1st Rib Resection Flashcards
What is Thoracic Outlet Syndrome?
Compression of the Subclavian Vessels and Brachial Plexus at the Thoracic Outlet
What can cause Thoracic Outlet Syndrome?
Boney/muscular abnormalities cause opening between Clavicle and First Rib to decrease
What are the symptoms of Thoracic Outlet Syndrome?
- Pain
- Edema
- Cramping
- Paresthesia
- Paget-Schroetter Syndrome
What is the leading symptom for surgical management of Thoracic Outlet Syndrome?
Paget-Schroetter Syndrome
What is Paget-Schroetter Syndrome?
Axillary-Subclavian Vein thrombosis from strenuous and repetitive activity of an upper extremity
-Occlusion of Subclavian Vein when arm is over 90 degrees
What procedure is done to correct Thoracic Outlet Syndrome?
First Rib Resection
-Removal of first rib to release compression
What are the two approaches to a 1st Rib Resection?
- Supraclavicular (arterial lesion)
- Transaxillary (venous/nervous lesion)
Which approach to a 1st Rib Resection is the most common and why?
Transaxillary approach is most common
-Safer because you don’t dissect the subclavian artery
What is Patient Positioning for a Transaxillary 1st Rib Resection?
- Lateral with operative side up
- Operative arm abducted in Machleder retractor
What instrument should be used to transect the Anterior Scalene muscle during a 1st Rib Resection?
Bipolar diathermy
-You don’t want the muscle to contract
Which muscle in the Thoracic Outlet is associated with Brachial Plexus compression?
Middle Scalene muscle
What is used to blunt dissect the Pleura off of rib?
Kittner (Cotton ball on a Kelly Clamp)
Where is the 1st Rib transected?
At the Costochondral Junction
What structure must be identified prior to transecting the 1st Rib from its attachment at vertebra T1?
Identify and protect the T1 nerve root
What type of drain used after a 1st Rib Resection?
10F Jackson-Pratt Drain
