Winged scapula following axillary thoracotomy with long thoracic nerve preservation

Isono, Tomomi; Mori, Satoshi; Kusumoto, Hidenori; Shiono, Hiroshi

doi:10.1136/bcr-2019-232970

Cited by 3 publications

(5 citation statements)

References 13 publications

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“…Few studies have evaluated the incidence of postsurgical articular problems in patients undergoing thoracic surgery; however, the investigators did not assess the scapula. 16,[32][33][34][35][36] In the study of Miranda et al, 33 a marked reduction in shoulder ROM and disability after surgery was present in a short-term evaluation. Rodríguez-Torres et al 32 presented a more extended follow-up with a less incisive reduction in ROM and assessed muscular trigger points after VATS.…”

Section: Discussionmentioning

confidence: 93%

“…The bibliographic literature search found few studies mentioning predictive factors or follow-up to clarify WS's incidence, risk factors, or prognosis after oncological thoracic surgery. 15,16,18 Moreover, we collected incidence data in neurological injury in robotic-assisted surgery, a new technique with few studies on postsurgical sequelae. 9 With a small amount of data available in the literature on thoracic surgery patients, our results are comparable only with previous studies in different populations, in which an incidence is reported of around 27% in breast cancer patients.…”

Section: Discussionmentioning

confidence: 99%

“…Neurological and motor impairments have been reported following different surgical approaches, [10][11][12][13][14] but evidence of this in thoracic surgery is scarce and not up to date with the current new technologies. [15][16][17] One deficit that may arise is the long thoracic nerve palsy presenting as a winged scapula (WS). This postsurgical sequela causes a posterior dislocation of the medial and inferior border of the scapula and could reduce the arm's range of motion (ROM) and significantly impact daily activities.…”

Section: Introductionmentioning

confidence: 99%

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The Incidence of Winged Scapula after Thoracic Cancer Surgery: A Prospective Cohort Study

Teixeira,

Sandrin,

da Silva

et al. 2024

Thorac Cardiovasc Surg

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Background Lung cancer is the leading cause of cancer-related deaths, and surgery is still the first treatment of choice in early and locally advanced cases. One of the iatrogenic complications is the serratus anterior palsy, which could lead to a winged scapula (WS). Unfortunately, the incidence of this deficit in thoracic surgery is unclear. Our primary aim was to determine the incidence of WS in lung cancer patients in a single-center experience. Methods We conducted a retrospective analysis of prospectively collected data with patients eligible for oncological thoracic surgery from March 2013 until January 2014. A physical evaluation of the WS was performed pre- and postoperatively, at the discharge and after 1 year of follow-up. Results A total of 485 patients were evaluated; 135 (27.8%) showed WS. Longer operative time (p < 0.0001), type of surgery (p < 0.0001), lymphadenectomy (p < 0.0001), and neoadjuvant treatment prior surgery (p = 0.0005) were significantly related to the WS injury. Multivariable analysis showed that type of surgery was significantly associated with WS (p < 0.0001). After 1 year, 41.6% still had WS. Conclusion The incidence of WS was similar to the literature. As WS incidence is underdiagnosed, assessment and correct education about possible deficits or impairments should be improved. Moreover, when a minimally invasive approach is not planned, it is a good clinical practice to discuss surgical strategies with surgeons to reduce this deficit.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Incidence of Winged Scapula after Thoracic Cancer Surgery: A Prospective Cohort Study

Teixeira,

Sandrin,

da Silva

et al. 2024

Thorac Cardiovasc Surg

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“…The majority of LTN dysfunction occurs as a result of closed trauma or following neuralgic amyotrophy as described by Parsonage and Turner (Kauppila & Vastamäki, 1996; Bizzarri et al, 2001; Isono et al, 2020). Despite advances in anatomical understanding, and the subsequent development of nerve‐sparing approaches and safe windows, there still remains a relatively high rate of iatrogenic injury to the LTN following shoulder, breast, and cardiothoracic surgery.…”

Section: Discussionmentioning

confidence: 99%

Variation of surgical anatomy of the thoracic portion of the long thoracic nerve

Ormsby

Hawkes

2021

Clinical Anatomy

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Decompression of the long thoracic nerve (LTN) is a potentially beneficial procedure for selected patients with LTN palsy. The aim of this work is to describe the surgical anatomy of the thoracic part of the LTN and highlight its variations. A retrospective review of patients undergoing exploration of the LTN was performed. Preoperatively, all patients had serratus anterior dysfunction and underwent electromyographic (EMG) assessment. All patients had an initial trial of nonoperative management. The surgical procedures were undertaken by the senior author. The anatomy of the LTN and the associated vasculature was recorded in patient records, and with digital photography. Forty‐five patients underwent LTN exploration. Two patients with iatrogenic injury were excluded, leaving 43 patients for analysis. Mean age was 36 years. Sixty‐seven percent of cases involved the dominant side. Trauma was the commonest cause, followed by neuralgic amyotrophy. Four patients had typical features of serratus anterior dysfunction but with normal EMG studies. Two distinct patterns of LTN anatomy were noted. In 79% of cases, a single major nerve trunk coursing along serratus anterior was observed and classified as a type I LTN. In 21% of cases, two equal major branches of the nerve were identified, which was classified as a type II LTN. Approximately one in five patients may have two major branches of the LTN. This is of clinical relevance to those who undertake any thoracic procedures, as well as those who are considering exploration of the LTN.

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“…In patients with bronchopleural fistula (BPF) due to complications of suppurative pleuropulmonary disease, along with medical treatments, surgical closure, including muscle flap, is performed to provide fistula coverage[ 6 ]. Axillary thoracotomy has a lower risk for muscle or nerve injury than the original thoracotomy, although there has been a case of injury to the intercostobrachial nerve or long thoracic nerve at the incision site or a very rare case of BP injury[ 7 , 8 ]. We report a patient who simultaneously suffered from BP injury, whole-division level, suprascapular nerve, and long thoracic nerve injury immediately following BPF closure surgery under general anesthesia in thoracic surgery.…”

Section: Introductionmentioning

confidence: 99%

Recovery of brachial plexus injury after bronchopleural fistula closure surgery based on electrodiagnostic study: A case report and review of literature

Go¹,

Kim²,

Kim³

et al. 2022

World J Clin Cases

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BACKGROUND Axillary thoracotomy and muscle flap are muscle- and nerve-sparing methods among the surgical approaches to bronchopleural fistula (BPF). However, in patients who are vulnerable to a nerve compression injury, nerve injury may occur. In this report, we present a unique case in which the brachial plexus (division level), suprascapular, and long thoracic nerve injury occurred after BPF closure surgery in a patient with ankylosing spondylitis and concomitant multiple joint contractures. CASE SUMMARY A 52-year-old man with a history of ankylosing spondylitis with shoulder joint contractures presented with right arm weakness and sensory impairment immediately after axillary thoracotomy and latissimus dorsi muscle flap surgery for BPF closure. During the surgery, the patient was positioned in a lateral decubitus position with the right arm hyper-abducted for approximately 6 h. Magnetic resonance imaging and ultrasound revealed subclavius muscle injury or myositis with brachial plexus (BP) compression and related neuropathy. An electrodiagnostic study confirmed the presence of BP injury involving the whole-division level, long thoracic, and suprascapular nerve injuries. He was treated with medication, physical therapy, and ultrasound-guided injections. Ultrasound-guided steroid injection at the BP, hydrodissection with 5% dextrose water at the BP and suprascapular nerve, and intra-articular steroid and hyaluronidase injection at the glenohumeral joint were performed. On postoperative day 194, the pain and arm weakness were resolved, and a follow-up electrodiagnostic study showed marked improvement. CONCLUSION Clinicians should consider the possibilities of multiple nerve injuries in patients with joint contracture, and treat each specific therapeutic target.

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Winged scapula following axillary thoracotomy with long thoracic nerve preservation

Cited by 3 publications

References 13 publications

The Incidence of Winged Scapula after Thoracic Cancer Surgery: A Prospective Cohort Study

The Incidence of Winged Scapula after Thoracic Cancer Surgery: A Prospective Cohort Study

Variation of surgical anatomy of the thoracic portion of the long thoracic nerve

Recovery of brachial plexus injury after bronchopleural fistula closure surgery based on electrodiagnostic study: A case report and review of literature

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