In shoulder narrowing surgery a segment of the clavicle is removed to pull in the width of the shoulders. While removing a segment of the clavicle bone length and putting back together is conceptually straightforward, performing it inside the limits of the small supraclavicular fossa incision adds a unique challenge to the surgery.
Given that the width of the incision is only 3.5cms in length, cutting a 2.5cm segment of the bone out and being able to put it back together in good alignment requires some specific technical maneuvers. In cutting out the bone segment there are two ways to do it. One method is to make the two bone cuts keeping the length of the bone intact and sliding the incision around to do so. (aka the mobile window concept) The other approach is to make the medial bone cut and allow the distal bone segment to move past the medial bone segment. (collapsing technique)
The distal bone segment is then grabbed and pulled out of the incision. One outside of the incision a reciprocating saw is used to cut off the desired amount.
The bone is dropped back into the incision, aligned to the proximal segment and double plate fixation applied.
In this clavicle reduction technique it relies on the more fixed proximal segment by the minimally mobile sternoclavicular joint. The distal segment is easily mobilized once its supportive length is removed.
I have done both clavicle osteotomy technique to remove the bone segment and each has their merits. With either technique the key is to place the fixation plate on the proximal segment first so at least one side is stabilized prior to the bone resection.
Dr. Barry Eppley
World-Renowned Plastic Surgeon