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AXILLA
It is a fat filled 
pyramidal space
between the lateral
thoracic wall and the
upper arm.
Nerves, blood vessels
and lymphatics pass
from the root of the
neck to the axilla
through the cervicoaxillary canal.

BOUNDARIES
The axilla has : 
1. Apex : it is bounded
by:
In front : clavicle. 
Behind : upper border
of the scapula.
Medially : outer 
border of the first rib.


BOUNDARIES
2. Base (lower end) 
It is formed by the 
hairy axillary skin.
Its boundaries are: 
In front : anterior 
axillary fold.
Behind : posterior 
axillary fold.
Medially: chest wall. 
WALLS
The axilla has the 
following walls :
Anterior. 
Posterior. 
Medial. 
Lateral. 
The base is stretched 
between the anterior and
posterior walls.
ANTERIOR WALL
Is formed by : 
1. Pectoralis 
major.
2. Pectoralis 
minor.
3. Subclavius & 
Clavipectoral 
fascia.
POSTERIOR WALL
Formed by : 
1. Subscapularis.
2. Latissmus 
dorsi.
3. Teres major. 

MEDIAL WALL
It is formed by : 
1. Upper (4) ribs. 
2. Intercostal 
muscles.
3. Serratus 
anterior.
SERRATUS ANTERIOR
Origin : 
Outer surface of
the upper (1-8)
ribs.
Insertion : 
Medial border of
the scapula
(especially the
inferior angle).


SERRATUS ANTERIOR
Nerve supply : 
Long thoracic nerve. 
Action : 
1. Holds the scapula 
against the thoracic wall.
2. protraction of the 
scapula.
3. Rotation of the scapula
(inferior angle).

WINGED SCAPULA
Injury to the long 
thoracic nerve (in radical
mastectomy) causes
paralysis of serratus
anterior.
The medial border and 
inferior angle of the
scapula will no longer be
kept closely applied to
the chest wall.
WINGED SCAPULA
It will protrude 
posteriorly.
The patient has 
difficulty in
raising the arm
above the head
(difficult in
rotation of the
scapula).
LATERAL WALL
It is narrow. 
It is formed by : 
1. Bicipital 
groove of the
humerus.
2. Biceps. 
3. 
Coracobrachialis.
CONTENTS
1. Axillary artery. 
2. Axillary vein. 
3. Cords of brachial
plexus.
4. Axillary lymph 
nodes.
5. Fat. 
6. Axillary sheath. 

AXILLARY ARTERY
Beginning : 
At the outer border of 
the 1st rib as a
continuation of the
subclavian artery.
Termination : 
Lower border of teres 
major by becoming the
brachial artery.
AXILLARY ARTERY
Course : 
It is divided by 
pectoralis minor
into three parts.
RELATIONS
The artery is 
enclosed
throughout its
course with the
brachial plexus and
the axillary vein
with a sheath of
deep fascia
(Axillary sheath).
1ST PART
It extends from the 
beginning of the artery to
the upper border of
pectoralis minor.
Anterior :skin, fascia and 
pectoralis major.
Posterior : long thoracic 
nerve.
1ST PART
Medial : axillary vein. 
Lateral : three cords 
of the brachial
plexus.
2ND PART
It is behind pectoralis 
minor.
Anterior : skin, fascia, 
pectoralis minor and
major.
Posterior : posterior 
cord of the brachial
plexus, subscapularis.
2ND PART
Medial : medial 
cord of the B.P.
and axillary vein.
Lateral :lateral 
cord of the B.P.
3RD PART
It begins at the lower
border of pectoralis
minor and ends at the
lower border of teres
major by becoming
the brachial artery.
Anterior : pectoralis 
major, medial root of
median nerve.

3RD PART
Posterior: 
Muscles: 
subscapularis, teres
major & latissmus
dorsi.
Nerves: axillary and
radial.

3RD PART
Lateral : 
Nerves 
musculocutaneo
us.
lateral root of 
median nerve.
Muscles : biceps
and
coracobrachialis.

3RD PART
Medial :Axillary 
vein.
Nerves :ulnar 
and medial
cutaneous nerve
of the arm.
BRANCHES
First part : 
superior (highest)
thoracic.
Second part : 
A. 
Thoracoacromial.
B. Lateral thoracic.

BRANCHES (3RD PART)
1. Anterior circumflex 
humeral.
2. Posterior circumflex 
both anastomose
around the surgical
neck of the humerus).
3. Subscapular : gives 
circumflex scapular
(share in the
anastomosis around
the scapula)
AXILLARY VEIN
Formation : 
Basilic vein + venae 
comitantes of the
brachial artery.
Beginning : 
Lower border of teres
major.
Course : 
It runs along the medial
side of the axillary
artery.


AXILLARY VEIN
Course : 
It runs along the 
medial side of the
axillary artery.
Trmination : 
At outer border of 
the 1st rib.
It becomes the 
subclavian vein.
AXILLARY LYMPH NODES
They are (6) groups.
They drain : 
1. Lateral quadrants
of the breast.
2. Thoracoabdominal
walls above
umbilicus.
3. Upper limb. 



AXILLARY LYMPH NODES
1. Pectoral (Anterior) 
Lie behind pectoralis 
major, along lower
border of pectoralis
minor.
It receives lymph from: 
1.Lateral quadrants of 
the breast.
2.Abdominal wall 
above umbilicus.

AXILLARY LYMPH NODES
2. Subscapular (Posterior)
Lie in front of 
subscapularis.
Receives lymph of the 
back down to the iliac
crest.
3. Lateral : 
Lie along medial side of 
the axillary vein.
Receives from the upper 
limb except its lateral

AXILLARY LYMPH NODES
4. Central : 
Lie in the axillary fat.
Receives from the 
above three groups.
5.Infraclavicular 
(deltopectoral):
Lie in the groove 
between pectoralis
major and deltoid
(outside axilla).

AXILLARY LYMPH NODES
5.Infraclavicular 
(deltopectoral):
Receives from 
lateral side of:
Arm, forearm and 
hand.
AXILLARY LYMPH NODES
6. Apical : 
Lie at the apex of the
axilla , at the lateral
border of the 1st rib.
It receives efferent 
vessels from all the
other lymph nodes.
They drain into the 
Subclavian lymph
trunk.

DRAINAGE
On right side : 
The trunk drains 
into right lymph
trunk.
On left side : 
It drains into 
thoracic duct.