AXILLARY WEB SYNDROME: NATURE AND LOCALIZATION

Abstract

Axillary Web Syndrome (AWS) is acomplication that can arise in patientsfollowing treatment for breast cancer. It isalso known variously as syndrome of theaxillary cords, syndrome of the axillaryadhesion, and cording lymphedema. The exactorigin, presentation, course, and treatment ofAWS is still largely undefined. Because solittle is known about AWS, we undertook acase series study consisting of 15 women whohad undergone breast cancer surgery andpresented with AWS. All subjects received aclinical examination which included body sizedetermination and detailed measurements ofthe size and location of the cords. The cordswere found to originate from the axilla,continue on the medial aspect of the arm upto the epitrochlea region, then to the anteromedianaspect of the forearm, and finallyreaching the base of the thumb. The cordsaveraged approximately 44% of the limblength. Correlation of the cord location withanatomical studies shows that in fact thispath follows the specific course taken by theantero-radial pedicle which arises at theanterior aspect of the elbow from the brachialmedial pedicule to anastomose in the axilla atthe level of the lateral thoracic chain nodes.Although our series is small, the correspondencebetween the physical findings and theanatomical studies strongly supports thenotion that the cords are lymphatic in origin.