Naslov
Brachial plexus injury during video-assisted thoracic surgery

Autori
M. Stančić, D. Stančić Rokotov, M. Šarlija, T. Banić, and G. Buljat

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Skup
2nd Croatian Trauma Congress with International Participation

Mjesto i datum
Zagreb, Hrvatska, 03.11.2005. - 05.11.2005

Vrsta sudjelovanja
Poster

Vrsta recenzije
Nije recenziran

Ključne riječi
Ozljede pleksusa brahijalisa
(Brachial plexus injury; video-assisted thoracic surgery)

Sažetak
Objective and importance: Video-assisted thoracic surgery (VATS) is relatively new less invasive surgical technique in trauma/orthopaedic surgeon’ s armament. According to metha analysis that included 12 randomized controlled trials VATS is associated with better outcome with same complication rate as open thoracotomy. However, we report a case in which plexus brachial was lacerated during VATS. Clinical presentation: A 19-year-old girl underwent VATS for the treatment of pneumothorax. Severe bleeding from the dome of pleura necessitated conversion to open procedure. In an attempt to perform hemostasis subclavian artery was occlusion. Postoperatively total sensomotor deficit of left arm was noticed. After 6 months, when patient for the first time visited our Division, brachial plexus exploration was indicated. Intervention: Nerve roots C5 and C6 were neutralized. Intraoperative nerve action potentials through lesion in continuity were positive. Lesion without continuity of nerve roots C7, C8 and T1, and medial and posterior fascicles were shown. Neuromas and gliomas were resected and graft repair with 10 autologous nerve grafts 7-8 cm long harvested from both sural nerves was performed. Carotico-brachial by-pass was done before wound closure. After eight-month follow-up useful motor function of shoulder abduction, elbow flexion and extension, and wrist extension was noticed. Deep pain sensation returns to the hand. Conclusion: This is the first case of brachial plexus injury complicating VATS procedure. Evidence based methodology frequently misses severe complications. Our case can be added to many reported cases that disprove negative perception of nerve repair results based on Woodhall and Seddon's experience from WW II.

Izvorni jezik
Engleski

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