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

Abstract

Brachial plexus injury is a rare complication during operation and anesthesia; it can occur as a result of various mechanisms such as inappropriate positioning, over-abduction and stretching the upper limbs. Brachial plexus injury can cause the poor function of the upper limb before recovery, and sometimes serious injury is unable to completely recovered the function permanently. Here, we report a female breast cancer patient who sustained a left brachial plexus palsy after modified radical mastectomy with immediate breast reconstruction with latissimusdorsi flap (LDF). The patient had fully recovered with normal function of her left upper limb six months postoperation after conservative treatment.

Characteristics of Patient with Brachial Plexus Injury in Neurophysiology Laboratory of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from 2003 to 2012

“…Actually, injuries to the brachial plexus during mastectomy and axillary dissection are rare. 17 The cause of BPI during mastectomy are direct surgical injuries to the brachial plexus, over-traction during axillary exploration, or over manipulation of the upper extremity in order to improve exposure. 18 This study has some limitations.…”

Brachial Plexus Injury in Abdominal and Breast Surgery

“…The famous British neuroscientist Victor Horseley described the compression and stretching mechanism after Budinger identified the brachial plexus injury in the breast surgery as a surgical complication in 1894 and attributed it to the toxic effect of chloroform [13,18]. According to this, during the operation, the nerve is first made sensitive to damage by the surgeon with the superficial position.…”

“…Then the nerve roots, the proximal part, the muscles, the faeces and the part to which the distal is connected are fixed, so that the force exerted by the surgeon will damage the nerve. Finally, Due to the narrow space between the clavicle and 1st costa, the pressure applied here can damage the nerve [13,19].…”

“…Especially abduction and limitation of flexion in the upper extremity and sensory loss in this dermatome area should be investigated [22]. Besides, electromyography [EMG] and Axon reflex tests may be helpful in diagnosis [13,22]. At the same time, EMG can give an idea of whether the injury is acute or chronic [23].…”

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There are recent studies reporting that the brachial plexus, rarely known to be iatrogenically injured due to stress and position at the time of surgery in breast and axilla surgeons, is up to 9% [13,14]. Although the mechanism is not fully explained, it is believed that the position at the time of surgery contributes to the Mini Review

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