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Thoracic outlet compression syndrome. Critique in 1982

W A Dale

    Archives of Surgery (Chicago, Ill. : 1960)
    |November 1, 1982
    PubMed
    Summary
    This summary is machine-generated.

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    Surgical treatment for thoracic outlet compression syndrome has variable outcomes and risks of serious neurologic injury. Reserved for last resort, scalenectomy may be preferred over first-rib resection for persistent symptoms.

    Area of Science:

    • Neurosurgery
    • Vascular Surgery
    • Thoracic Surgery

    Background:

    • Thoracic outlet compression syndrome (TOCS) presents diagnostic challenges and varied surgical outcomes.
    • Transaxillary first-rib resection is a common surgical approach for TOCS.

    Observation:

    • A review of 76 patients showed mixed results, with 55% excellent, 35% good, and 9% failure.
    • National survey data revealed significant postoperative brachial plexus injuries (273 cases) following first-rib resection, with 52 incomplete recoveries.

    Findings:

    • The variability in outcomes and potential for severe neurologic sequelae necessitate a reevaluation of TOCS surgical indications and techniques.
    • Scalenectomy, when performed comprehensively (not simple division), shows promising results and should be considered, potentially reserving first-rib resection for refractory cases.

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    Implications:

    • Surgical intervention for TOCS should be considered a last resort due to inherent risks and variable efficacy.
    • Further research into optimal surgical techniques and patient selection is warranted to improve outcomes for TOCS patients.