Venous pectoralis minor syndrome: a rare subdivision of the thoracic outlet syndrome.

We analysed data of all patients who had received surgery for rare, isolated venous pectoralis minor syndrome at our tertiary institution from January 2015 to December 2018. Venous duplex scan was the preferred mode of diagnosis in all our patients. We operated on patients via a 5-6 cm deltopectoral groove incision. Ten procedures were performed on 6 patients, of whom 5 were female. The median age was 23 years (range 17-33 years). Three patients (2 female, 1 male) with bilateral pectoralis minor syndrome had separate procedures performed over a course of a few weeks. The median operating time was 22 min (range 15-95 min). Median blood loss was 20 ml (range 5-410 ml). The median hospital stay was 2 days (range 1-5 days). There was one complication in the form of a recurrence on the right side in a patient who had bilateral pectoralis minor syndrome. No other morbidities were recorded. Nine of 10 procedures (90%) were classified by patients as being satisfactory, where symptoms had partially or completely resolved. Our experience emphasizes the need for a systematic search and to maintain a high index of suspicion for venous pectoralis minor syndrome in all patients complaining of painful symptoms related to thoracic outlet syndrome. The deltopectoral groove approach is a simple and straightforward incision with a gentle learning curve.

A magnet built on bronchoscopic suction for extraction of tracheobronchial headscarf pins: a novel technique and review of a tertiary centre experience.

OBJECTIVES: Airway metal pins are one of the most commonly inhaled foreign bodies in Eastern societies in young females wearing headscarves. We innovated a modified bronchoscopic technique to extract tracheobronchial headscarf pins by the insertion of a magnet to allow an easy and non-traumatic extraction of the pins. The aim of this study was to assess the feasibility and safety of our new technique and compare it with our large previous experience with the classic bronchoscopic method of extraction of tracheobronchial headscarf pins. METHODS: We performed a study comparing our retrospective experience of classic bronchoscopic extraction from February 2004 to January 2014 and prospective experience with our modified technique using the magnet from January 2014 to June 2015. An institutional review board and new device approval were obtained. RESULTS: Three hundred and twenty-six procedures on 315 patients were performed during our initial 10-year experience. Of them, 304 patients were females. The median age of our group was 13 (0-62). The median time from inhalation to procedure was 1 day (0-1022). After introducing our modified new technique using the magnet, 20 procedures were performed. Nineteen were females. The median time of the procedure and the need to forcefully bend the pin for extraction were in favour of the new technique in comparison with our classic approach (2 vs 6 min; P < 0.001) (2 patients = 20% vs 192 = 58%; P < 0.001). The conversion rate to surgery was also in favour of the modified technique but did not reach statistical significance (0 = 0% vs 15 = 4.8%; P = 0.32). All patients who underwent the modified technique were discharged home on the same day of the procedure. No procedural complications were recorded. All remain well on a follow-up period of up to 14 months. CONCLUSIONS: Bronchoscopic extraction of tracheobronchial inhaled headscarf pins using a novel technique using homemade magnets was safer and simpler in comparison with our large experience with the classic approach. We advise the use of this device (or concept) in selected patients in centres dealing with this problem.

Reversed autogenous sternal plate flaps for treatment of sternal clefts: A novel technique.

OBJECTIVE: A sternal cleft is an extremely rare congenital anomaly resulting from a failure of the fusion of the sternal bars. The condition can be classified as complete or incomplete, where there is an inferior or less commonly a superior attachment. We report our experience with a modified surgical technique using a reverse autogenous sternal plate flap to treat complete sternal clefts in children beyond the neonatal period without the need for any prosthetic material or disruption of the chest wall structure. PATIENTS AND METHODS: The technique was performed on three patients beyond the neonatal period at the age of 2, 4 and 12years. Two patients were female and one was a male. All cases were performed by a single surgeon. Parents were consented for the new technique. Institutional review board (IRB) approval was obtained. RESULTS: Recovery in all children was uncomplicated, and they were discharged home after 4, 4 and 5days respectively. There were no morbidities among all 3 patients. Review at 4 and 12weeks revealed complete wound healing and a well-united sternum. All remain asymptomatic on a median follow-up period of 22months. CONCLUSIONS: Our new technique in repairing complete sternal clefts was easy, reproducible and generated satisfactory results on a reasonable follow up period. Most importantly we avoided the use of prosthetic material and any disruption to the chest wall structure in a subgroup of older patients.