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. 2022 Feb 26;14(2):e22619.
doi: 10.7759/cureus.22619. eCollection 2022 Feb.

Revisiting the Surgical Approaches to Decompression in Quadrilateral Space Syndrome: A Cadaveric Study

Sundip Charmode  1 , Simmi Mehra  1 , Sudhir Kushwaha  2
Affiliations

Revisiting the Surgical Approaches to Decompression in Quadrilateral Space Syndrome: A Cadaveric Study

Sundip Charmode et al. Cureus. .

Abstract

Background Quadrangular space syndrome involves compression of the axillary nerve and posterior circumflex humeral artery. In a few cases, its management requires surgical decompression. The current study reviews the surgical approaches used in the decompression of neurovascular structures and presents our reflections and recommendations. Methodology In this study, four human cadavers were used for dissection of the axillae and the scapular region by the senior residents of the Department of Anatomy and Department of Orthopedics. The residents dissected the quadrangular space in the eight upper limbs using anterior and posterior surgical approaches. Results To identify the quadrangular space and secure its contents, the posterior approach was recognized as the easier and quicker method by both Anatomy and Orthopedic residents; however, it may result in increased postoperative morbidity. Although the anterior (deltopectoral) approach involves more skill, it reduces postoperative morbidity. Conclusions The anterior (deltopectoral) approach with suggested modifications can be an effective method in the surgical decompression of quadrangular space syndrome. The authors suggest more cadaveric studies to provide anatomists and surgeons with the opportunity to practice and evaluate older and newer surgical approaches.

Keywords: axillary nerve; decompression; posterior circumflex humeral artery; quadrangular space; surgical approach.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Boundaries of the quadrangular space.
This figure was created by the authors.
Figure 2
Figure 2. Surgical incision made in the anterior (deltopectoral) approach.
Image available from https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/scapula/approach/deltopectoral-approach [12].
Figure 3
Figure 3. The anterior approach showing the quadrangular space between the deltopectoral groove along with the contents (AXN and PHCA) passing through it.
AXN: axillary nerve; PHCA: posterior humeral circumflex artery
Figure 4
Figure 4. Posterior approach to the axilla showing the quadrangular space along with the contents (AXN and PHCA) passing through it.
AXN: axillary nerve; PHCA: posterior humeral circumflex artery
See this image and copyright information in PMC

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