Journal of plastic, reconstructive & aesthetic surgery : JPRAS · 2019
Exploration of the axillary nerve through an open posterior endoscopic-assisted (OPEA) approach: First clinical experience.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Maldonado Andrés A, Spinner Robert J, Frank Johannes, Sauerbier Michael
Аннотация
INTRODUCTION: Previous studies have described a segment of the axillary nerve (AN) that cannot be surgically explored through the deltopectoral and posterior surgical open approaches (blind zone). We present the first two cases using an endoscopic-assisted approach to explore the AN through a posterior approach.
MATERIAL AND METHODS: Two patients were evaluated, in whom clinical, electrodiagnostic testing, and MRI could not localize the level of the AN dysfunction. An open posterior endoscopic-assisted (OPEA) approach was performed 4 and 9 months after injury in an attempt to visualize all segments of the AN. Photographs and videos were taken to evaluate the intraoperative visualization of the AN and provide long-term clinical follow-up.
RESULTS: Almost the entire AN was visualized with the scope through the OPEA approach, avoiding the deltopectoral approach. No AN lesion was found during the nerve exploration. A triceps branch to AN transfer, using the previous posterior approach, was performed. Patients in both groups achieved a deltoid muscle function of BMRC grade 4 after 24 and 9 months, respectively.
CONCLUSION: The exploration of the AN through the OPEA approach was a useful strategy to visualize the blind zone of the AN without requiring the addition of a deltopectoral approach. We believe this novel technique has a role in selected cases of AN injury.
MATERIAL AND METHODS: Two patients were evaluated, in whom clinical, electrodiagnostic testing, and MRI could not localize the level of the AN dysfunction. An open posterior endoscopic-assisted (OPEA) approach was performed 4 and 9 months after injury in an attempt to visualize all segments of the AN. Photographs and videos were taken to evaluate the intraoperative visualization of the AN and provide long-term clinical follow-up.
RESULTS: Almost the entire AN was visualized with the scope through the OPEA approach, avoiding the deltopectoral approach. No AN lesion was found during the nerve exploration. A triceps branch to AN transfer, using the previous posterior approach, was performed. Patients in both groups achieved a deltoid muscle function of BMRC grade 4 after 24 and 9 months, respectively.
CONCLUSION: The exploration of the AN through the OPEA approach was a useful strategy to visualize the blind zone of the AN without requiring the addition of a deltopectoral approach. We believe this novel technique has a role in selected cases of AN injury.