Part of the TeachMe Series

Consent: Cervical Rib Excision

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Original Author(s): Ollie Jones
Last updated: February 14, 2019
Revisions: 10

Original Author(s): Ollie Jones
Last updated: February 14, 2019
Revisions: 10

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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.