At the present time several operative approaches are advocated for removing the upper thoracic sympathetic ganglia in treatment of vasospastic diseases of the upper extremity, such as Raynaud's disease. Adson and Brown1 removed the upper thoracic sympathetic ganglia through a paraspinal, extrapleural approach. Palumbo3 approached the ganglia through an anterior transpleural incision, and Crandell and Bosien2 initiated the transaxillary, transpleural approach.
In the dorsal approach of Adson and Brown1 exposure is accomplished by incision and retraction of the heavy musculature between the scapula and the spine, with removal of one or more of the transverse processes in the upper thoracic area. This procedure presents the following disadvantages:
1. Respiration during anesthesia is markedly handicapped with the patient in the face-down position.
2. The necessity of removing the transverse process to expose the ganglia adequately may, in its removal, distort or destroy existing anatomic sympathetic relationships.
CROWLEY RT, ECONOMY DE. Extrapleural Posterolateral Approach for Upper Thoracic Sympathectomy: A Preliminary Report. AMA Arch Surg. 1957;74(6):974–977. doi:10.1001/archsurg.1957.01280120152018
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