Trapezius sparing minimally aggressive surgical technique for sprengel deformity: A case report

Sprengel deformity is a rare congenital anomaly of the pectoral girdle of unknown incidence. Surgical intervention is indicated in moderate to severe cases having functional and cosmetic impairment. Various surgical corrective procedures have evolved over the past decades, however the extensive magnitude of some of the surgical techniques have sometimes resulted in an unwarranted worse outcome due to associated complications like brachial plexus palsy, scapular winging, sternoclavicular joint prominence, improper scar healing and keloid formation which restrict such procedures to experienced hands at few centres. We report a case of Cavendish grade 3 Sprengel deformity in a five-year-old boy managed with a minimally aggressive modified technique of preserving the trapezius and restricting the surgery to excision of omovertebral bar and supraspinatous part of scapula by a transverse incision overlying the spine of scapula. In Sprengel deformity, the trapezius attached to the elevated scapula is underdeveloped and the technique of retraction instead of detachment of this muscle during surgery, can prevent scar adhesions and improve wound healing. In our patient, satisfactory cosmetic correction and good functional shoulder movements were achieved with minimal intervention.