| 저자 |
Dong-Ha Kang1*, Gi-Wook Kim 1,2, Sung-Hee Park1,2, Myoung-Hwan Ko1,2, Jeong-Hwan Seo1,2, Yu Hui Won1,2† |
Introduction
Complications after mastectomy with axillary resection in patients with breast cancer are most commonly associated with lymphedema, as well as peripheral nerve injury and surgical site infection, and so on. Based on previous reports, it is known that the injury of the intercostobrachial nerve(ICBN) account for largest part of the peripheral nerve injury after breast surgery, followed by medial brachial cutaneous nerve(MBCN) of the arm. Here, we present the rare case who suffered from an injury to the medial antebrachial cutaneous nerve(MACN) of forearm after breast cancer surgery.
Case presentation
A 49 years old woman, on April 2018, accidentally noticed palpable mass in her left breast. The patient underwent various breast evaluations and diagnosed with invasive ductal carcinoma(pT2N1).
Partial mastectomy with axillary lymph node dissection(ALND) level 1, 2 was done on May 24, 2018. Patient was supine with arm extension positioned during surgery and skin incision type was radial linear incision. On the 12th postoperative day, the patient complained of numbness in the medial area of left forearm with overall edema of the left arm. Peripheral nerve injury in the left arm was suspected, and left MACN lesion was detected on nerve conduction study, which showed right MACN of forearm with onset latency of 2.05ms, amplitude of 12.3mV, and left MACN of forearm with onset latency of 1.75ms, amplitude of 4.3mV(Table 1, Fig 1-A). The amplitude of left MACN nerve was 34.9% of the amplitude of right MACN. The patient was done with rehabilitative treatment for lymphedema and nerve injury and discharged on 23 May, 2018.
She had finished chemotherapy for about 5 months after discharge, and she was feeling pain in her left forearm even more aggravated compared with the time of admission (VAS 7). Follow up electrophysiologic study was performed approximately 9 months after the previous one, and left MACN lesion was still detected and there was no interval change. The result of nerve conduction study was onset latency of 1.60ms, amplitude of 15.9mV with right MACN of forearm, and onset latency of 2.20ms, amplitude of 5.2mV with left MACN of forearm, which showed still 32.7% of right MACN amplitude(Table 1, Fig 1-B). After taking medication and rehabilitation for about 2 months, she felt mild improvement of the pain(VAS 7→5).
Conclusion
Nerve injuries as following complication of breast surgery with ALND are common in ICBN and MBCN, but MACN damage can also occur considering its anatomic course. The MACN of forearm runs in parallel with the ICBN and MBCN in the lateral area and passes through the axillary area.
There are studies that mentioned about ICBN dividing proximally to give a contribution to the MACN and about great variation of MACN. If patients who underwent breast cancer surgery with axillary dissection uncommonly complain of sensory symptoms in the forearm, we need to consider injury of MACN and carry out a check on it. |
