ABSTRACT
As discussed by Urschel [13], 50 to 70 percent of patients with symptoms of thoracic outlet syndrome may be treated conservatively by nonsurgical methods. Patients who still have symptoms after years of such therapy are referred to us for surgical treatment. Failure to obtain symptomatic relief after scalenotomy alone [8] caused us to abandon this treatment. The advantages of the subclavicular approach to first rib resection are as follows: (1) The operation is easy and fast. (2) There is good visibility in the operative field. (3) The neurovascular bundle to the arm lies cephalad and out of harm's way. (4) The complication (infection) rate is very low. (5) The operation allows adequate resection of the first rib. (6) The operation allows the addition of upper extremity sympathectomy. The disadvantage is the position of the scar in a young woman, although lateral placement of the scar does not seem to cause much emotional trauma.
Subject(s)
Cervical Rib Syndrome/surgery , Ribs/surgery , Thoracic Outlet Syndrome/surgery , Adolescent , Adult , Aged , Brachial Plexus , Clavicle , Female , Humans , Male , Methods , Middle Aged , SyndromeABSTRACT
We believe that proximal thoracic duct ligation is a relatively simple yet conclusive means of control of chylothorax. One should still attempt conservative management of the lesion with aspiration therapy, tube thorocostomy and the adminstration of medium length triglyceride fatty acid diets. However, if this is not successful within two to three weeks, one should not wait for disastrous nutritional degeneration before recommending this form of surgical intervention.
