Figure 3.

A 55-year-old male underwent left transaxillary partial first rib resection and anterior scalenectomy elsewhere (patient no. 12 in Table 7). He presented 5.7 years after the surgery with weakness of the left upper extremity (a) and pain which was aggravated during manual work. Exploration revealed severe scarring in the supraclavicular area and hardness in palpation of the entire plexus. Most severe fibrosis was observed in the C8, T1 roots, and lower trunk (b). Reconstruction included extensive neurolysis of the entire brachial plexus, removal of fibrotic bands, anterior and middle scalenectomy, and resection of remnants of the 1st rib (c). At the last office visit, the patient experienced improvement of upper extremity function and intermittent pain which was well tolerated (good result; d).