BACKGROUND: We report about our experiences using a single supraclavicular incision at the base of the neck for Thoracic Outlet Syndrome (TOS) surgery. METHODS: 10 patients aged between 12 and 59 years (mean 31 years) underwent 12 times a TOS procedure. Patients suffered from compression of their brachial plexus with main affection of the ulnar nerve (9 out of 12 cases). Electroneurography was positive for TOS 4 times in 3 patients, in other 3 patients additionally a distal nerve compression syndrome was evident. In 7 cases (5 patients) a cervical rib was present on X-ray. In 10 cases (8 patients) the subclavian artery showed a stenosis behind the clavicle on MRI-angiography. In all cases the brachial plexus was prepared and a complete scalenotomy was performed. Whenever present the cervical rib was resected and in 2 cases the first rib (1 with/1 without cervical rib) was taken out. RESULTS: The surgical procedures did not cause relevant complications. All patients were without discomfort within 6 months, including the nerve regeneration disturbances. One patient suffered from TOS recurrence 10 months after surgery (scalenotomy without resection of the 1st rib). CONCLUSION: The single supraclavicular incision provided sufficient access to the structures of the brachial plexus, the subclavian artery and the cervical and 1st rib in all cases. The procedure produced not only sufficient pain relief and normalized extremity function but also a cosmetically acceptable, nearly invisible scar.
BACKGROUND: We report about our experiences using a single supraclavicular incision at the base of the neck for Thoracic Outlet Syndrome (TOS) surgery. METHODS: 10 patients aged between 12 and 59 years (mean 31 years) underwent 12 times a TOS procedure. Patients suffered from compression of their brachial plexus with main affection of the ulnar nerve (9 out of 12 cases). Electroneurography was positive for TOS 4 times in 3 patients, in other 3 patients additionally a distal nerve compression syndrome was evident. In 7 cases (5 patients) a cervical rib was present on X-ray. In 10 cases (8 patients) the subclavian artery showed a stenosis behind the clavicle on MRI-angiography. In all cases the brachial plexus was prepared and a complete scalenotomy was performed. Whenever present the cervical rib was resected and in 2 cases the first rib (1 with/1 without cervical rib) was taken out. RESULTS: The surgical procedures did not cause relevant complications. All patients were without discomfort within 6 months, including the nerve regeneration disturbances. One patient suffered from TOS recurrence 10 months after surgery (scalenotomy without resection of the 1st rib). CONCLUSION: The single supraclavicular incision provided sufficient access to the structures of the brachial plexus, the subclavian artery and the cervical and 1st rib in all cases. The procedure produced not only sufficient pain relief and normalized extremity function but also a cosmetically acceptable, nearly invisible scar.
Authors: Lars B Dahlin; Clas Backman; Henrik Düppe; Harukazu Saito; Anette Chemnitz; Kasim Abul-Kasim; Pavel Maly Journal: J Brachial Plex Peripher Nerve Inj Date: 2009-09-06