Operative Report

For a year they couldn't figure out what was wrong, then I got tentatively diagnosed with a pretty rare and highly misunderstood: Thoracic Outlet Syndrome. For more information about the diagnostic process, I have abridged two of the DOCTOR'S LETTERS. One who ended up doing the surgery, and the other, writes a humorously verbose letter. I find it hilarious (in my weird textual sense of humor) the way he tries to cover all his ground.

After about four or five months of physical therapy with two different therapist's approaches, I still wasn't better. I resorted to a seemingly draconian surgery based on a nebulous diagnosis because I figured, what other choice do I have? To be in chronic pain and unable to use my right hand (I am right handed) and wait for it to magically disappear didn't seem like a good option. So I risked the surgery, also because I had faith in these surgeons: Dr.Ducic and Dr.Marshall. They were planning on taking out my first rib, scalene muscle, and doing other things I couldn't recall because I don't have the medical vocabulary. See, they were going to remove those things hoping that might work because it sometimes does relieve symptoms of TOS. Turns out I made the right decision; upon opening me up they did indeed find the real cause of the pain I'd been suffering for a year and a half...





(A drawing a few weeks before the surgery)

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OPERATIVE REPORT
SURGEON: BLAIR MARSHALL

Preoperative Diagnosis: Thoracic Outlet Syndrome
Postoperative Diagnosis: Thoracic Outlet Syndrome


INDICATIONS OF THE PROCEDURE:
Patient is young woman with impingement of her brachial plexus on the level of the thoracic outlet. She was evaluated preopertively and found to be a good candidate for the first rib resection. She was aware of the risks and details associated with the procedure in fact a 50% chance of improvement of her symptoms. She was willing to proceed.



These collages I made a few weeks before the surgery, includes copies of my real X-RAYS.
If you click on em you can see em bigger.



DESCRIPTIONS OF THE PROCEDURE:
After Dr.Ducic performed the incision division of the scalenes and neurolysis of the brachial plexus, we were called into the room. The tubercle of the first rib was identified. The subclavian was retracted superiorly and we dissected onto the periosteum of the rib and then dissected circumferentially around the rib. We extended this underneath the subclavian and the brachial plexus up posteriorly to the level of insertion on the transverse process.

There was a quite strong verticle angle of the rib in this location, suggesting that it may have in fact certainly been the cause of her symptoms.

We dissected all the way to the vertbral body and then ligament was divided. Initially we transected the rib between the subclavian and brachial plexus, and then sequentially took out the posterior aspect of the first rib all the way back cleanly off the vertebral body at the level of the ligament, and then anteriorly, taking care to avoid the injury to the brachial plexus, subclavian artery, and vein, anteriorly to the level of the manubrium.

One this was done, the wound was packed. Hemostatis was obtained, and then a Penrose drain was placed and the wound was closed in laters with absorbable suture. I, Dr.Blair Marshall, was present for the entire thoracic portion of the prodecdure and responsible for the conduct of the case.



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So that's just Dr.Marshall's operative report; still waiting Dr.Ducic's. He took the scalene muscle out, re-arranged nerves and veins, clipped arteries, somethingsomething. I'd like to read it because he said some crazy stuff was going on in there and all the medical terminology slips my mind. I'd like it in writing.

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