Page 122 - Microsurgery

Radiation-Induced Plexitis

This condition occurs in patients who have undergone therapeutic radiation for hematologic
tumors, breast cancer, apex lung tumors, or other thoracic structures near the brachial
plexus requiring targeted radiotherapy that may expose the plexus.

These lesions are progressively evolving and result from radiation-induced nerve damage.
Surgical management involves plexus neurolysis followed by revascularization using the
pectoralis minor muscle flap. This flap is placed onto the neurolyzed area with the aim of
providing improved vascularization to the damaged nerves.

The purpose of this technique is to establish a barrier between the brachial plexus and
surrounding fibrotic or scarred tissues, enhance the local environment by improving
vascularization around nerve structures, reduce neuropathic pain, and prevent further nerve
deterioration.

The pectoralis minor muscle is selected due to its anatomical proximity to the brachial
plexus, its rich vascular supply promoting trophic and anti-inflammatory effects on the
injured nerves, and its relatively minor functional role in shoulder movement, making it an
ideal candidate for interposition without significant functional impairment.

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