Consent: Cervical Rib Excision - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent. Overview of Procedure Thoracic outlet syndrome refers to compression of the nerves, arteries, and veins that pass through the thoracic outlet, by the bones and/or muscles. This may cause neurogenic, venous or arterial problems. It may occur due to trauma, a cervical rib, a fibrous band, anatomical variability, or muscle hypertrophy. Surgical treatment can involve removal of a cervical rib or even the 1st rib. Complications Intra-Operative Complication Description of Complication Potential Ways to Reduce Risk Haemorrhage This can occur due to damage to either the axillary artery or the vein or its branches, and may require blood transfusion. Injury to surrounding structures The brachial plexus passes through the operative field and must be carefully dissected. Anaesthetic risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation Early Complication Description of Complication Potential Ways to Reduce Risk Pain The patient will essentially have a broken bone, therefore it will be painful. Local anaesthesia will be used during the procedure. Bleeding There is a small chance of bleeding and bruising post-surgery. Infection Superficial wound infection is possible, although rare in this case. Peri-operative antibiotics will reduce the risk of wound and graft infections Scarring A transverse incision both above and below the rib will result in a scar, which can form a keloid scar. Seroma A swelling of lymphatic fluid may occur due to disruption of the lymph nodes and channels. Careful dissection of the lymphatic nodes and channels with ligation will minimise this risk. Blood clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate. Persistent symptoms Due to the complex nature of thoracic outlet syndrome, surgery may not completely resolve symptoms. Pneumothorax This occurs in approximately 10% of patients due to the proximity of the rib to the pleura. Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery. Late Complication Description of Complication Potential Ways to Reduce Risk Reintervention Occasionally persistent symptoms may occur, requiring potential further rib excision. Frequent questions What is thoracic outlet syndrome and how is it related to cervical rib excision? Thoracic outlet syndrome is a condition caused by the compression of nerves, arteries, and veins at the thoracic outlet, often due to anatomical variations like a cervical rib. Surgical intervention, such as cervical rib excision, may be necessary to alleviate symptoms associated with this syndrome. What are the common complications associated with cervical rib excision? Common complications of cervical rib excision include haemorrhage, injury to surrounding structures like the brachial plexus, and anaesthetic risks. Other potential issues include pain, bleeding, infection, scarring, and the formation of seromas. How can the risk of complications during cervical rib excision be minimised? To reduce the risk of complications, careful dissection of the brachial plexus and lymphatic structures is essential. Additionally, administering peri-operative antibiotics and employing strategies like anti-embolism stockings can help mitigate risks such as infection and blood clots. What are the early complications a patient might experience after cervical rib excision? Early complications may include pain, bleeding, and infection, with pain being expected due to bone manipulation. Other concerns, although rare, include scarring and seroma formation, which can be managed through careful surgical techniques. Can cervical rib excision completely resolve symptoms of thoracic outlet syndrome? While cervical rib excision aims to alleviate symptoms of thoracic outlet syndrome, persistent symptoms may still occur due to the complex nature of the condition. In some cases, further intervention may be necessary if symptoms do not improve. Rate This Article