Our Summary

This study explores how often a condition called thoracic outlet syndrome (TOS) occurs after a surgical procedure called the Nuss procedure, which is used to correct a chest deformity known as pectus excavatum. TOS usually causes numbness, fatigue, or pain in the upper limbs.

The study looked at 85 patients (58 men and 27 women) who had undergone the Nuss procedure. It found that none of the patients who were preadolescent developed TOS after surgery. However, among adult patients, 15.2% of men and 33% of women did experience TOS post-surgery.

The study also found that patients who got TOS had certain common characteristics: they had a more severe chest deformity (as measured by something called the Haller index), their chest walls were fully developed (maturity), they were more likely to be women (femininity), and the bars used to correct their deformity were usually placed at higher spaces between their ribs.

In simpler terms, the study suggests that adults, especially women, with a severe chest deformity who undergo the Nuss procedure are at a higher risk of developing TOS. The position of the bars used in the surgery also seems to play a role in the development of this condition.

FAQs

  1. What is the likelihood of developing thoracic outlet syndrome (TOS) after undergoing Nuss procedure?
  2. Are there any common characteristics found in patients who developed TOS after the Nuss procedure?
  3. Does the placement of the bars used in the Nuss procedure affect the risk of developing TOS?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about thoracic outlet syndrome surgery is to carefully discuss the risks and benefits of the Nuss procedure with your surgeon before undergoing the surgery. It is important to understand that there is a potential risk of developing TOS post-surgery, especially if you are an adult with a severe chest deformity. Additionally, make sure to follow all post-operative instructions provided by your surgeon and attend all follow-up appointments to monitor for any signs or symptoms of TOS. If you experience any numbness, fatigue, or pain in your upper limbs after surgery, be sure to notify your healthcare provider immediately.

Suitable For

Therefore, patients who are recommended thoracic outlet syndrome surgery are typically adults, especially women, with a severe chest deformity who have undergone the Nuss procedure. These patients may experience symptoms such as numbness, fatigue, or pain in the upper limbs, and may benefit from surgical intervention to relieve their symptoms.

Timeline

Before thoracic outlet syndrome surgery:

  1. Patients may experience symptoms such as numbness, fatigue, or pain in the upper limbs.
  2. Patients undergo diagnostic tests to confirm the presence of thoracic outlet syndrome.
  3. Patients discuss treatment options with their healthcare providers and decide to undergo surgery.
  4. Pre-operative preparations are made, including medical evaluations and discussions about the risks and benefits of the surgery.

After thoracic outlet syndrome surgery:

  1. Patients undergo the surgical procedure to correct the compression of the nerves and blood vessels in the thoracic outlet.
  2. Post-operative recovery begins, which may involve pain management, physical therapy, and follow-up appointments with the surgeon.
  3. Patients may experience relief from the symptoms of thoracic outlet syndrome as the nerves and blood vessels are no longer compressed.
  4. Patients may need to make lifestyle changes or modifications to prevent the recurrence of thoracic outlet syndrome.
  5. Long-term follow-up is required to monitor the success of the surgery and address any complications that may arise.

What to Ask Your Doctor

Some questions a patient should ask their doctor about thoracic outlet syndrome surgery include:

  1. What are the potential risks and complications associated with thoracic outlet syndrome surgery?
  2. Am I at a higher risk of developing thoracic outlet syndrome based on my age, gender, and severity of my chest deformity?
  3. How will the position of the bars used in the surgery impact my risk of developing thoracic outlet syndrome?
  4. Are there any alternative treatment options available for my chest deformity that do not carry the risk of thoracic outlet syndrome?
  5. What symptoms should I watch out for after surgery that may indicate the development of thoracic outlet syndrome?
  6. How is thoracic outlet syndrome typically diagnosed and treated if it does occur after surgery?
  7. What is the likelihood of needing additional surgical procedures or interventions if thoracic outlet syndrome develops post-surgery?
  8. Are there any specific exercises or lifestyle changes I can make to reduce my risk of developing thoracic outlet syndrome after surgery?
  9. How will my recovery and rehabilitation process be affected if I do develop thoracic outlet syndrome?
  10. Are there any specific precautions or measures I should take during my recovery period to minimize the risk of thoracic outlet syndrome?

Reference

Authors: Nagasao T, Morotomi T, Kuriyama M, Kogure T, Kudo H, Hamamoto Y, Tamai M. Journal: J Plast Reconstr Aesthet Surg. 2017 Oct;70(10):1433-1439. doi: 10.1016/j.bjps.2017.05.043. Epub 2017 Jun 3. PMID: 28662867