Bilateral Brachial Plexus Palsy After a Right-Side Modified Radical Mastectomy with Immediate TRAM Flap Reconstruction

Abstract

A 65-year-old women developed bilateral brachial plexus palsy after unilateral modified radical mastectomy with TRAM flap reconstruction. The patient recovered spontaneously. The failure of appropriate intra-operative positioning to prevent the injury is discussed.

A case of bilateral brachial plexus palsy due to shoulder braces

“…Intraoperative brachial plexus palsies have been reported with various combinations of these positioning conditions [2][3][4][5][6]. The initial diagnosis of the loss of BP readings was that of monitor malfunction.…”

“…The ASA Task Force on the Prevention of Perioperative Peripheral Neuropathies indicated, in a practice advisory, that 93% of anesthesiologists surveyed agreed that limiting arm abduction to less than 90°might decrease risk of brachial plexus injury [13]. Case reports of brachial plexus palsy occurring with arm abduction less than 90° [3][4][5][6] and a cadaver study examining the biomechanics of nerve strain [14] suggest that even arm positions less than 90°of abduction still place some patients at risk for brachial plexus palsy.…”

Complications in Breast Surgery

“…For example, pneumothorax can be related to either inadvertent pleural puncture during wire localization or to inadvertently deep dissection within an intercostal space. Also, patients can develop brachial plexopathy related to stretch injury caused by malpositioning in the operating room [1]. The American Society of Anesthesiology recommends upper extremity positioning such that maximal angle at the shoulder is 90 , with neutral forearm position, and use of padded armboards [2].…”

Brachial plexus palsy after a left-side modified radical mastectomy with immediate latissimusdorsi flap reconstruction: report of a case

“…Various mechanisms such as inappropriate position, over-abducting and stretching the upper limb contribute to the occurrence of the injury. But even when reasonable care is taken to make sure patients are positioned in an appropriate position, paralysis of the brachial plexus sometimes occurs during the performance of an elective surgical procedure [3]. We report a female breast cancer patient who developed left brachial plexus palsy after modified radical mastectomy with immediate breast reconstruction with latissimusdorsi flap (LDF).…”