Subclavicular approach to first rib resection

Murphy, Thomas O.; Piper, Clinton A.; Kanar, Edmund A.; McAlexander, Robert A.

doi:10.1016/0002-9610(80)90351-7

Cited by 19 publications

(6 citation statements)

References 9 publications

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“…While the susceptibility of the Adson test remained at 27% in some series, Murphy reported a 100% positive response to the it [28]; in our study, this rate was 86.5%. False positivity is much lower in the Adson test than in the costoclavicular test and hyperabduction test [28,29]: Rayan reported a false positive rate of 13.5% for the Adson test and 47% for the costoclavicular test in a study in 200 extremities of 100 volunteers [29]. Pleva reported a false positive rate of 62% for the hyperabduction test and 11% for the Adson test in a study of 53 medical students with no symptoms [30].…”

Section: Discussioncontrasting

confidence: 49%

Torasik Outlet Sendromunda Cerrahi Tedavinin Etkinliği

Aslaner¹

2020

Acta Medica Alanya

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Amaç: Bu çalışmada, Torasik outlet sendromu tanısı konulan hastalarda cerrahi tedavinin etkinliğini değerlendirmeyi amaçladık. Hastalar ve Yöntem: 1991 ile 2004 yılları arasında Torasik Outlet Sendromu tanısı almış ve tedavi yöntemi olarak cerrahi uygulanmış otuz yedi olgunun yaş, cins, meslek dağılımı, anamnez ve fizik muayene bulguları, semptomları, preoperatif tetkikleri, operasyon bulguları, postoperatif komplikasyonları, postoperatif hastanede kalış süreleri ve operasyon sonuçlan incelenerek yapıldı. Bulgular: Olguların çoğu 15-35 yaş grubunda (% 72.97) ve kadınlardan (% 91,9) oluşmaktaydı. Bu olguların çoğu ev hanımıydı (% 51.4). En sık rastlanılan semptomlar ağrı (%94,6) ve uyuşma (% 78.4) idi. Fizik muayenede en sık kullanılan test Adson testi idi. Adson testi %86 oranında pozitif bulundu. Radyolojik testlerde en sık karşılaşılan patoloji servikal kosta anomalisiydi (% 37.8). üst ekstremite EMG sinin %48.6, üst ekstremite arteriel doplerinde% 13.5 oranında TOS u desteklediği bulundu. Cerrahide transaksiller girişim ile birinci kosta ve servikal kosta rezeksiyonu. skalenektomi fibromüsküler bantların kesilmesi işlemlerini uyguladık. Cerrahiden sonra erken dönemde %78.4 oranında tam düzelme görüldü. Olguların hiçbirinde mortalite olmadı. Sonuç: Bu çalışmada TOS hastalarda, uygun olgularda ve iyi cerrahi teknik ile sonuçlar tatmin edici bulundu. Cerrahi başarı oranı %97 lere kadar çıkabilmektedir.

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Section: Discussioncontrasting

confidence: 49%

Torasik Outlet Sendromunda Cerrahi Tedavinin Etkinliği

Aslaner¹

2020

Acta Medica Alanya

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“…The surgical approach can be selected according to the locoregional extension of the tumor in these different zones of the thoracic inlet (Table 2). These approaches have been previously described in published studies [5][6][7][8][9][10][11][12][13][14][15][16] ; therefore, the surgical details were not included in the present report.…”

Section: Surgical Approachmentioning

confidence: 99%

“…The subclavicular approach is performed by an incision along the upper edge of the second rib below the clavicle, providing exposure to the first rib after dividing the pectoralis major muscle along its fibers and retracting the pectoralis minor muscle laterally. 8 Sectioning of the costochondral junction of the first rib and division of the costoclavicular ligament opens the costoclavicular space and provides access to the anterior part of the first rib up to the subclavian vein and anterior scalene muscle. The subclavicular incision can be combined with a vertical cervicotomy along the anterior border of the sternocleidomastoid muscle in an L-shape fashion to either split the manubrium and elevate the sternoclavicular articulation with the clavicle (transmanubrial approach) or divide the sternal attachment of the sternocleidomastoid muscle and remove the proximal part of the clavicle (transcervical-thoracic approach) to have adequate exposure of the subclavian vein and artery.…”

Section: Surgical Approachmentioning

confidence: 99%

Surgical approaches to apical thoracic malignancies

Perrot

Rampersaud

2012

The Journal of Thoracic and Cardiovascular Surgery

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Objective: Several surgical approaches have been described to access apical thoracic malignancies extending into the thoracic inlet. However, most publications have focused on a specific approach and considered the thoracic inlet as 1 entity. In the present analysis, we divided the thoracic inlet into 5 different zones requiring specific surgical considerations to identify the best approach for each zone.Methods: A review of 22 consecutive patients undergoing surgery for apical thoracic malignancies extending into the thoracic inlet from January 2005 to November 2011 was performed.Results: Different surgical approaches were used for each zone. The first (anterolateral) zone required a subclavicular approach to open the costoclavicular space and expose the subclavian vein with or without elevating or removing the clavicle (n ¼ 4). The second (anterocentral) zone required a transverse supraclavicular approach with or without extension to a partial (trapdoor) or full sternotomy (n ¼ 10). The third (posterosuperior) zone located between the top of the subclavian artery and the T1 vertebra along the posterior superior border of the first rib was the most difficult area to access (n ¼ 5). The transclavicular approach was ideally suited to expose this zone in our experience. The fourth (posteroinferior) zone and fifth (inferolateral) zone located posteriorly and laterally along the inferior border of the first rib were accessed using a posterolateral and posterotransaxillary approach, respectively (n ¼ 3). Conclusions:The thoracic inlet could be divided into 5 zones requiring specific surgical considerations and different approaches. Division of the thoracic inlet into these zones could provide more clarity and guidance for thoracic surgeons to select the correct surgical approach.

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“…Secondly, there is much controversy regarding the optimal surgical procedure for relieving the symptoms. Whilst current debate is largely focused on whether a transaxillary or supraclavicular approach gives best results, other procedures are well described [5][6][7][8][9][10]. Nonetheless, there is much variation in the reported post-operative outcome, whichever procedure is used.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Transaxillary Rib Resection for Thoracic Outlet Syndrome — a 10 Year Experience

Fulford,

Baguneid,

Ibrahim

et al. 2001

Cardiovascular Surgery

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Background: This study assessed the outcome of transaxillary first and/or cervical rib resection in a unit, which has a policy of combined assessment by a neurologist and vascular surgeon. Methods: 61 patients underwent 83 transaxillary rib resections for thoracic outlet syndrome. A retrospective casenote review of these patients was undertaken. All patients completed a telephone questionnaire regarding long-term outcome. Results: Post-operative outpatient assessment at a median of 6 months recorded 91.5% improved, of whom 61.5% were symptom-free. 61% were available for the telephone questionnaire at a median follow-up of 4 yr. 74% reported an improvement, with complete resolution in 58%. Six described temporary improvement following surgery. Conclusion: Transaxillary rib resection is a safe and effective procedure, allowing almost two thirds of patients a return to normal activity. Combined assessment by vascular and neurological teams may help in patient selection for surgery, as well as the accurate long-term assessment of outcome.

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Subclavicular approach to first rib resection

Cited by 19 publications

References 9 publications

Torasik Outlet Sendromunda Cerrahi Tedavinin Etkinliği

Torasik Outlet Sendromunda Cerrahi Tedavinin Etkinliği

Surgical approaches to apical thoracic malignancies

Outcome of Transaxillary Rib Resection for Thoracic Outlet Syndrome — a 10 Year Experience

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