[painfueled]

Dear new forum friends,
I'm popping my forum-posting cherry because popping Flexeril is seemingly a Fail. Sigh.
One year, one long list of doctors and one awesome career ago - I was diagnosed with Neurogenic TOS. In about 12 hours I will be officially 7 days post-op and while I was hardly expecting a trip to Disneyland, right now I'd settle for a coin operated bed that's out of order.

Initially, my surgeon gave me 3 options:
1. Transaxillary approach
2. Supraclavicular approach
3. Agree to be part of a study they are conducting and let them choose for me (between 1 and 2) at random.

He told me to think it over and in the meantime, sent me for more x-rays. At my next appointment, he reviewed the x-rays with me and stated that he will definitely need to remove the first rib along with performing a scalenectomy and while the point of entry was still my decision - he tends to prefer supraclavicular when first rib resection is required. I chose supraclavicular.

Post-op, he spoke with my family in the waiting room and just said he felt strongly that everything went very well. He repeated these sediments to me directly once I woke, and visited me daily. I had a drain from the incision above my clavicle, which nurses checked/emptied hourly. Upon release, I was told to let the wound dressing above my clavicle fall off on it’s own, along with the gauze placed over the drain hole, and scheduled a follow-up in 3 weeks.

Today - a week later - I noticed my armpit was feeling sore, as if it had a lump or bruise. I reached into my shirt to touch it and to my surprise - found a 3” incision in my armpit that is raised at least 1/2”. I went through all of my paperwork again, frantically, trying to figure out how I missed the memo on being cut in both places, I found nothing. I called the family member who's been the point of contact since the day of my surgery and asked her if she knew about the armpit incision and she was equally unaware.

What the cut:
1. Not once was I ever told (over the last 7 months of planning this surgery) that 2 incisions (during operation #1) were a possibility.
1b. I was only advised that if I had chosen the transaxillary approach for my initial operation and required an additional surgery later on to remove scar tissue, the second operation would have to be supraclavicular and I could end up with nerve damage in both locations unnecessarily.
2. Not once did a nurse or doctor examine the armpit incision, or mention it when reviewing home care instructions with my family.

I completely understand that things can change during an operation and whatever needs to be done to ensure my well-being, will be done. However, I am beside myself over the non-disclosure issue that this seemingly presents. I feel violated, and rather devastated quite frankly. I have searched endlessly online for the content needed to participate in this very important discussion, but even Google is miffed.

In short (a reach, I know) - has anyone else been given scenarios (or aware of) that would require both a supraclavicular AND transaxillary incision for neurogenic TOS while on the table? For realz ... once I authorized the insurance submittal - my experience with this surgical team has been almost comical, but without the laughs, and I've been willing to overlook their blond moments because my eyes were bound to the prize. This little sit-eeation, however, is like awarding Oscar's to the entire Baywatch cast!

[Sea Pines 50]

So much of this depends on the individual surgeon's preference as well as, as you say, what he or she may discover while you are on the table in terms of how involved the first rib is, say, or how to best extract the entire rib (it is key not to leave any portion in, as that can cause more problems down the road and can even grow back in some cases!).

There are top docs doing TOS surgery who will first perform the first rib resection only; going back in for a scalenectomy only if symptoms recur afterwards. Typically, the claim is made that only about 25% of TOSers will need the second "re-do" surgery. Other top docs are "soft tissue" guys - the first surgery will be a scalenectomy (performed supraclaviculary) only, with the rib only taken if sx recur or it becomes obvious during the scalenectomy itself that the rib must be extracted. Then there are surgeons like your guy (apparently!), who routinely do both a first rib resection and a scalenectomy at the first go-round. I believe Dr. Donahue (sp), who is the "flavor of the month" on this forum, does things this way, just like your surgeon ultimately did.

I have heard that the transaxillary approach is the best approach for a first rib resection, but that it is difficult to do a complete scalenectomy without using the supraclavicular approach. In your case, perhaps since both the first rib resection and the scalenectomy were needed, you got a double whammy.

Who is your surgeon? If I were you I would try not to become too upset about this. I think you will find that both incisions will heal nicely and not leave you with noticeable scars. But I understand your point: The surgeon should have told you that both approaches might be necessary in your case to do the best job possible for you.

Your best bet would be to contact the surgeon's nurse asap and tell them your concerns. Ask to have the surgeon call you directly, and also request a copy of the surgical report (which could also clear some of this up). You don't need this aggravation hanging over your head while trying to heal from major neurovascular surgery.

I've had a left first rib resection only, for which I traveled to Denver for Dr. Annest to perform using a transaxillary approach. If I have to have a re-do at some point in the future, then the surgeon will definitely have to go in supraclavicularly in order to extract whatever's left of my L anterior scalene muscle as well as the middle scalene muscle, which Annest reattached to the cut end of the first rib. (He is the only TOS surgeon I know of who does this - they all have their favorite way of getting the job done I guess.)

If you're not doing it already, get a couple bags of frozen peas and place one over each incision when you're lying down or in a recliner. That will really help with any inflammation or localized pain you're still having from your very recent surgery. Also, I would ask the surgeon if he would write you a 'script for valium instead of the Flexeril if that is not working for you and your muscles are in spasm. It just works better short-term imo.

Others will no doubt chime in with their own takes on this. I wish you a speedy recovery and a lot of success with your post-surgical outcome. This stuff ain't none of it easy, Friend! Please do stick around and keep posting.

[Jomar]

I would be a bit put off that this second site was not checked or mentioned at all??

I'd definitely call Dr office and /or hospital and ask about it, and ask about care of this second site also..

[painfueled]

Originally Posted by Jo*mar

I would be a bit put off that this second site was not checked or mentioned at all??

I'd definitely call Dr office and /or hospital and ask about it, and ask about care of this second site also..

That's my biggest concern - a whole week went by before I "found" this second incision. thank you kindly for your response!

[Eight]

Originally Posted by painfueled

That's my biggest concern - a whole week went by before I "found" this second incision. thank you kindly for your response!

Who was your surgeon? Dr. Annest? I was offered the same study. The scar in the armpit was likely a pec minor release. Call and talk to the doctors nurse, she can let you know what's up.

Put neosporin with pain reliever on your surgical scars like mad. I had a pec minor release in December, and my scars are as pretty as can be.

[nospam]

Originally Posted by Eight

The scar in the armpit was likely a pec minor release.

That was going to be my guess. OP, what did you learn to be the case?