[Reprinted from The Medical News, Jan. 8, 1898.] 
EXCISION OF THE RIGHT CLAVICLE FOR 
OSTEOSARCOM A. 
GEORGE TULLY VAUGHAN, M.D., 
OF WASHINGTON, D. C.; 
PASSED-ASSISTANT SURGEON, U. S. M. H. S.; PROFESSOR OF PRIN- 
CIPLES AND PRACTICE OF SURGERY IN GEORGE- 
TOWN UNIVERSITY’, 
W, S., American, aged twenty-eight years, was ad- 
mitted to the marine ward of the German Hospital, Phil- 
adelphia, October 15, 1895. His family history was 
negative, and he denied all venereal diseases and rheuma- 
tism. During March, seven months before admission, he 
began to complain of pain situated in the right clavicle. 
Shortly afterward enlargement of the bone became ap- 
parent. The pain was of a dull aching character, often 
radiating to the chest and mastoid process on the right 
side, and was aggravated by use of the arm. On exam- 
ination, the inner two-thirds of the clavicle was found to 
consist of a hard, spindle-shaped tumor, extending to 
within 2}4 cm. of the joint. The right external jugular 
vein was distended. 
October 22d, under ether anesthesia, the entire right 
clavicle, with the tumor, was removed by an incision ex- 
tending along the bone from one end to the other, dis- 
jointing the acromial end first, dissecting the tumor loose 
from the surrounding parts, and last, disarticulating at 
the sternoclavicular articulation. The tumor was broken 
through while using the bone as a lever in separating its 
sternal attachments. To control the hemorrhage, it was 
necessary to apply over twenty ligatures. To prevent 
dropping of the shoulder, the detached portions of the 
trapezius and sternocleidomastoid muscles above were 
carefully sutured to corresponding portions of the deltoid 
and pectoralis major muscles below. The wound was closed with catgut sutures, leaving an opening in the 
middle for a gauze drain, and the dressing was applied, 
with the arm in the Velpeau position. 
Subsequent to the operation, the highest tempera- 
ture was 102.20 F., which continued for one day only 
Fig. i. 
Showing site of operation and resulting deformity after excision 
of the clavicle. 
Fourteen days after the operation the patient was out of 
bed. The wound healed by primary union, except at 
two points, one in the middle and one at the outer end, 
which healed by granulation. Forty-one days after the 
operation the patient was discharged. There was no de- 
formity and no interference with the function of the arm. 
The tumor measured 11.25 c.cm. in circumference, and, 
on microscopic examination, was pronounced a mixed-cell ■sarcoma. The accompanying illustration shows the con- 
dition of the parts one year subsequent to the operation, 
and it will be seen that there is absolutely no deformity 
except the absence of the clavicular prominence on the 
right side. During the interval he had been performing 
his accustomed work as fireman on a steamboat, and 
stated that he felt no inconvenience from the loss of the 
clavicle, his arm being free from pain and as strong as 
ever. With his clothes on there was no evidence of drop- 
ping of the shoulder, and after stripping it was barely 
perceptible—not more than one centimeter—which is no 
-more than is often observed in the normal individual. 
Excision of the entire clavicle seems to be a rare opera- 
tion, though partial excision is comparatively common. 
Professor Ashhurst up to 1893, had been able to collect 
but 36 cases of the complete operation at one sitting, fol- 
lowing which there were 7 deaths, a mortality of nearly 20 
per cent. It seems that Dr. Charles McCreary did the 
first complete excision in 1813, removing the right clavicle 
from a boy of fourteen, with scrofulous caries; that of 
Remmer in 1732, given by Gross as the first operation, 
having been, according to Ashhurst, a partial excision. 
The same author gives the mortality from partial excision, 
or excision a deux temps, in 76 cases as a little over 14 
per cent. The celebrated operation of Dr. Mott,1 per- 
formed during 1828, for sarcoma of the left clavicle, which 
required nearly four hours for its performance, and in 
which forty ligatures were employed, was a case of partial 
excision, though from the size of the tumor and the part 
of the clavicle removed—the inner end—was really a more 
formidable operation than the majority of cases of com- 
plete excision. Dr. Mott referred to it as his “ Waterloo 
operation,” and said that it was without a precedent, and 
far surpassed in tediousness, difficulty, and danger any- 
thing he had ever witnessed or performed. 
1 A7nerican Journal of the Medical Sciences, January, 1883.