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Reoperation for thoracic outlet syndrome
1Department of Surgery, Kennestone Hospital, Marietta, Georgia.
The Journal of Cardiovascular Surgery
|May 1, 1989
Summary
Reoperation for thoracic outlet syndrome (TOS) addresses severe pain from scar tissue. Key surgical strategies include removing causes of recurrence, nerve decompression, and using membranes to prevent scarring.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Vascular Surgery
Background:
- Recurrent thoracic outlet syndrome (TOS) causes severe arm, shoulder, and neck pain.
- Scar tissue fixation of the brachial plexus is a common cause of TOS recurrence.
- Identifying upper tract (neck) or lower tract (thoracic outlet) recurrence is crucial.
Purpose of the Study:
- To present clinical history and operative findings in 60 patients undergoing reoperation for TOS.
- To outline causes of TOS recurrence discovered during surgery.
- To discuss surgical management principles and adjuncts for recurrent TOS.
Main Methods:
- Review of clinical data and operative findings in 60 patients with recurrent TOS.
- Identification of causes of recurrence, including scar fixation.
- Surgical techniques: neurolysis, nerve coverage with fat, and use of expanded PTFE (Gore-Tex) membrane.
Main Results:
- Scar fixation of the brachial plexus was a primary finding in recurrent TOS.
- Surgical principles focused on eliminating recurrence causes and thorough nerve decompression.
- Expanded PTFE membrane use was discussed as an adjunct to prevent scarring.
Conclusions:
- Effective management of recurrent TOS requires addressing specific causes of recurrence.
- Thorough neurolysis and nerve protection are essential surgical steps.
- Surgeons must be prepared for potential intraoperative complications like nerve injury and bleeding.