Combined Surgical Treatment of Thoracic Outlet Syndrome: Transaxillary First Rib Resection and Transcervical Scalenectomy[1]

Zusammenfassung

Viele verschiedene Operationsverfahren sind zur Behandlung des Thoracic-outlet-Syndroms (TOS) entwickelt worden, bei dem neurovaskuläre Strukturen am „thoracic outlet“ komprimiert werden. Die transaxilläre Resektion der ersten Rippe sowie die transzervikale vordere und mittlere Skalenektomie sind die häufigsten Standardverfahren. Einige Chirurgen begannen Anfang der 80er-Jahre, beide Verfahren zu kombinieren (zuerst die Skalenektomie, dann die transaxilläre Rippenresektion). Wir haben erprobt, dass diese Kombination in umgekehrter Reihenfolge (zuerst die Resektion der ersten Rippe und anschließend sofortige vordere und mittlere Skalenektomie) zu einer vollständigen Entlastung des „thoracic outlet“ führt, die Symptome besser lindert und die Rezidivrate senkt.

Abstract

Many different procedures have been developed to treat thoracic outlet compression syndrome (TOCS), a condition in which neurovascular structures in the thoracic outlet region are compressed. Currently, transaxillary first rib resection and transcervical anterior and middle scalenectomy are the most popular and standard procedures. In the early 1980s, some surgeons started to perform both procedures, starting with the scalenectomy and following with a transaxillary first rib resection. We have found that performing these procedures in the reverse order, starting with the first rib resection and following immediately with a transcervical anterior and middle scalenectomy accomplishes total decompression of the thoracic outlet area with much better improvement of symptoms and much lower recurrence rate.

Schlüsselwörter

TOS - Resektion erste Rippe - Skalenektomie

Key words

TOS - first rib resection - scalenectomy

1 Reprinted with permission and slight modifications from Atasoy E: Combined surgical treatment of thoracic outlet syndrome: transaxillary first rib resection and transcervical scalenectomy. Hand Clin 2004; 20: 71 - 82

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1 Reprinted with permission and slight modifications from Atasoy E: Combined surgical treatment of thoracic outlet syndrome: transaxillary first rib resection and transcervical scalenectomy. Hand Clin 2004; 20: 71 - 82