Exploration of the axillary nerve through an open posterior endoscopic-assisted (OPEA) approach: First clinical experience. Issue 2 (February 2020)

• Record Type: Journal Article
• Authors: Maldonado, Andrés A.; Spinner, Robert J.; Frank, Johannes; Sauerbier, Michael
• Is Part Of: Journal of plastic, reconstructive & aesthetic surgery. Volume 73:Issue 2(2020)
• Page Start: 209
• Page End: 213
• Publication Date: 2020-02
• Subjects: Axillary nerve -- Axillary nerve exploration -- Blind zone -- Open posterior endoscopic-assisted approach -- Arthroscopy; Surgery, Plastic -- Great Britain -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Surgery, Plastic -- Great Britain -- Periodicals; 617.9505
• DOI: 10.1016/j.bjps.2019.07.026
• Languages: English
• ISSNs: 1748-6815

Abstract

Abstract: Introduction: Previous studies have described a segment of the axillary nerve (AN) that cannot be surgically explored through the deltopectoral and posterior surgical open approaches (blind zone). We present the first two cases using an endoscopic-assisted approach to explore the AN through a posterior approach. Material and methods : Two patients were evaluated, in whom clinical, electrodiagnostic testing, and MRI could not localize the level of the AN dysfunction. An open posterior endoscopic-assisted (OPEA) approach was performed 4 and 9 months after injury in an attempt to visualize all segments of the AN. Photographs and videos were taken to evaluate the intraoperative visualization of the AN and provide long-term clinical follow-up. Results: Almost the entire AN was visualized with the scope through the OPEA approach, avoiding the deltopectoral approach. No AN lesion was found during the nerve exploration. A triceps branch to AN transfer, using the previous posterior approach, was performed. Patients in both groups achieved a deltoid muscle function of BMRC grade 4 after 24 and 9 months, respectively. Conclusion: The exploration of the AN through the OPEA approach was a useful strategy to visualize the blind zone of the AN without requiring the addition of a deltopectoral approach. We believe this novel technique has a role in selected cases of AN injury.