Supraclavicular resection of the first rib for thoracic outlet syndrome

Hempel, G.; Rusher, Albert Holly; Wheeler, Clarence G.; Hunt, Don; Bukhari, Hassan I.

doi:10.1016/0002-9610(81)90159-8

Cited by 61 publications

(18 citation statements)

References 10 publications

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“…In decompressing the thoracic outlet it has been stated 6 that "it is better to excise the floor than the roof" and this has led to many surgeons performing routine first rib resections on most patients with thoracic outlet syndrome. 3,4,8,10,14,17 However, equally good results can be obtained by performing anterior and middle 24 and excising any local constricting anatomy such as fibrotendinous bands and cervical ribs alone. 11,13,25 Roos, who probably has the largest published series of thoracic outlet decompression, states that supraclavicular scalenectomy should be reserved for patients with upper nerve root compression (C5, C6, C7) and for lower nerve root (C8, T1), arterial, and venous compression, transaxillary first rib resection should be the treatment of choice.…”

Section: Discussionmentioning

confidence: 96%

“…Many surgical approaches to the thoracic outlet have been described (supraclavicular, 3 transaxillary, 4 infraclavicular, 5 and posterior, 6 and anterolateral thoracotomy 7 ), but the extent to which the thoracic outlet is decompressed is still a matter of some debate among surgeons. While there are many advocates for routine first rib resection in all patients via a transaxillary or supraclavicular approach, [8][9][10] some units have reported comparable results using routine scalenectomy with or without fibrous band/cervical rib excision alone.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Experience of Supraclavicular Exploration and Decompression for Treatment of Thoracic Outlet Syndrome

McCarthy

Varty

London

et al. 1999

Annals of Vascular Surgery

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Experience of Supraclavicular Exploration and Decompression for Treatment of Thoracic Outlet Syndrome

McCarthy

Varty

London

et al. 1999

Annals of Vascular Surgery

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“…Bundan kaçınmak için bazı cerrahlar 1.kosta rezeksiyonu yanında supraklavikuler yaklaşımı da ekleyerek komplet skalenektomi yapılmasını önermektedir (15).…”

Section: Etiyolojiunclassified

Recurrent thoracic outlet syndrome and surgical treatment

Yüksel¹

2014

Toraks Cer Bult

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Thoracic Outlet Syndrome is refers to compression of one or more of the neurovascular structures in the cervicoaxillary canal. Surgical treatment can be applied with transaxillary, supraclavicular/infraclavicular or posterior approach. After surgical treatment success rates are around 80% (37-100%). Recurrence is seen in 15-20% of the patients and the most cause of these recurrences is the scar tissue in the operation zone. The first choice of treatment in recurrent thoracic outlet syndrome is physical therapy and medical therapy. In case of failure with medical treatments, a reoperation could be performed. The reoperation is planned considering the incission in the first surgery, and the localization of the pressure. The basis of the reoperation is completing the deficient phases of the first surgery and neurolysis. It is til a challenging problem to prevent postoperative scar tissue. Starting physiotherapy in the very early postoperative period is known as the most effective treatment in preventing recurrences. Key words: Recurrent Thoracic Outlet Syndrome and Surgical Treatment ÖzetTorasik Çıkış Sendromu; bir ya da daha fazla nörovasküler yapının servikoaksiller kanal içerisinde bası altında kalması sonucunda ortaya çıkan semptomlar kompleksidir. Cerrahi tedavi transaksiller, supraklavikuler/infraklavikuler ya da posterior girişim ile uygulanabilmektedir. Cerrahi tedavi sonrasında başarı oranları yaklaşık %80 civarındadır (%37-100). Hastaların %15-20'sinde nüks gelişebilir ve bu nükslerin en sık nedeni operasyon bölgesinde oluşan skar dokusudur. Nüks torasik çıkış sendromunun tedavisinde ilk tercih fizik tedavi ve ilaç tedavisi gibi konservatif yöntemlerdir. Medikal tedavinin başarısız olduğu durumlarda ise reoperasyon gerçekleştirilebilir. Reoperasyon, ilk operasyonda uygulanan kesi, yapılan işlemler ve basının hangi bölgede olduğu-na göre planlanır. Reperasyonun temelini ilk operasyonun eksik kalan aşamalarının tamamlanması ve nöroliz oluşturur. Postoperatif skar dokusunun oluşmasını önlemek hala çözü-lememiş bir sorundur. Postoperatif ilk saatler de dahil olmak üzere erken dönemde fizik tedavinin başlaması nükslerin önlenmesinde bilinen en etkili yöntemdir. Anahtar kelimeler: Nüks torasik çıkış sendromu, cerrahi tedavi Nüks Torasik Çıkış Sendromu ve Cerrahi TedavisiTorasik Çıkış Sendromu (TOS); nörovasküler yapı-ların servikoaksiller kanal içerisinde; birinci kosta, klavikula, kostaklavikuler ligament ve skalen kaslar arasında bası altında kalması sonucunda ortaya çıkan semptomlar kompleksidir. Nörojenik, venöz ve arteriyel olmak üzere 3 farklı tipi vardır. Bu sendromun ortaya çıkmasına neden olduğu düşünülen faktörlerin başında servikal kosta, kas ya da tendon anomalileri gelmektedir. Kolların elevasyonunu, başın üstüne kaldırılmasını ya da öne doğru uzatılmasını gerektiren araba kullanmak, bilgisayarda yazı yazmak ya da bir şey taşımak gibi etkinlikler semptomları kötüleşti-rir. Üst ekstremitenin nötral pozisyona getirilmesi ile semptomlar hızla düzelir (1-3).Fizik muayenede var ise servikal kost...

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“…TOS ameliyatlarında majör komplikasyonlar olarak literatürde duktus torasikusun yaralanmasına bağlı şilotoraks, frenik sinir veya brakiyal pleksus yaralanması, subklaviyan arter ve venin yaralanması ve hayatı tehdit edici kanama bildirilmiştir (31,32). Morbidite içe-risinde plevral açılma en sıklıkla görülürken, parestezi, geçici Horner Sendromu, geçici torasikus longus sinir zedelenmesi, subklaviyan ven yaralanması veya trombozu gibi durumlar sayılabilir.…”

Section: Komplikasyonlarunclassified

Mixed type thoracic outlet syndrome

Koçer¹

2014

Toraks Cer Bult

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Thoracic outlet syndrome as defined in English literature is a set of symptoms which arise in consequence of the compression/irritation of subclavian artery and vein and or brachial plexus along the vertebral to axillary region of the apertura thoracis superior. As well three different types of thoracic outlet had been defined: Neurogenic (90-95%); vascular (5-10%) and mixed (20%). Thoracic outlet syndrome is a source of disagreement among clinicians regarding its incidence, diagnosing benchmarks and optimal treatment. Thoracic outlet syndrome is a highly controversial subject. It is quite a rare clinical situation having a percentage of 0.3-0.7. But its real incidence is still controversial. Because objective confirmatory tests are often lacking. Hence the exact incidence is not known and the thoracic outlet syndrome is sad to be overdiagnosed by some authors and underdiagnosed by the others. In this text we would like to describe especially mixed type but also the other thoracic outlet syndrome categories according to clinical presentations, diagnosing methods and treatment modalities briefly.

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Supraclavicular resection of the first rib for thoracic outlet syndrome

Cited by 61 publications

References 10 publications

Experience of Supraclavicular Exploration and Decompression for Treatment of Thoracic Outlet Syndrome

Experience of Supraclavicular Exploration and Decompression for Treatment of Thoracic Outlet Syndrome

Recurrent thoracic outlet syndrome and surgical treatment

Mixed type thoracic outlet syndrome

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