Morbid musculoskeletal sequelae of thoracotomy for tracheoesophageal fistula.
The standard surgical approach for tracheoesophageal fistula (TEF) is right dorso-lateral thoracotomy. The late musculoskeletal consequences of the operation have been evaluated only rarely. Two hundred and seventy-seven patients with TEF were operated upon during the past 16 years, 117 of whom were available for long term (3 to 16 year) study. Twenty-nine of the patients had significant musculoskeletal deformities: (1) Twenty-one patients (23.8%) had prominent elevation of the right shoulder or "winged" scapula secondary to partial paralysis of the latissimus dorsi muscle; (2) Eighteen (20%) had marked asymmetry of the thoracic wall from atrophy of the serratus anterior muscle; (3) Nine (10%) had fusion of the ribs, in one of whom major respiratory dysfunction was a consequence; (4) Seven (7.8%) had severe thoracic scoliosis. The deformity was not of sufficient severity to warrant surgical correction but all patients required physiotherapy; (5) In two children (2.2%), fixation of the skin cicatrix to the bony thorax limited the mobility of the ipsilateral shoulder; (6) And finally, in three girls (3.3%), the thoracotomy scar disfigured the right breast leading to mammary maldevelopment in one adolescent. The latter child required plastic release of the entrapped breast. The dorso-lateral thoracic incision for tracheoesophageal atresia may lead to significant musculoskeletal complications and, since other alternatives are available, should be reevaluated as the recommended surgical approach.
D001847:Bone Diseases / Q000209:etiology*; D001940:Breast / Q000254:growth & development; D002648:Child; D002675:Child, Preschool; D004933:Esophageal Atresia / Q000601:surgery; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009133:Muscular Atrophy / Q000209:etiology; D009135:Muscular Diseases / Q000209:etiology*; D010243:Paralysis / Q000209:etiology; D011183:Postoperative Complications; D012129:Respiratory Function Tests; D012272:Ribs; D012600:Scoliosis / Q000209:etiology; D012783:Shoulder Dislocation / Q000209:etiology; D013896:Thoracic Diseases / Q000209:etiology; D013903:Thoracic Surgery; D014138:Tracheoesophageal Fistula / Q000601:surgery*