Skip to main content
SpringerLink
Log in

The zonal pattern of arterial supply to the brachial plexus and its clinical significance

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

To provide the anatomical basis of blood supply of brachial plexus for the clinical microsurgical treatment of brachial plexus injury.

Methods

Thirteen adult anticorrosive cadaveric specimens (8 males, 5 females) were dissected in this study. 3 fresh cases (2 males, 1 female) were used to observe the zonal pattern of arteries supplying brachial plexus, and 10 cases (6 males, 4 females) were used to observe the source and distribution of the brachial plexus arteries under microscope.

Results

The brachial plexus is supplied by branches of the subclavian–axillary axis (SAA), and these branches anastomose each other. According to distribution feature, blood supply of the brachial plexus could be divided into three zones. The first zone was from the nerve roots of intervertebral foramina to its proximal trunks, which was supplied by the vertebral artery and the deep cervical artery. The second zone was from the distal nerve trunks of the brachial plexus, encompassing the divisions to its proximal cords, which was supplied by direct branches of the subclavian artery or by branches originating from the dorsal scapular artery. The third zone was from the distal portion of the cords to terminal branches of the brachial plexus, which was supplied by direct branches of the axillary artery.

Conclusions

The zonal pattern of arterial supply to the brachial plexus is a systematic and comprehensive modality to improve anatomical basis for the clinical microsurgical treatment for brachial plexus injury.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Adachi B, Hasebe K, Daigaku KI (1928) Das Arteriensystem der Japaner. Kaiserlich-Japanischen Universitat zu Kyoto, Kyoto, pp 20–71

    Google Scholar 

  2. Angelica-Almeida M, Casal D, Mafra M, Mascarenhas-Lemos L, Martins-Ferreira J, Ferraz-Oliveira M, Amarante J, Goyri-O’Neill J (2013) Brachial plexus morphology and vascular supply in the wistar rat. Acta Med Port 26:243–250

    PubMed  Google Scholar 

  3. Bean RB (1905) A composite study of the subclavian artery in man. Am J Anat 4:303–328

    Article  Google Scholar 

  4. Bergman RA, Thompson SA, Afifi AK, Saadeh FA (1988) Compendium of human anatomic variation: text, atlas, and world literature. Urban & Schwarzenberg, Munich, pp 141–142

    Google Scholar 

  5. Bjorkman A, Weibull A, Svensson H, Dahlin L (2016) Cerebral reorganization in patients with brachial plexus birth injury and residual shoulder problems. Front Neurol 7:240. https://doi.org/10.3389/fneur.2016.00240

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chang SL, Lai CH, Lai HC, Hung CJ, Lee WL (2017) Successful treatment of inadvertent subclavian artery cannulation by arterial closure device. Can J Anaesth 64:544–545. https://doi.org/10.1007/s12630-017-0828-x

    Article  PubMed  Google Scholar 

  7. Claassen H, Schmitt O, Wree A, Schulze M (2016) Variations in brachial plexus with respect to concomitant accompanying aberrant arm arteries. Ann Anat 208:40–48. https://doi.org/10.1016/j.aanat.2016.07.007

    Article  PubMed  Google Scholar 

  8. Jalaie H, Grommes J, Sailer A, Greiner A, Binnebösel M, Kalder J, Schurink GW, Jacobs MJ (2014) Treatment of symptomatic aberrant subclavian arteries. Eur J Vasc Endovasc Surg 48:521–526. https://doi.org/10.1016/j.ejvs.2014.06.040

    Article  PubMed  CAS  Google Scholar 

  9. Kikuchi Y, Oishi M, Shimizu D (2011) Morphology of brachial plexus and axillary artery in bonobo (Pan paniscus). Anat Histol Embryol 40:68–72. https://doi.org/10.1111/j.1439-0264.2010.01040.x

    Article  PubMed  CAS  Google Scholar 

  10. Kim IS, Yang HH, Tae HJ, Na IJ, Leem HS, Ahn DC (2010) Branching patterns of the subclavian arteries in German Shepherd dogs. Anat Histol Embryol 39:529–533. https://doi.org/10.1111/j.1439-0264.2010.01025.x

    Article  PubMed  Google Scholar 

  11. Laumonerie P, Capek S, Amrami KK, Dyck PJ, Spinner RJ (2017) Targeted fascicular biopsy of the brachial plexus: rationale and operative technique. Neurosurg Focus 42:E9. https://doi.org/10.3171/2017.1.FOCUS16404

    Article  PubMed  Google Scholar 

  12. Levy SM, Taylor GI, Baudet J, Guerin J, Casoli V, Pan WR, Houseman ND (2003) Angiosomes of the brachial plexus: an anatomical study. Plast Reconstr Surg 112:1799–1806. https://doi.org/10.1097/01.PRS.0000091162.25751.6B

    Article  PubMed  Google Scholar 

  13. Li MXL, He Q, Hu ZL, Chen SH, Lv YC, Liu ZH, Wen Y, Peng TH (2015) Applied anatomical study of the vascularized ulnar nerve and its blood supply for cubital tunnel syndrome at the elbow region. Neural Regener Res 10:141–145. https://doi.org/10.4103/1673-5374.150723

    Article  Google Scholar 

  14. Nonthasaen P, Nasu H, Kagawa E, Akita K (2017) A morphological comparison of the extraforaminal ligament between the cervical and thoracic regions. Surg Radiol Anat. https://doi.org/10.1007/s00276-017-1963-3

    Article  PubMed  Google Scholar 

  15. Peng TH, Ding HM, Chen SH, Tang ML, Hong L, Tan JG, Wang AP, Xu DC (2009) Demonstration of three injection methods for the analysis of extrinsic and intrinsic blood supply of the peripheral nerve. Surg Radiol Anat 31:567–571. https://doi.org/10.1007/s00276-009-0480-4

    Article  PubMed  Google Scholar 

  16. Pet MA, Ray WZ, Yee A, Mackinnon SE (2011) Nerve transfer to the triceps after brachial plexus injury: report of four cases. J Hand Surg 36:398–405. https://doi.org/10.1016/j.jhsa.2010.11.024

    Article  Google Scholar 

  17. Pet MA, Lipira AB, Ko JH (2016) Nerve transfers for the restoration of wrist, finger, and thumb extension after high radial nerve injury. Hand Clin 32:191–207. https://doi.org/10.1016/j.hcl.2015.12.007

    Article  PubMed  Google Scholar 

  18. Shin AY, Spinner RJ (2005) Clinically relevant surgical anatomy and exposures of the brachial plexus. Hand Clin 21:1–11. https://doi.org/10.1016/j.hcl.2004.09.006

    Article  PubMed  Google Scholar 

  19. Soldado F, Ghizoni MF, Bertelli J (2016) Thoracodorsal nerve transfer for triceps reinnervation in partial brachial plexus injuries. Microsurgery 36:191–197. https://doi.org/10.1002/micr.22386

    Article  PubMed  Google Scholar 

  20. Tang M, Gorbutt KA, Peethambaran A, Yang L, Nelson VS, Chang KW (2016) High prevalence of cranial asymmetry exists in infants with neonatal brachial plexus palsy. J Pediatr Rehabil Med 9:271–277. https://doi.org/10.3233/PRM-160396

    Article  PubMed  Google Scholar 

  21. Venieratos D, Anagnostopoulou S (1998) Classification of communications between the musculocutaneous and median nerves. Clin Anat 11:327–331. https://doi.org/10.1002/(SICI)1098-2353(1998)11:5<327::AID-CA6>3.0.CO;2-M

    Article  PubMed  CAS  Google Scholar 

  22. Woźniak J, Kędzia A, Dudek K (2013) Variability of the trunks and divisions of the brachial plexus in human fetuses. Adv Clin Exp Med 22:309–318

    PubMed  Google Scholar 

  23. Yang LJ, Chang KW, Chung KC (2012) A systematic review of nerve transfer and nerve repair for the treatment of adult upper brachial plexus injury. Neurosurgery 71:417–429. https://doi.org/10.1227/NEU.0b013e318257be98

    Article  PubMed  Google Scholar 

  24. Yang J, Li X, Hou Y, Yang Y, Qin B, Fu G, Qi J, Zhu Q, Liu X, Gu L (2015) Development of a novel experimental rat model for brachial plexus avulsion injury. Neuroreport 26:501–509. https://doi.org/10.1097/WNR.0000000000000378

    Article  PubMed  Google Scholar 

  25. Zhong LY, Wang AP, Hong L, Chen SH, Wang XQ, Lv YC, Peng TH (2016) Microanatomy of the brachial plexus roots and its clinical significance. Surg Radiol Anat 39:601–610. https://doi.org/10.1007/s00276-016-1784-9

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This project was financed by the National Natural Science Foundation of China (Grant No. 81770460 to Yun-cheng Lv, Grant No. 81600040 to Ai-ping Wang), the startup funds for Ph.D.s in the University of South China (Grant No. 2014XQD37), Zhengxiang scholar program (Prof. Xiangyang Tang) of the University of South China, the construct program of the key discipline in Hunan Province, Key Lab for Clinical Anatomy & Reproductive Medicine of Hengyang city (Grant No. 2017KJ182).

Author information

Authors and Affiliations

  1. Clinical Anatomy & Reproductive Medicine Application Institute, School of Medicine, University of South China, Hengyang, 421001, China

    An-bo Gao, Yun-cheng Lv, Ai-ping Wang, Li-yuan Zhong & Tian-hong Peng

  2. Dr. Paul Brand Centre for Hand Surgery and Peripheral Nerve Surgery, Christian Medical College Hospital, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India

    Binu-prathap Thomas

  3. Department of Anatomy, Wenzhou Medical University, Wenzhou, 325035, China

    Mao-lin Tang

Authors
  1. An-bo Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yun-cheng Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ai-ping Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Li-yuan Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mao-lin Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Binu-prathap Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tian-hong Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ABG: data collection; data analysis; manuscript writing and editing. YCL: protocol development; data analysis; manuscript editing. APW: data analysis. LYZ: data analysis; manuscript editing. MLT: protocol development; data collection; data analysis; manuscript editing. BPT: data analysis; manuscript editing. THP: protocol development; data analysis; data collection; manuscript editing.

Corresponding authors

Correspondence to Binu-prathap Thomas or Tian-hong Peng.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

Written consent approval of the School of Medicine in the University of South China was obtained for all procedures performed in this study involving human participants. This study was in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gao, Ab., Lv, Yc., Wang, Ap. et al. The zonal pattern of arterial supply to the brachial plexus and its clinical significance. Surg Radiol Anat 40, 815–822 (2018). https://doi.org/10.1007/s00276-018-2024-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-018-2024-2

Keywords

Search

Navigation