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Postmastectomy brachial plexus injury exacerbated by tissue expansion
1Division of Plastic and Reconstructive Surgery, University of Minnesota Medical School, Minneapolis, MN 55455.
Annals of Plastic Surgery
|October 1, 1991
Summary
Brachial plexus neurapraxia after mastectomy tissue expansion resolved upon deflation. This suggests nerve compression from the expander, potentially exacerbated by prior injury.
Area of Science:
- Plastic surgery
- Neurology
- Oncology
Background:
- Modified radical mastectomy and immediate tissue expander placement are common breast reconstruction procedures.
- Brachial plexus injuries can occur, impacting arm and hand function.
- Tissue expanders are used to gradually create space for implants.
Observation:
- A patient developed neurapraxia of the brachial plexus following mastectomy and tissue expander placement.
- Neurological symptoms initially improved but suddenly worsened after the fourth expansion.
- Symptoms primarily affected the median nerve distribution.
Findings:
- Deflating the tissue expander from 18 mm Hg to 8 mm Hg relieved acute neurological symptoms.
- The nerve injury mechanism is hypothesized to be compressive, possibly a double-crush phenomenon.
- Anatomical proximity of the expander, pectoralis minor tendon, and neurovascular structures is noted.
Implications:
- Careful monitoring of tissue expander pressure is crucial in patients with a history of nerve injury.
- Understanding the biomechanics of tissue expanders is important for preventing neurological complications.
- This case highlights a potential risk of compressive neuropathy in breast reconstruction patients.