Branching Patterns Of The Posterior Cord Of The Brachial Plexus In Human Fetuses: A Morphological Study With Anatomical And Surgical Significance
DOI:
https://doi.org/10.67440/ahj.v21i5s.1286Keywords:
Brachial plexus; Human fetus; Anatomical variation; Nerve Block; Surgical anatomy; Regional anesthesia; Nerve Transfer; Axillary nerve.Abstract
Background: The posterior cord supplies muscles of posterior wall of axilla and extensor compartments of the upper limb. Variations in the Branching pattern may increase the risk of iatrogenic injury during axillary surgery, nerve blocks, and neurotization. This study aims to describe the developmental morphology and variations in branching pattern of the posterior cord of the brachial plexus in human fetuses and to assess their surgical relevance
Methods: Thirty upper limbs from 15 human fetuses (20–40 weeks gestation) were dissected. Posterior cord Branching patterns were documented and photographed. Statistical associations between laterality and variations were analyzed using Fisher’s exact test via IBM SPSS 28.0 (P<0.05).
Results: Variations were observed in 47% (14/30) of limbs and 67% (10/15) of fetuses. These variations were more prevalent on the right side (64%) and were more frequently unilateral (60%) than bilateral (40%). The most common variation was a common trunk for the axillary nerve (AN) and lower subscapular nerve (LSN), occurring in 57% (8/14) of variant limbs. Other significant patterns included the AN or upper subscapular nerve arising from the posterior division of the upper trunk (4/14), various common trunks involving the thoracodorsal nerve, and instances of triple subscapular nerves.
Conclusion: Fetal posterior cord branching exhibits significant morphological variability. Awareness of these anatomical patterns is essential to prevent iatrogenic nerve injury during pediatric axillary surgery, neurotization, and regional anesthesia
