Function of the upper limbs after resection of the chest wall
Introduction. The study of the causes of decreased function of the upper limb (DFUL) after the chest wall resection has been the focus of only a few publications. Resection of the sternoclavicular joint and clavicle is an obvious reason for the DFUL. Other reasons are not so obvious - displacement of the pectoralis major muscle or its resection, intersection or resection of the trapezius or rhomboid muscles, large defect of the chest wall in the area covered with the scapula. The approach to reconstruction of the chest wall, i.e. the ability to prevent or reduce the degree of declined function.Material and methods. In the N.N. Blokhin NMIC of Oncology from 2000 to 2019, 258 surgical procedures have been performed on primary and metastatic tumors localized on the chest wall. 123 patients (47.7%) suffered of functional disorders in upper limb postoperatively. The deterioration was due to the movement of the pectoralis major muscle or resection, after trapezius and/or rhomboid muscles were crossed or resected, after large defects of the chest wall in the area covered with the scapula, after interventions on the sternoclavicular joint. We used assessed the MSTS scale for assessment of the severity of DFUL. Mathematical accuracy was calculated using UTest Mann-Whitney, χ2.The results. The intersection or resection of the trapezius or rhomboid muscles did not lead to a significant DFUL. Resection of the pectoralis major muscle and its use as a displaced flap is only in rare cases accompanied by a DFUL of less than 80%. More severe DFUL had been in patients with a larger volume of resection of the pectoralis major muscle or after usage of counter pectoral flaps with excessive tension. Resections in the sternoclavicular joint area naturally led to DFUL up to 20% or more according to MSTS. Defects of the chest wall in the area covered by the scapula and adjacent areas, ranging from 50 cm2 to 320 cm2 (Md=105 cm2), followed by DFUL 20% or more.Conclusions. Interventions on the trapezius, rhomboid and pectoralis major muscles did not lead to a significant DFUL. In cases of interventions on the sternoclavicular joint, movable reconstruction with a low risk of instability should be performed. At the same time, the choice of reconstruction method remains the subject of research, as well as for the reconstruction of a defect in the area covered by the scapula.