Supraclavicular first rib resection.

A supraclavicular approach will facilitate brachial plexus decompression and first rib resection. It allows the surgeon a complete visualization of all the neurovascular elements and removal of the first rib. In particular, under direct vision, the most posterior aspects of the first rib can be easily visualized and removed. During this dissection, care is taken to preserve the supraclavicular nerves. The technique of opening the pleura to allow drainage into the pleural cavity rather than around the brachial plexus will decrease postoperative scarring around the neural elements. Similarly, gentle but early postoperative movement of the head, neck, and upper extremity is encouraged in order to minimize scar formation around the brachial plexus.