Exposing Brachial Plexus: A Surgical Technique to Visualize Brachial Plexus in Neonatal Piglet

The brachial plexus is a network of nerves present around the neck and the shoulder region that supplies the upper limbs. The plexus roots originate above the fifth to seventh cervical vertebrae and the first thoracic vertebra. These roots unite to form the superior, middle, and inferior trunks.

Each of these trunks diverges into anterior and posterior divisions. These divisions proceed towards the axillary region or the armpit, where they recombine to form three cords: the posterior, lateral, and medial cords. The cords travel laterally toward the arm, finally terminating in the nerve branches, namely the musculocutaneous, axillary, radial, median, and ulnar nerves.

To expose the brachial plexus, begin by taking an anesthetized neonatal piglet with the forelimb stretched to expose the axilla. Make a midline incision from the sternum towards the tracheal opening. Extend the top part of this cut towards the forelimb at the level of the third cervical vertebra.

At the base of the midline incision, cut the skin at the third thoracic vertebra level and extend it towards the forelimb. Remove the superficial skin and muscle layers to locate the lower three cervical and first thoracic vertebrae and identify the brachial plexus. Examine the intactness of the exposed brachial plexus before further testing.