The Effectiveness of the Extended Surgical Approach to Visualize the Axillary Nerve in the Blind Zone in an Arthroscopic Axillary Nerve Injury Model

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2016-12, Vol.69 (12), p.1697-1703
• Main Authors: Maldonado, Andrés A., M.D. Ph.D, Spinner, Robert J., M.D, Bishop, Allen T., M.D, Shin, Alexander Y., M.D, Elhassan, Bassem T., M.D
• Format: Article
• Language: English
• Subjects: Adult; Arthroscopy - methods; Axilla - innervation; Axilla - surgery; Axillary nerve; Axillary nerve exploration; Axillary nerve injury classification; Axillary nerve injury model; Blind zone; Brachial Plexus - pathology; Brachial Plexus - surgery; Extended approach; Humans; Models, Anatomic; Peripheral Nerve Injuries - classification; Peripheral Nerve Injuries - surgery; Plastic Surgery; Reconstructive Surgical Procedures - methods
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2016.09.016

Abstract Introduction The aims of this study are to perform a model of axillary nerve (AN) injury during an arthroscopic capsular plication to analyze the site for potential nerve injury; and to determine the AN length that can be seen through standard and extended anterior, axillary and posterior approaches. Material and Methods Six arthroscopic inferior capsular plications were performed in 3 human adult frozen cadavers. A non-absorbable suture is used to plicate the inferior capsule aiming at capturing the AN (at a location closest to the joint capsule). Then, we attempted to explore the AN through 3 different surgical approaches (each approach was performed in 2 shoulders): a standard and extended anterior, axillary and posterior approaches. Surgical clips were used to mark the AN length that was visualized through each approach. Results The AN injury was located in a range from 5.4 cm to 7.8 cm from its origin from the posterior cord. This location corresponds with the previously described AN injury zone B (blind) and zone C (circumflex). Compared to the standard approaches, the extended anterior, axillary and posterior approaches improved the visualization of the AN by 3.6 cm, 1.5 cm and 2.8 cm respectively. None of these approaches independently was sufficient to expose the entire course of the AN. Conclusions The blind zone is a potential location for AN injury after inferior capsular plication. Based on this study, a combination of a standard and an extended surgical approaches may lead to better exposure of most the AN length.