| Iatrogenic thoracic outlet syndrome secondary to vertical expandable prosthetic titanium rib expansion thoracoplasty: pathogenesis and strategies for prevention/treatment. | |
| | |
MedLine Citation:
|
PMID: 19098642 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: An innovative treatment for thoracic insufficiency syndrome involves a vertical expansion of the chest wall through a horizontal chest wall osteotomy maintained by a distraction device (vertical expandable prosthetic titanium rib or VEPTR). Upper-extremity neurovascular dysfunction has been reported after expansion. The purposes of this study are to identify potential etiologies for compression of the brachial plexus after expansion thoracoplasty and to suggest strategies to reduce the incidence of this complication. METHODS: A simulated VEPTR procedure was performed on 8 fresh cadaveric specimens. Manometric measurements were taken in the 3 anatomic regions of the thoracic outlet after thoracotomy and rib distraction were performed. Confirmation of the location of compression was performed by placing barium-impregnated putty along the course of the brachial plexus and evaluating the effect of expansion using video fluoroscopy. A midclavicular osteotomy was then performed and video fluoroscopy repeated. RESULTS: A 20% increase in pressure was seen in the costoclavicular region of the thoracic outlet after expansion. Constriction of the midclavicular region of the thoracic outlet between the first rib and clavicle was confirmed using the putty model. Midclavicular osteotomy alleviated this region of compression. CONCLUSIONS: Expansion thoracoplasty with the VEPTR procedure causes increased pressure in the costoclavicular region of the thoracic outlet. A midclavicular osteotomy may be one method to alleviate thoracic outlet narrowing after VEPTR procedure, although the short- and long-term effects of this is procedure is not known. CLINICAL RELEVANCE: Our model supports an iatrogenic thoracic outlet syndrome caused by expansion thoracoplasty. Based on our data as well as a review of the literature, we recommend intraoperative neurologic monitoring of the ipsilateral upper extremity during the VEPTR procedure. |
| | |
Authors:
|
Ahmad Nassr; Annalise Noelle Larson; Benjamin Crane; Kim W Hammerberg; Peter F Sturm; Steven M Mardjetko |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: Journal of pediatric orthopedics Volume: 29 ISSN: 1539-2570 ISO Abbreviation: J Pediatr Orthop Publication Date: 2009 Jan-Feb |
Date Detail:
|
Created Date: 2008-12-22 Completed Date: 2009-02-23 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 8109053 Medline TA: J Pediatr Orthop Country: United States |
Other Details:
|
Languages: eng Pagination: 31-4 Citation Subset: IM |
Affiliation:
|
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 5905, USA. nassr.ahmad@mayo.edu |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Barium
/
diagnostic use Cadaver Clavicle / surgery Fluoroscopy / methods Humans Manometry / methods Monitoring, Intraoperative / methods* Osteotomy / methods Postoperative Complications / etiology, prevention & control* Pressure Prostheses and Implants / adverse effects Ribs / surgery Thoracic Outlet Syndrome / etiology, pathology, prevention & control* Thoracoplasty / adverse effects* Titanium Upper Extremity / innervation Video Recording |
| Chemical | |
Reg. No./Substance:
|
7440-32-6/Titanium; 7440-39-3/Barium |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Simultaneous ipsilateral avulsion of the anterior superior and anterior inferior iliac spines in an ...
Next Document: Early changes in pulmonary function after vertical expandable prosthetic titanium rib insertion in c...