Artikel
Surgical Management of Thoracic Outlet Syndrome: A Single-Centre Review
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Autoren
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Karen Slater
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, University of Glasgow, University of British Columbia, Vancouver, Canada, Glasgow, United Kingdom
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Andrew Hart
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
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David Leonard
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Thoracic outlet syndrome (TOS) results from compression of one of more of the brachial plexus, subclavian vein, or subclavian artery as they pass from the neck into the axilla. Presenting signs and symptoms, location of compression, and responsible structures can vary. We sought to review the indications, operative findings, treatment, and outcomes for all patients treated at our centre.
Methods: A retrospective review of all thoracic outlet syndrome patients treated surgically by a single operator was performed. Patients were identified by theatre logbooks. Data was extracted via review of medical records, theatre records, and investigations.
Results and Conclusions: 32 primary procedures (7 bilateral, 7 right-sided, 11 left-sided) were performed in 25 patients (18 female) from October 2010 to September 2018. Surgical indications included one or more of sensory change (24/32), weakness (23/32), or neurogenic pain (20/32) in 31 out of 32 cases.
One case was abandoned intra-operatively due to respiratory compromise. All other patients were treated with surgical exploration, release/excision of compressive soft tissues, neurolysis, and rib resection if indicated. Compressive structures included scalene musculature, fibrotic tissues, first rib, and anomalous structures including cervical rib, with multiple involved structures documented in 29 of 31 cases.
Complications were common (19/31), with cervical plexus pain/paraesthesia occurring most frequently (12 cases, 1 refractory). Major complications (1 haemothorax, 1 pneumothorax) occurred in 2 cases. Satisfactory symptom resolution was reported by 84% of patients (26/31). 1 patient underwent surgical re-exploration for recurrent symptoms.
The operative findings demonstrate varied and multiple structures contributing to thoracic outlet syndrome. Surgical decompression is individualized according to the pathology encountered. Despite a high rate of minor complications, surgical exploration and decompression effectively treats TOS symptoms in the majority of patients.
