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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Pedicled dectopectoral adipofascial flap and lipofilling techniques for management of recurrent thoracic outlet syndrome

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  • Henk Giele - Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
  • presenting/speaker Aliabbas Moosa - Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
  • Roisin Dolan - Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1963

doi: 10.3205/19ifssh0472, urn:nbn:de:0183-19ifssh04721

Published: February 6, 2020

© 2020 Giele et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Thoracic outlet syndrome (TOS) is a symptom complex caused by compression of one or more of three neurovascular structures: the brachial plexus, subclavian vein, or subclavian artery, between the first rib and clavicle. Management of recurrent cases of thoracic outlet syndrome present a challenging clinical conundrum. Various surgical techniques have been described to introduce a 'firebreak' in attempt to reduce recurrence rates.

We report for the first time, the novel technique of a pedicled adipofascial flap +/- adjunctive lipofilling in attempt to reduce further recurrence of TOS, improve functional outcomes and improve scar quality.

Methods: We analysed data from a prospectively maintained database comprising patients presenting consecutively for surgical management of TOS. All cases of recurrent TOS were identified and clinically assessed by the senior author (HG) at the Oxford University Hospitals NHS Trust between April 1997 and November 2017. All patients underwent standard pre-operative investigations to include: 1. clinical history and upper limb examination 2. provocative TOS tests for vascular and neural compression 3. MRI spine and brachial plexus 4. electrophysiological studies.

Patients diagnosed with recurrent TOS underwent brachial plexus re-exploration, neurolysis+/- arteriolysis and pedicled deltopectoral adipofascial flap overlying the clavicle +/- lipofilling.

Results and Conclusions: Recurrent cases of TOS were identified in 22% of our cohort (n=30).

There was a female preponderance in this cohort (75%) and age ranged from 22-75 years (mean: 41 years).

80% of patient reported improved scar quality and 65% reported reduced pain scores following the procedure.

To conclude, we describe the novel technique of pedicled deltopectoral adipofascial flap +/- adjunctive lipofilling for the management of recurrent TOS, with good surgical and functional patient-reported outcomes.