THE MICROCIRCULATORY EFFECTS OF PERIPHERAL SYMPATHECTOMY

Microvascular physiology following peripheral artery sympathectomy was evaluated in seven hands with refractory pain (n = 7) and ulceration (n = 7) by serial isolated cold stress testing, which measures digital temperature and cutaneous perfusion (laser Doppler fluxmetry). All pa tients (n = 6) had vasospasm (secondary Raynaud's phenomenon) and arte riographically proven digital and palmar occlusive disease. Microcircu latory flow responses were correlated with symptoms and signs (includi ng ulcer healing) before and after (2-8 weeks, 12-15 weeks, and 24 wee ks) peripheral sympathectomy. Baseline data were compared with those o f controls (n = 7 extremities). following surgery, all seven hands had diminished pain; six had ulcer healing and one had ulcer reduction. I solated cold stress testing demonstrated abnormalities in temperature and laser Doppler fluxmetry response between patients and controls. Al though total flow (reflected by temperature) was not significantly inc reased after surgery, peripheral sympathectomy increased nutritional f low in these patients with combined vasospastic vessels and occlusive injury. The clinical changes observed following peripheral sympathecto my appear to be related to postsurgical correction of abnormal arterio venous shunting and to improved nutritional blood flow to ischemic are as. This accounts for the resultant diminution of pain and healing of ulcers observed in these patients after surgery.