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The microcirculatory effects of peripheral sympathectomy
L A Koman1, B P Smith, F E Pollock
1Department of Orthopaedic Surgery, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27157-1070, USA.
The Journal of Hand Surgery
|September 1, 1995
Summary
Peripheral sympathectomy improved blood flow and reduced pain and ulcers in patients with severe hand conditions. This surgery enhanced nutritional flow, aiding recovery from vasospasm and occlusive disease.
Area of Science:
- Vascular Surgery
- Microcirculation Physiology
- Peripheral Artery Disease
Background:
- Patients with refractory pain and ulceration due to secondary Raynaud's phenomenon and occlusive arterial disease often have limited treatment options.
- Microvascular dysfunction, including vasospasm and abnormal arteriovenous shunting, contributes to ischemic symptoms in the extremities.
Purpose of the Study:
- To evaluate the impact of peripheral sympathectomy on microvascular physiology in patients with severe hand pain and ulceration.
- To correlate microcirculatory flow responses with clinical outcomes, including pain reduction and ulcer healing, after sympathectomy.
Main Methods:
- Serial isolated cold stress testing (ICST) was used to measure digital temperature and cutaneous perfusion (laser Doppler fluxmetry).
- Microcirculatory responses were assessed before and at multiple time points after peripheral sympathectomy (2-8 weeks, 12-15 weeks, 24 weeks).
- Baseline data from patients (n=7) were compared with control subjects (n=7 extremities).
Main Results:
- Following sympathectomy, all patients reported diminished pain, and six out of seven experienced ulcer healing or reduction.
- ICST revealed abnormalities in temperature and laser Doppler fluxmetry responses in patients compared to controls, persisting post-surgery.
- While total flow (temperature) did not significantly increase, peripheral sympathectomy enhanced nutritional blood flow to ischemic areas.
Conclusions:
- Peripheral sympathectomy effectively improves clinical symptoms, including pain and ulceration, in patients with vasospastic and occlusive arterial disease of the hand.
- The therapeutic benefits are attributed to the correction of abnormal arteriovenous shunting and improved nutritional blood flow to ischemic tissues.
- Sympathectomy represents a viable surgical option for managing refractory microvascular dysfunction in the upper extremities.