HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Serdar Han Erkan Yildirim Kanat Özisik Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Han, S. Articles by Sakinci, U. Search for Related Content PubMed PubMed Citation Articles by Han, S. Articles by Sakinci, U. Related Collections Chest wall Peripheral vascular

Eur J Cardiothorac Surg 2003;24:428-433
© 2003 Elsevier Science NL

Transaxillary approach in thoracic outlet syndrome: the importance of resection of the first-rib

Ankara Numune Education and Research Hospital, Thoracic Surgery Department, Ankara, Turkey

Received 5 March 2003; received in revised form 3 May 2003; accepted 12 May 2003.

^* Corresponding author. Mamak Caddesi 43/11 Demirlibahce, 06340 Ankara, Turkey. Tel.: +90-312-3633074; fax: +90-312-3103460
e-mail: serdarhan1{at}yahoo.com

Objective: The aim of this study was to analyze the transaxillary surgical approach and results of thoracic outlet cases in our clinic in the light of the recent literature data. Methods: Between 1996 and 2002 a series of 35 cases diagnosed as thoracic outlet syndrome (TOS) hospitalized and surgically treated in our clinic have been studied retrospectively. Results: Twenty-six of our cases were females (75%) and the mean age was 25±1 (17–40 years). The most important symptom was localized pain in the arm. In 90% of the cases the Adson, hyperabduction and abduction external rotation (AER) tests were positive. There was paresthesia in 30 cases (85%), atrophy in 3 cases (10%), and cyanosis in 6 cases (20%). Preoperative electromyogram (EMG) was demonstrated as 56.7 m/s (50–65) and postoperative EMG was demonstrated as 65.1 m/s (60–71). Postoperative EMG values were significantly higher than the preoperative EMG values (p<0.001). All patients were operated using the transaxillary approach. A total number of 40 operations were performed. Upon radiological investigation (n=17) 50% of the patients were found to have cervical ribs. In 30 cases (85%) the results were very good and in four cases (12%) good, and in one case (3%) the results were bad. There was no recurrence and reoperation in the long term follow-up. Conclusion: Careful patient history and physical examination should be done by a team, which consists of thoracic surgeon, physical therapy specialist, and a neurologist. Total resection of the first-rib with periosteally should be preferred in all of these cases with accompanying pathologies such as cervical rib, fibrous ligaments, and scalenius muscles. The transaxillary approach has provided a good exposure for the resection of cervical ribs, the first-rib and excision of fibrous ligaments and scalenius muscle by a perfect cosmetic result. All the patients should be encouraged for 2 months of physical exercises starting from early postoperative period.

Key Words: Thoracic outlet syndrome • Surgery • Transaxillary approach