Split Pectoralis Major Tendon Transfer With Achilles Allograft for Chronic Medial Scapular Winging.

Background: Split pectoralis major tendon (PMT) transfer is effective at treating persistent medial scapular winging refractory to conservative management. Indications: The primary indication for a PMT transfer is scapular winging secondary to serratus anterior palsy caused by long thoracic nerve injury. In this case, the patient is a 22-year-old male with years of symptoms that interfere with his activities of daily living and ability to play recreational basketball. Technique Description: The patient was placed in a semi-supine position. The deltopectoral interval was identified and dissected. The sternal head of the pectoralis major was isolated and tagged, and a tenotomy was then performed. An Achilles allograft was prepared in a sterile fashion and secured to the pectoralis tendon using multiple heavy nonabsorbable sutures. A scapular incision was made to identify the inferior angle of the scapula. A bone tunnel was created, and the allograft was shuttled through the aperture and tensioned into place. Results: Split PMT transfer is associated with improved pain scores and functional outcomes, while offering a lower complication rate than other surgical techniques. Patient satisfaction is high; 80% of patients would recommend the surgery. The patient in this case is now 16 weeks post-surgery and reports 0 out of 10 pain. Discussion/Conclusion: This technique study demonstrates that split PMT transfer with Achilles allograft augmentation is a viable treatment option for patients with persistent scapular winging. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.