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Iatrogenic compression of the thoracic outlet
Insights
Surgical procedures in the thoracic outlet can cause arterial injury and brachial plexus compression. Re-establishing the costo-clavicular space is key to correcting these iatrogenic injuries.
Area of Science:
- Orthopedic Surgery
- Neuroscience
- Anatomy
Background:
- Surgical interventions in the thoracic outlet region carry risks of neurovascular complications.
- Iatrogenic injuries, including arterial damage and brachial plexus compression, have been documented.
- These injuries can arise from procedures altering the costo-clavicular space.
Observation:
- An initial report detailed iatrogenic injury during scapular lowering for Sprengel's deformity correction in a child.
- Neurovascular bundle compression occurred between the clavicle and first rib during this surgical migration.
- Two adult cases of iatrogenic brachial plexus injury are presented following clavicle area operations.
Findings:
- The developmental anatomy of the costo-clavicular area and upper limb descent is reviewed.
- Alterations in the clavicle-first rib relationship can occur in adults due to surgery.
- Correction of iatrogenic brachial plexus injuries was achieved by restoring the costo-clavicular space.
Implications:
- Understanding thoracic outlet anatomy is crucial for preventing surgical complications.
- Awareness of potential neurovascular compression is vital for surgeons operating in the clavicle and shoulder region.
- Restoring anatomical relationships, specifically the costo-clavicular space, can effectively manage iatrogenic brachial plexus injuries.
Abstract:
Arterial injury and brachial plexus nerve compression have been reported in association with surgical procedures in the area of the thoracic outlet. An initial report of iatrogenic injury was related to the operative correction of Sprengel's deformity, which required lowering of the scapula in a child. Compression of the neurovascular bundle between the clavicle and the first rib occurred during this surgical migration. The developmental anatomy of the costo-clavicular area and the descent of the upper limb from its initial cervical position are reviewed. This relationship between the clavicle and the first rib may also be altered by surgical procedures carried out on adults. Two cases of the iatrogenic injury to the brachial plexus are reported in association with operations performed in the area of the clavicle. Correction of these injuries resulted when the costoclavicular space was re-established.