Nerves at Risk in Axillary Dissection

Expansion

• Long thoracic nerve (C5, C6, C7) - supplies serratus anterior. Injury causes a winged scapula
• Thoracodorsal nerve (C6, C7, C8) - supplies latissimus dorsi. Injury weakens adduction, extension and medial rotation of the arm
• Intercostobrachial nerve (lateral cutaneous branch of T2) - sensation to the upper inner arm and axillary skin. Injury or deliberate division causes numbness or neuropathic pain there

The intercostobrachial nerve is the one most often sacrificed, and persistent post-mastectomy pain in its distribution is a recognised complication that should be mentioned during consent.

The long thoracic nerve runs on the surface of serratus anterior against the chest wall, while the thoracodorsal nerve runs with its vessels on the deep surface of latissimus dorsi at the posterior axillary wall.