Over a 20 year period, 60 patients underwent 76 procedures for upper dorsal
sympathectomy, usually with a transaxillary approach but occasionally with an anterior approach. Procedures in male patients and in those that were carried out on the right side were most frequent. There were few simultaneous procedures. The extent of
sympathectomy included resection of the lower half of the stellate ganglion through the fourth thoracic
ganglion. The results were satisfying for patients with vasospastic disorders and
hyperhidrosis and quite acceptable for those with
causalgia and vaso-occlusive disorders. Complication rates and the incidence of postoperative
Horner's syndrome were low. There were prominent differences in results among the various age groups. In addition, female patients and those with bilateral procedures had less favorable results. Factors that did not appear to affect results included technique of surgical approach, extent of
sympathectomy, presence of
Horner's syndrome, or the addition of other procedures. Current indications for upper dorsal
sympathectomy include cases of Raynaud's and Buerger's diseases refractory to
drug therapy,
causalgia, vaso-occlusive disorders, and
hyperhidrosis.