Split Pectoralis Major Transfer for Chronic Medial Scapular Winging

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Sports Medicine

Background:

• Scapular winging, often caused by long thoracic nerve injury leading to serratus anterior palsy, results in shoulder pain, weakness, and disability.
• Conservative treatments for persistent scapular winging are often insufficient, necessitating surgical intervention.
• Existing surgical options like scapulothoracic fusion have high complication rates and limited functional gains.

Purpose of the Study:

• To describe a novel surgical technique for chronic medial scapular winging: indirect, split pectoralis major transfer with allograft augmentation.
• To highlight the advantages of this technique over traditional treatments for scapular winging.
• To provide a detailed technical description and rationale for the presented procedure.

Main Methods:

• Description of an indirect, split pectoralis major transfer technique.
• Augmentation of the tendon transfer using allograft tissue.
• Focus on secure, tension-free transfer to the inferolateral scapula for dynamic stabilization.

Main Results:

• The described technique provides dynamic stabilization of the scapula.
• It offers a secure and tension-free tendon transfer.
• Potential advantages include a relatively low complication rate, acceptable cosmesis, and improved range of motion compared to alternatives.

Conclusions:

• Indirect, split pectoralis major transfer with allograft augmentation is a viable surgical option for chronic medial scapular winging.
• This method demonstrates potential for better functional outcomes and fewer complications than scapulothoracic fusion.
• Further clinical studies are needed to compare direct versus indirect split transfer techniques.