SYMPATHECTOMY, CERVICODORSAL

General Information

DEFINITION-Removing a section of the sympathetic nerves located near the spinal cord in the upper back.

BODY PARTS INVOLVED-Cervicodorsal sympathetic nerves (part of the autonomic nervous system) that control contraction and expansion of small arteries in the arms; lungs; ribs and control pain.

REASONS FOR SURGERY

• Relieve post-traumatic pain complex.
• Restoration of normal blood supply to the arms. Removing part of the sympathetic nervous system stops spasms in the blood vessels that can cause or aggravate partial obstruction.

SURGICAL RISK INCREASES WITH

• Obesity; smoking; alcoholism.
• Atherosclerosis or diabetes mellitus.
• Chronic illness.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

What To Expect

WHO OPERATES-General surgeon, neurosurgeon or vascular surgeon.

WHERE PERFORMED-Hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood and urine studies; x-rays of chest; ECG (See Glossary); diagnostic sympathetic nerve block.
• After surgery: Blood studies.

ANESTHESIA-General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• An incision is made in the armpit.
• The muscles are divided, and part of the 3rd rib is removed.
• One lung is allowed to collapse temporarily to allow easier entry into the chest cavity.
• The cervical and dorsal sympathetic nerve chains are identified and divided.
• The ribs are reconstructed and held in place with heavy sutures. The lung is re-expanded. The muscles and skin edges are closed with sutures or clips, which usually can be removed about 1 week after surgery.
• This procedure can now be done via a thoroscope (an optical instrument with a lighted tip).

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Inadvertent injury to lung tissue.

AVERAGE HOSPITAL STAY-7 days.

PROBABLE OUTCOME-Expect complete healing without complications. Circulation will improve in 3 to 4 days. Allow about 4 weeks for recovery from surgery.

Postoperative Care

† Move and elevate legs often while resting in bed to decrease the likelihood of deep--vein blood clots.

† You may use non--prescription drugs, such as acetaminophen, for minor pain.

† To help recovery and aid your well--

being, resume daily activities, including work, as soon as you are able.

• Avoid vigorous exercise for 6 weeks after surgery. > Resume driving 18 days after returning home.

DIET-Clear liquid diet until the gastrointestinal tract functions again. Then eat a well-balanced diet to promote healing. After recovery, eat a low-fat, low--salt diet (see diets in Appendix).

Call Your Doctor If

Any of the following occurs:

• Increased pain, swelling, redness, drainage or bleeding in the surgical area.
• Signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• Nausea, vomiting, constipation or abdominal swelling.
• Coldness, discoloration or numbness in the hand.
• Cough, shortness of breath or chest pain.