Protecting the brachial plexus during median sternotomy

Sternal force distribution during median sternotomy retraction

“…General suggested methods to minimize rib fractures and brachial plexus injuries are a reduced retraction distance and traction adapted to the patient size and different patient positioning. 3,12,26,29 Further literature 28,[30][31][32] and our results of the SSR measurements suggest a positioning of the SSR blades in a more caudal position, if surgically possible. That would reduce the forces on the cranial thoracic structures with smaller rib curvatures and minimize fractures at the manubrium or the first ribs.…”

Pain Symptoms Accompanying Chronic Poststernotomy Pain: A Pilot Study

“…Interestingly, these other symptoms are as commonly reported as sternal tenderness [4,5]. Postoperative pain of the neck, shoulders, and back is considered a separate postsurgical complication and have been attributed to either injury of the brachial plexus due to first rib fracture, positioning of the patient during surgery, sternal retraction, or cannulation of the internal jugular vein, although the reports regarding this have been very contradictory [8–13].…”

Prognosis of intraoperative brachial plexus injury: a review of 22 cases

“…Of the remaining 17 patients, 14 recovered within 6 months and three had residual injury. Presumably our method of data collection would have missed 94% (if not all) of the cases of Tomlinson and colleagues 13 and 32% of Parks' cases. 6 It is therefore impossible to judge what fraction of all cases of PBP actually went on to referral to the hand clinic.…”

“…It has been reported that most cases of PBP after sternotomy are already asymptomatic at the time of hospital discharge. 13 Parks 6 reported 25 cases of PBP of whom eight suffered mild injury and recovered in an average time of 9 days. Of the remaining 17 patients, 14 recovered within 6 months and three had residual injury.…”