Restoring the Severed Breast and Chest following Seat Belt Trauma

Abstract

Summary: In this article, we presented 2 cases of rare clinical presentation of 3-point lap-diagonal seat belt injuries and provided a brief overview of the spectrum of the associated deformity and morbidity. Both of our patients presented in a delayed fashion during the subacute period at 12 and 4 months, respectively, following their traumatic seat belt injuries, which improved with surgical intervention. Ideally, these injuries should be repaired during the subacute period once any life-threatening injuries have been addressed, because seat belt–restraint injuries may otherwise lead to chronic pain, functional loss, and physical deformity.

Surgical Management of Pectoralis Major Tears of the Sternal Origin Because of Seat Belt Trauma

“…Specific reports of pectoralis major injury from seat belts are rare and have been treated with both observation and delayed surgical repair [5][6][7] . Gautschi et al reported on the conservative management of a seat belt-related pectoralis major injury with return of 4/5 strength on manual muscle testing 7 .…”

“…Harvey et al describe mesh reconstruction of an intramuscular rupture of the pectoralis major from a seat belt injury with good return of strength and function at 3 years 5 . Noel et al describe surgical repair the pectoralis muscle belly 4 months after a seat belt injury with primary side-to-side repair with an improvement in pain scores but residual restricted abduction of the arm 6 .…”

“…ectoralis major tendon ruptures are associated with injuries involving sports, motor vehicle accidents (MVAs), and the workplace. Typically, these ruptures occur at the tendon attachment to the humerus or at the musculotendinous junction just proximal to the humeral insertion, although midsubstance ruptures have also been reported [1][2][3][4][5][6][7][8][9] . Tears of the pectoralis major muscle at its sternal origin, however, are exceedingly rare, but have been associated with seat belt injuries in MVAs [5][6][7] .…”

“…Typically, these ruptures occur at the tendon attachment to the humerus or at the musculotendinous junction just proximal to the humeral insertion, although midsubstance ruptures have also been reported [1][2][3][4][5][6][7][8][9] . Tears of the pectoralis major muscle at its sternal origin, however, are exceedingly rare, but have been associated with seat belt injuries in MVAs [5][6][7] . We are aware of only 1 case reported in the orthopaedic literature that was managed operatively 1 .…”

Breast Reconstruction after Blunt Breast Trauma: Systematic Review and Case Report Using the Ribeiro Technique

“…Scevola A., et al [9] applied conventional breast reduction techniques and a posterior glandular flap in gland reshaping and lipofilling to fill in substance loss and improve breast contour. Noel O., et al [11], designed a modified inferior dermoglandular pedicle to correct the defect and standard reduction in the contralateral breast. However, they do not describe the surgical technique used.…”