Digital artery sympathectomy.

A very distal sympathectomy at the level of the origin of the proper digital arteries has been devised. Four men and four women have been operated on for digital vascular insufficiency due to frostbite, crush injuries, scleroderma, and Raynaud's disease. The operation is done through a palmar approach and the adventitia removed, over a length of 3 to 4 mm, from the proper digital arteries distal to the junction of the distal perforating artery with the common digital artery. Three frostbite victims have done well; their ulcers have healed, pain symptoms have improved, and a skin temperature rise of 1.5 degrees to 2.5 degrees F has persisted over a 17-year follow-up. Two crushed fingers have shown some, but not impressive, permanent symptomatic improvement. Three women had four operations for Raynaud-type disease. Two of the women, 40 and 41 years of age, showed a permanent skin temperature rise of only 2 degrees and 1 degree F, respectively. They showed significant, but not total, pain relief. The third woman, 22 years of age, had atrophic, curled index and thumb nails. After sympathectomy, the nails grew normally, there was significant pain relief, and the patient showed a permanent 3 degrees F rise in skin temperature.