Sympathectomy of the Upper Extremity

For a long time the standard sympathectomy of the upper extremity consisted of cervicodorsal ganglionectomy—removal of the inferior cervical and first and second dorsal ganglions. In 1934, Freeman, Smithwick and White1began a series of studies which led to the employment of preganglionic sympathectomy in the treatment of Raynaud's disease of the upper extremity.2This was based on the proposition that the standard cervicodorsal ganglionectomy being postganglionic renders the vessels of the extremity more sensitive to circulating epinephrine. In 1936, Smithwick3proposed a preganglionic sympathectomy to be carried out as follows: The dorsal sympathetic chain is severed below the third dorsal ganglion. All rami to and from the second and third ganglions are severed, and the proximal end of the chain is sutured into the muscles of the back to insure against regeneration. To insure complete ramisectomy, segments of the second and third intercostal nerves are removed