Muscular variations in axilla, incidence, embryological and surgical significance

Hundred axillary dissections were conducted by the first author over four years. A muscular slip was observed during such a routine axillary dissection in a cadaver extending from the lower border of Latissimus dorsi muscle to the trilaminar tendinous insertion of pectoralis major muscle. The arch was identified as the “Axillary arch of Langer”. This attribute’s its incidence to 1% in south Indian population. The paramount importance of the arch to the surgeons operating in the axilla has been discussed. The article aims at describing the various reported muscular variations in the axilla, their embryological basis and surgical significance as their knowledge is vital due to their relevance in hyper abduction syndromes, post mastectomy breast reconstruction using latissimus dorsi myocutaneous flaps, lymphoedema, differential diagnosis of axillary swellings and thoracic outlet syndrome.