Shock, Trauma and the Surgeon

The place of upper dorsal sympathectomy in the treatment of primary raynaud's disease

“…It is well known that this varies from patient to patient and from one side of the body to the other (Ray, Hinsey, and Geohegan, 1943). Felder and others (1949), Peacock (1960)~ and Simeone (1963 have noted that relapse is always associated with return of sympathetic nervous activity, albeit short of the preoperative level. Ray (1953) and Goetz (1959) have suggested that sympathectomy should extend from the middle cervical ganglion downwards to include D2 or 3 ganglia in order to achieve complete denervation and to prevent reorganization of sympathetic pathways or 'sprouting' of intact adjacent fibres.…”

“…The addition of total stellate 28 RAYNAUD'S DISEASE 429 ganglionectom y, and possibly middle cervical ganglionectomy (Goetz, 1959), may be worth while, but the inherent nuisance of Horner's syndrome probably renders this unjustifiable in the less severe forms of the disease. Of alternative forms of treatment, Peacock (1960) has suggested a regime which appears to be beneficial in some patients, although our experience with it in a small group of cases has not been encouraging (Slaney, 1964). Should this treatment fail to achieve any benefit the only remaining alternative is the use of one or more of the many vasodilator drugs at present available.…”