First Rib Resection

In cases of severe thoracic outlet syndrome (neurological, venous or arterial) it may be necessary to decompress the thoracic outlet with an operation. This is achieved by dividing some of the muscles inserting into the first rib and then removing a segment of the first rib.

The first rib is a small rib which does not play a significant role in breathing and can be removed without compromising the function of the rib cage.

The procedure is performed under general anaesthesia. The operation may be performed through an incision in the armpit, or more commonly around the collar bone. Once the operative site has been sterilised and the drapes placed, the incision is made. This is deepened through the fat and soft tissues. The muscles (including Scalenus Anterior) attached to the rib are identified. There are several important nerves around these muscles which are protected.

The Scalenus Anterior muscle is divided, exposing the major artery and nerve plexus of the upper limb. By dividing the muscle, this already significantly decompresses the thoracic outlet.

The artery, vein and nerves are protected and the rib is carefully freed from the adherent soft tissues. The first rib is then carefully divided at the front. The rib is then divided further back and a segment removed, often in pieces. This exposes the tough fascia (Sibson’s Fascia) which covers the top of the lung, and decompresses the thoracic outlet. The Subclavius muscle is also divided to ensure complete decompression.

The area is then washed and checked for haemostasis. A small drain is usually placed. The wound is then closed in layers and an invisible dissolving suture placed to close the skin.

Post Operatively, you will be carefully monitored in recovery and the ward.

The procedure is usually safe but there are some potential complications. These include anaesthetic complications including heart problems, stroke, pneumonia and death. These are rare. There are also surgical complications including bleeding, infection, nerve damage, arterial damage, a collection or leakage of clear lymph fluid, and other less common complications. One complication specific to the operation is a collection of air between the lung and the inside of the rib cage. This is called a pneumothorax and may need a chest drain to correct.

For Post Operative Instructions click here.