Cervical Rib-Rib Excision- Sternum and Marrow Biopsy

Cervical Rib

A cervical rib (i.e., a rib arising from the anterior tubercle of the transverse process of the 7th cervical vertebra) occurs in about0.5% of humans. It may have a free anterior end, may be connected to the 1st rib by a fibrous band, or may articulate with the 1st rib. The importance of a cervical rib is that it can cause pressure on the lower trunk of the brachial plexus in some patients, producing pain down the medial side of the forearm and hand and wasting of the small muscles of the hand. It can also exert pressure on the overlying subclavian artery and interfere with the circulation of the upper limb

Rib Excision

Rib excision is commonly performed by thoracic surgeons wishing to gain entrance to the thoracic cavity. A longitudinal incision is made through the periosteum on the outer surface of the rib, and a segment of the rib is removed. A second longitudinal incision is then made through the bed of the rib, which is the inner covering of periosteum. After the operation, the rib regenerates from the osteogenetic layer of the periosteum.

Sternum and Marrow Biopsy

Since the sternum possesses red hematopoietic marrow throughout life, it is a common site for marrow biopsy. Under a local anesthetic, a wide-bore needle is introduced into the marrow cavity through the anterior surface of the bone. The sternum may also be split at operation to allow the surgeon to gain easy access to the heart, great vessels, and thymus.