BackgroundSurgical treatment of thoracic outlet syndrome (TOS) is necessary when non-surgical treatments fail. Complications of surgical procedures vary from short-term post-surgical pain to permanent disability. The outcome of TOS surgery is affected by the visibility during the operation. In this study, we have compared the complications arising during the supraclavicular and the transaxillary approaches to determine the appropriate approach for TOS surgery.MethodsIn this study, 448 patients with symptoms of TOS were assessed. The male-to-female ratio was approximately 1:4, and the mean age was 34.5 years. Overall, 102 operations were performed, including unilateral, bilateral, and reoperations, and the patients were retrospectively evaluated. Of the 102 patients, 63 underwent the supraclavicular approach, 32 underwent the transaxillary approach, and 7 underwent the transaxillary approach followed by the supraclavicular approach. Complications were evaluated over 24 months.ResultsThe prevalence of pneumothorax, hemothorax, and vessel injuries in the transaxillary and the supraclavicular approaches was equal. We found more permanent and transient brachial plexus injuries in the case of the transaxillary approach than in the case of the supraclavicular approach, but the difference was not statistically significant. Persistent pain and symptoms were significantly more common in patients who underwent the transaxillary approach (p<0.05).ConclusionThe supraclavicular approach seems to be the more effective technique of the two because it offers the surgeon better access to the brachial plexus and a direct view. This approach for a TOS operation offers a better surgical outcome and lower reoperation rates than the transaxillary method. Our results showed the supraclavicular approach to be the preferred method for TOS operations.

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In an eight year period, 12 patients were treated by the contra-lateral medial pectoral nerve as motor nerve innervation of the transplanted free gracilis muscle to the paralytic upper limb. The gracilis muscle was used for both elbow and digital flexion. Results were assessed by the MRC grading system and success was defined as muscle strength of M4 and M3 which was observed in seven patients (58%). The motor level of the muscle in two patients was M0 and in two it was M1 to M2. The donor pectoral muscle of these 12 patients showed no deficit in motor and sensory functions. This method can be used for treatment of brachial plexus palsy, regaining useful function of the reconstructed limb.