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After incising the skin, superficial tissue and platysma, the investing layer of the deep cervical fascia will be exposed. It is incised and the lateral border of the stemomastoid is retracted medially to expose the scalenus anterior muscle lying behind the stemomastoid. When the scalenus anterior muscle is exposed, a careful search should be made for the phrenic nerve, which lies in front of the scalenus muscle but behind the prevertebral fascia.

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The phrenic nerve is protected and the insertion of the buy Dapoxetine not injured. The brachial plexus is retracted gently downwards and forwards and the scalenus medius muscle is defined. The cervical rib is cleared off all attachments and the pleura must be safe-guarded. The rib is next disarticulated from the transverse process of the seventh cervical vertebra or is divided as far posteriorly as possible.

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