Thuau François, Gadbled Guillaume, Goronflot Thomas, Perrot Pierre, Poinas Alexandra, Lancien Ugo
Plastic Reconstructive, and Aesthetic Surgery Department, Nantes University, CHU Nantes, Nantes, France.
Orthopedic and Traumatology Surgery Department, Nantes University, CHU Nantes, Nantes, France.
Int J Surg Protoc. 2025 Apr 21;29(2):57-62. doi: 10.1097/SP9.0000000000000045. eCollection 2025 Jun.
Neurogenic thoracic outlet syndrome (NTOS), characterized by brachial plexus compression, causes chronic pain and numbness in the upper extremities. Recurrences are common after surgical treatment, which typically includes an anterior scalenectomy and rib resection. Brachial plexus neurolysis and flap coverage can reduce scar fibrosis and prevent further recurrence. The latissimus dorsi flap is a common choice for this purpose. However, perforator fat flaps minimize donor site complications by avoiding muscle harvesting. Furthermore, a free flap transfer prevents new scars from developing in an already painful anatomical region. Given the lack of literature on this subject, we plan to use validated and recommended questionnaires to investigate the impact on pain and quality of life of brachial plexus wrapping with a free fat flap following neurolysis in cases of recurrent NTOS.
FIRST is a single-center, prospective observational pilot study recruiting participants over 24 months. Eligible patients over the age of 18 are treated with brachial plexus neurolysis and a free perforator fat flap for recurrent NTOS. The study aims to enroll 20 patients and involves preoperative and postoperative assessments at a six-month follow-up. The primary outcome, measured using numerical scales, is pain reduction. Secondary outcomes include decreased painful body surface area, maximum and average pain levels, changes in quality of life, upper limb function, and anxiety-depressive symptoms, which are measured using various validated scales and questionnaires.
This study will provide insight into the efficacy of free perforator fat flaps in recurrent NTOS using standardized, validated assessments for neuropathic pain, including psychosocial aspects. By providing vascularization around the brachial plexus, fat flaps may reduce inflammation, fibrosis, and perineural scar adhesions, thereby alleviating pain. This technique also avoids extensive local dissection required for regional flaps and reduces donor site morbidity. Potential limitations include the technical complexity of free flap surgery.
神经源性胸廓出口综合征（NTOS）以臂丛神经受压为特征，可导致上肢慢性疼痛和麻木。手术治疗后复发很常见，手术通常包括前斜角肌切除术和肋骨切除术。臂丛神经松解术和皮瓣覆盖可减少瘢痕纤维化并防止进一步复发。背阔肌皮瓣是为此目的的常见选择。然而，穿支脂肪瓣通过避免肌肉取材可将供区并发症降至最低。此外，游离皮瓣转移可防止在本已疼痛的解剖区域形成新的瘢痕。鉴于缺乏关于该主题的文献，我们计划使用经过验证和推荐的问卷来调查复发性NTOS病例在神经松解术后用游离脂肪瓣包裹臂丛神经对疼痛和生活质量的影响。
FIRST是一项单中心、前瞻性观察性试点研究，招募患者超过24个月。年龄超过18岁的符合条件的复发性NTOS患者接受臂丛神经松解术和游离穿支脂肪瓣治疗。该研究旨在招募20名患者，并在6个月的随访中进行术前和术后评估。使用数字量表测量的主要结局是疼痛减轻。次要结局包括疼痛体表面积减少、最大和平均疼痛水平、生活质量变化、上肢功能以及焦虑抑郁症状，这些使用各种经过验证的量表和问卷进行测量。
本研究将通过对神经性疼痛（包括心理社会方面）进行标准化、经过验证的评估，深入了解游离穿支脂肪瓣在复发性NTOS中的疗效。通过在臂丛神经周围提供血管化，脂肪瓣可能减少炎症、纤维化和神经周围瘢痕粘连，从而减轻疼痛。该技术还避免了区域皮瓣所需的广泛局部解剖，并降低了供区发病率。潜在的局限性包括游离皮瓣手术的技术复杂性。
