TOS-surgery via a single supraclavicular incision.

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.