Neurovascular Disorders of The Upper Extremity

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Abstract
ALTHOUGH the value of sympathectomy in the management of neurovascular disease of the upper extremity is well established, there has been continued dissatisfaction with the surgical approaches to the dorsal sympathetic chain. The disadvantages of these procedures have stimulated efforts to find a more direct approach that would minimally disturb anatomy and provide better exposure of the upper thoracic ganglia. Jonnesco4 and Bruning,3 in 1923, first described the anterior cervical approach to dorsal sympathectomy. Although this is a simple technique causing a minimal disruption of normal anatomy, it failed to provide exposure of the third and fourth ganglia. Adson and Brown,1 in 1929, described the posterior approach. This technique requires resection of the transverse process of the second dorsal vertebra, a portion of the second rib, and a segment of the second intercostal nerve. It is a time-consuming approach which fails to provide exposure of the lower

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