Surgery

First Rib Resection

The patient was taken to the operating room for resection of the left cervical rib and first rib through a supraclavicular approach.	The incision was made transversely, starting three centimeters above the medial third of the clavicle, extending laterally to the anterior border of the left trapezius.	The platysma was opened and the external jugular vein was isolated and divided.
The clavicular head of the sternocleidomastoid muscle was divided and the underlying scalene fat pad was dissected from lateral to medial.	The anterior scalene muscle was exposed and the medial cord of the brachial plexus was encircled with a vessel loop and gently retracted laterally.	The subclavian artery was encircled with a vessel loop and retracted medially. The area was carefully explored, and the left phrenic nerve was not seen within the operative field, probably because of an aberrant course due to the variant anatomy. The anterior scalene muscle was carefully divided, exposing the first rib.
The first and second rib were cleared of intercostal attachments and resected with small bites of a double action rongeur. The periosteum was taken with the bone to prevent bony regrowth.	The cut end of the first rib is visible between the subclavian artery and brachial plexus.	The completed resection is shown.

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