Thoracic oudet syndrome denotes compression of the brachial plexus, the subclavian vessels, or both, accompanied by paresthesia, pain, numbness, and fatigue in the affected extremity. The chief contributing factors are bone abnormalities (fractured clavicle, cervical rib, or hypoplastic first rib), which are present in 30 percent of the cases;* in fact, the first rib is generally regarded as being the most important anatomic structure in the pathogenesis of thoracic oudet syndrome. Other potential contributing factors include tumors, poor posture, pendulous breasts, sagging shoulders, and muscular hypertrophy.
Because of their size, reliability, and long arc of rotation, latissimus dorsi flaps have long been preferred for reconstructing after radical mastectomy. To the authors knowledge, however, this is the first case of thoracic oudet syndrome attributable to breast reconstruction with such a flap. Plastic surgeons should keep this complication in mind when performing reconstructive procedures, and thoracic surgeons should be aware of it when treating thoracic oudet syndrome in women who have had these procedures.
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