PMID: 12187358

Issn Print: 0148-7043

Publication Date: 2002/08/01


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Bilateral Brachial Plexus Palsy After a Prolonged Surgical Procedure of Reduction Mammaplasty, Abdominoplasty, and Liposuction

Gurler Akinbingol; Huseyin Borman; Tugrul Maral

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Excerpt

Brachial plexus palsy is a very rare complication that occurs when the arms are held in extreme positions throughout a surgery. The potential for brachial plexus palsy arises when the arms are held in hyperabduction, full supination, or pronation for a long period. 1–4 Because the upper extremities are outside the operative field, the surgeon may not observe them closely during the operation. We report a patient who underwent reduction mammaplasty, abdominoplasty, and liposuction during the same session. She developed transient bilateral brachial plexus palsy after this prolonged operation and made a gradual recovery.
The patient was an obese 56-year-old woman who was 1.6 m tall and weighed 145 kg. During the procedure, her arms were positioned and fixed gently at slightly less than 90 deg to the trunk. The operation lasted nearly 6 hours. Immediately after surgery, the patient reported bilateral arm weakness and pain, as well as hand numbness. Physical examination and electrodiagnostic tests revealed bilateral denervation of the brachial plexus. Physical and medical therapy was initiated during the postoperative period. The patient regained normal motor and sensory functions over approximately 5 months.
Bilateral brachial plexus palsy is an extremely rare complication of aesthetic plastic surgery. It is rare to see this condition after any surgical procedure. It seems that the most likely cause of brachial plexus palsy is stretching of the nerves resulting from malpositioning of the arms during surgery. The plexus is under maximum tension when the arm is fully supinated or pronated in abduction. 1,2 In a very obese patient, the actual amount of tension applied may not be anticipated because of the patient’s larger arm circumference. In such cases, high levels of tension may be reached at lesser degrees of abduction.
The aim of this correspondence is to draw attention to the possibility of brachial plexus palsy after plastic surgery. This situation is very distressing, especially when it occurs after an aesthetic operation. The problem can be prevented with continuous attention from both the anesthesiologist and the surgeon. When operating on overweight patients, arm abduction should be reduced during positioning, and it is best to keep the arms at an acute angle to the body during long procedures.
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