Radial Nerve Paralysis due to Kent Retractor during Upper Abdominal Opertion

Kim, Ki Jun; Park, Wyun Kon

Abstract

A 52 year old female patient was operated under the diagnosis of stomach cancer. She was very obese; her body weight and height were 95.5 kg and 161.5 cm, respectively. Radical subtotal gastrectomy was performed and the operation time was 4 hour and 40 minutes. The day following surgery, signs of right radial nerve palsy including wrist drop were noted. Neurologic examination revealed O-l/5 power of the wrist and finger extensor muscles of the right arm with reduced sensation in the radial aspects of the dorsum of the hand. The electromyography & nerve conduction test revealed incomplete right radial nerve injury above elbow level. During surgery, the patient was in the supine position, the right arm fully adducted to the lateral side of the trunk, and the left arm was 90 degree abducted from the trunk. The blood pressure cuff had been applied to the right upper arm and automated sequential blood pressure measurements performed every 5 minutes during the operation. Thirty minutes into the procedure, a Kent retractor had been applied, the side frame of which contacted the patients right upper arm. We hypothesize that firm pressure from the retractor frame against radial nerve where it passes superficially in the upper arm was responsible for the injury. No abnormalities in function of the automatic cuff were discovered. The patient was discharged 19 days after operation with partial recovery of the radial nerve palsy. Two months later the radial nerve palsy had completly resolved.