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Anterior Transthoracic Approach for Upper Thoracic Sympathectomy

Anterior Transthoracic Approach for Upper Thoracic Sympathectomy Abstract INTRODUCTION The most commonly employed surgical approach for a sympathectomy for the upper extremity or for relief of angina pectoris with or without coronary insufficiency is the posterior extrapleural operation of the Smith-wick type, or its modification. For sympathetic denervation of the upper extremity by this technique, a resection of a short posterior section of the third rib was accomplished with the patient in a face-down position. A portion of the second and third intercostal nerves was resected, the rami communicantes or the sympathetic chain at these levels were divided, and the sympathetic chain was likewise divided below the third sympathetic ganglion, whereas, the denervation of the heart required a more extensive resection of the upper sympathetic chain.This former posterior approach had its many pitfalls and limitations, which were mainly technical. The degree and type of exposure were usually inadequate, imposing many obstacles, particularly of performance of an operation http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

Anterior Transthoracic Approach for Upper Thoracic Sympathectomy

A.M.A. Archives Surgery , Volume 72 (4) – Apr 1, 1956

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Publisher
American Medical Association
Copyright
Copyright © 1956 American Medical Association. All Rights Reserved.
ISSN
0096-6908
DOI
10.1001/archsurg.1956.01270220107014
Publisher site
See Article on Publisher Site

Abstract

Abstract INTRODUCTION The most commonly employed surgical approach for a sympathectomy for the upper extremity or for relief of angina pectoris with or without coronary insufficiency is the posterior extrapleural operation of the Smith-wick type, or its modification. For sympathetic denervation of the upper extremity by this technique, a resection of a short posterior section of the third rib was accomplished with the patient in a face-down position. A portion of the second and third intercostal nerves was resected, the rami communicantes or the sympathetic chain at these levels were divided, and the sympathetic chain was likewise divided below the third sympathetic ganglion, whereas, the denervation of the heart required a more extensive resection of the upper sympathetic chain.This former posterior approach had its many pitfalls and limitations, which were mainly technical. The degree and type of exposure were usually inadequate, imposing many obstacles, particularly of performance of an operation

Journal

A.M.A. Archives SurgeryAmerican Medical Association

Published: Apr 1, 1956

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