Surgery

The patient was taken to the operating room for resection of the left cervical rib and first rib through a supraclavicular approach.
For more surgery pictures, click here!
*Pictures may be graphic

A 1^st rib resection is usually only done as a last resort, or when there is an obvious vascular obstruction. Another situation that may require surgery would be if the patient has cervical ribs or "extra" ribs that are causing vascular and/or neurological compression in the brachial plexus (shoulder region). This surgery is typically performed one of 2 ways. Through the armpit (trans-axillary approach) or from above the collar-bone (cervical approach).

Trans-axillary approach – First, an incision will be made under your armpit (usually about 2 inches). Then they will tunnel up to the 1st rib, which is located under your collarbone. Once in position, they will cut off the bone at the sternum and proceed to do the same in the back. They also have to cut what scalene muscle is attached to the 1st rib. Some doctors leave the muscle to atrophy and some completely remove it.

Cervical approach - The procedure is the same, only it is done through an incision above the collarbone.

There are different risks with each approach to the surgery. With the Trans-axillary approach, there may be a greater risk of a punctured lung, although, this is a risk either way. You will also most likely have more pain and a longer recovery time with this approach because the muscles will need to be stretched considerably far, as they tunnel through to the 1st rib. However, the scar will be less visible as it is under your arm. With the cervical approach, there is less muscle and tissue damage, but a greater risk of hitting a vein or artery with the incision made directly above the vein passage. Your surgeon will decide what he/she is most comfortable with and should discuss the risks and benefits of the different approaches with you.

Surgery Tips

Learn the pain scale and be prepared to use if after surgery. This will help the doctors and nurses to keep your pain level manageable. (Pain scale is 0-10, 0 being no pain and 10 being the worst imaginable pain.)
Try not to take so many drugs after surgery that you are in no pain. If you have little or no pain, it will be easier to do too much and re-injure yourself, setting back your recovery time. Keep the pain at a manageable level but enough so that you have to take it easy! Give your body time to heal.
If travelling out of state for surgery, bring lots of pillows. It is important to be able to rest comfortably after surgery. Most hotels are not known for their plush, comfy pillows!
Try to keep moving the arm. You will most likely lose a lot of range of motion after surgery, but the sooner you get it moving, the easier it will be to regain full motion. Remember to stay in a pain free range! In the shower is a good time to do these exercises because your muscles are warm.
If helpful, use ice or heat to relieve pain and swelling.
Keep lotion or vitamin E oil on your scars to help keep them soft and pliable. Vitamin E oil can also help to fade the scar more quickly.
When out in public places, wear a sling. It may give your arm more support, but more importantly, it will tell others to stay away! You do not want to get bumped after surgery. People see a sling and will most likely try to avoid bumping you.
Because of the loss of scalene muscle attached to the 1st rib, it is quite common for the head to feel very heavy! Try to rest often while the other muscles in the neck learn to take over.
Desensitization is a must!!! You need to be touching the surgery area as much as possible. Use your hand, a washcloth, body brush, sponge, blanket...etc. Try to get different textures of things. Gently rub them on the area (or have someone do it for you) as often as possible and for at least 10 minutes at a time. Hand-held massage wands are also very helpful. They are about a foot long and have a ball on the end. Your goal will be to put the ball directly up against your armpit. It will take a long time to get to that point. Until then, put a blanket, towel, etc...in between the massager and your skin. Turn it on low and leave it there for 15 minutes. You should feel it tingling all the way down your arm. You might even have to start with it just vibrating the pillow you are resting your arm on. This is very normal!! The armpit is where all the nerves pass through for your arm, which makes it a great location for this desensitization technique!! If at all possible, wear tighter fitting clothes too. The constant rubbing on the area will desensitize it much faster. These techniques will help to calm the nerve down quickly by getting them used to touch. Try to do these several times a day.
Have clothes that are easy to put on. You will most likely not be able to get something over your head, so button-up or zip tops are a must!
Chest tubes are very common during a rib resection. Talk to your doctor beforehand to learn about this procedure.
Freeze meals ahead of time in microwave safe containers. You won’t feel like cooking for a while. This way, you can have home cooked meals without the hassle!
Bags of frozen peas work great as ice bags.
Put all necessary phone numbers in one spot so you or your family can find them easily.
Try and get your pain prescription before you’re released so family members can have it filled and waiting for you when you get home.
Make sure you have someone that can stay with you full time for at least the first 2-3 days - you will need it
Bring clothes that are easy to get in and out of to the hospital. You will need to wear something when you go home!! Slip-on shoes are also recommended.
Have the house as neat as possible before you have surgery. You won’t be up to cleaning for a while.
Have a place set up at home where you can spend your recovery. Make sure that you have easy access to whatever you might need. (Ex. TV, remote, pillows, etc…)
Don’t overdo it. This will be a slow recovery. Get plenty of rest and let your body heal!

Disclaimer:
This information was not put together by a medical professional.
Please see a doctor for proper diagnosis.