.

Axillary Artery
The subscapular artery, the branch of the axillary artery with the greatest diameter but shortest length descends along the lateral border of the subscapularis on the posterior axillary wall. It soon terminates by dividing into the Circumflex scapular Thoracodorsal arteries.

Axillary Artery
The circumflex scapular artery, often the larger terminal branch of the subscapular artery, (curves posteriorly around the lateral border of the scapula, passing posteriorly between the subscapularis and the teres major to supply muscles on the dorsum of the scapula). It participates in the anastomoses around the scapula.

The thoracodorsal artery continues the general course of the subscapular artery to the inferior angle of the scapula and supplies adjacent muscles, principally the latissimus dorsi. It also participates in the arterial anastomoses around the scapula.

Axillary Artery
The circumflex humeral arteries Encircle the surgical neck of the humerus, anastomosing with each other. a) Anterior circumflex humeral artery passes laterally, deep to the coracobrachialis and biceps brachii. It gives off an ascending branch that supplies the shoulder. b) Larger Posterior circumflex humeral artery passes medially through the posterior wall of the axilla via the quadrangular space with the axillary nerve to supply the glenohumeral joint and surrounding muscles (e.g., the deltoid, teres major and minor, and long head of the triceps)

Axillary Vein
Axillary Vein The axillary vein lies initially (distally) on the anteromedial side of the axillary artery, with its terminal part anteroinferior to the artery This large vein is formed by the union of the --Brachial vein (the accompanying veins of the brachial artery) -- Basilic vein at the inferior border of the teres major. The axillary vein is described as having three parts that correspond to the three parts of the axillary artery. Thus the initial, distal end is the third part, whereas the terminal, proximal end is the first part. The axillary vein (first part) ends at the lateral border of the 1st rib, where it becomes the subclavian vein.

Axillary Vein
The veins of the axilla are more abundant than the arteries, are highly variable, and frequently anastomose.

The axillary vein receives tributaries that generally correspond to branches of the axillary artery with a few major exceptions:
The veins corresponding to the branches of the thoracoacromial artery do not merge to enter by a common tributary; some enter independently into the axillary vein, but others empty into the cephalic vein, which then enters the axillary vein superior to the pectoralis minor, close to its transition into the subclavian vein. The axillary vein receives, directly or indirectly, the thoracoepigastric vein(s), which is(are) formed by the anastomoses of superficial veins from the inguinal region with tributaries of the axillary vein (usually the lateral thoracic vein). These veins constitute a collateral route that enables venous return in the presence of obstruction of the inferior vena cava

AXILLA (Boundaries & Content)

By

Dr Raza Younus
General Surgeon Assistant Professor Department of Anatomy Avicenna Medical College

Axillary Lymph Nodes

Axillary Lymph Nodes The fibrofatty connective tissue of the axilla (axillary fat) contains many lymph nodes. The axillary lymph nodes are arranged in five principal groups: pectoral, subscapular, humeral, central, and apical.

The groups are arranged in a manner that reflects the pyramidal shape of the axilla

Axillary Lymph Nodes

Three groups of axillary nodes are related to the triangular base, one group at each corner of the pyramid: The pectoral (anterior) nodes consist of three to five nodes that lie along the medial wall of the axilla, around the lateral thoracic vein and the inferior border of the pectoralis minor. The pectoral nodes receive lymph mainly from the anterior thoracic wall, including most of the breast (especially the superolateral [upper outer] quadrant and subareolar plexus)

Axillary Lymph Nodes

The subscapular (posterior) nodes consist of six or seven nodes that lie along the posterior axillary fold and subscapular The humeral (lateral) nodes consist of four to six nodes that lie along the lateral wall of the axilla, medial and posterior to the axillary vein. These nodes receive nearly all the lymph from the upper limb, except that carried by the lymphatic vessels accompanying the cephalic vein, which primarily drain directly to the apical axillary and infraclavicular nodes. Efferent lymphatic vessels from these three groups pass to the central nodes.

Axillary Lymph Nodes

Central Nodes: The central nodes are three or four large nodes situated deep to the pectoralis minor near the base of the axilla, in association with the second part of the axillary artery. Apical Nodes: Efferent vessels from the central nodes pass to the apical nodes. The apical nodes are located at the apex of the axilla along the medial side of the axillary vein and the first part of the axillary artery. The apical nodes receive lymph from -- all other groups of axillary lymph nodes -- from lymphatics accompanying the proximal cephalic vein. Efferent vessels from the apical group of nodes traverse the cervicoaxillary canal.

Axillary Lymph Nodes

These efferent vessels ultimately unite to form the Subclavian lymphatic trunk,

although some vessels may drain en route through the Clavicular (infraclavicular and supraclavicular) nodes.
Once formed, the subclavian trunk on the right side may be joined by the jugular and bronchomediastinal trunks to form the right lymphatic duct, it may enter the right venous angle independently.

On the left side, the subclavian trunk most commonly joins the thoracic duct

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