Combined surgical treatment of thoracic outlet syndrome: transaxillary first rib resection and transcervical scalenectomy.

Transaxillary first rib resection and transcervical scalenectomy are common procedures used for treatment of thoracic outlet syndrome (TOS). In the early 1980s, some surgeons started to perform both procedures, starting with the scalenectomy and following with a transaxillary first rib resection. The author has found that performing these procedures in the reverse order, starting with the first rib resection and following immediately with a transcervical scalenectomy is an easier approach, providing total decompression, better relief of symptoms, and a lower recurrence rate.