The anatomical result of peri-arterial sympathectomy

Abstract

SURGEON TO OUT-PATIENTS'DEPARTMENT, GLASOOW ROYAL INFIRMARY.OF recent years operative procedures upon the vasomotor nerves have been increasingly made use of in endeavouring t o alleviate or cure a variety of clinical conditions. The principle underlying these operations is the physiological observation that division of the vasomotor nerves is followed by a peripheral vasodilatation. The usual method is to perform peri-arterial sympathectomy proximally in a limb with a view t o causing increased vascularity distally. The results have been notably varied in all conditions for which the treatment has been tried, and the uncertainty of result may be correlated with our present lack of precise knowledge of the origin, distribution, and function of the vasomotor nerves. Experimental study of the vasomotor nerves in animals can yield useful information, but it has been noted (Woollard,l 1926) HrsToRY.-Mrs. P., age 57, was admitted to Mr. Duffs Surgical Unit a t the Glasgow Royal Infirmary on Oct. 2, 192G. She had suffered from diabetes mellitus for twelve years and had been receiving insulin for one and a half years. Nine weeks before admission gangrene began in the right foot, accompanied by much pain.ON ADMIssIoN.-The patient was in poor general condition and suffering severe pain. There was an area of moist gangrene the size of her hand on the dorsum and outer side of the foot, overlapping the external malleolus. The foot elsewhere was cold and blue, the vessels of the limb were sclerosed, and popliteal pulsation was just perceptible. The urine contained abundant sugar and albumin.During the next two months the glycosuria was controlled by insulin, and local surgical measures were applied t o the foot. Sloughs were gradually removed until a sluggish ulcer remained, making no progress. Morphia was occasionally required for the relief of pain. A trial of peri-arterial sympathectomy was decided upon. and the following extracts from the case record indicate the effect on the leg :-

A Part of the Medial Branch of the Deep Peroneal Nerve Distributes the Dorsal Pedis Artery and Its Distribution Area is Close to the Acupuncture Point LR3 (Taichong)

“…We previously showed that the distribution areas of parts of the cutaneous branches of the radial nerve, i.e., VBs, were limited at the radial artery [6]. By contrast, several studies have reported that VBs reach the femoral, popliteal, anterior tibial, posterior tibial, and peroneal arteries [9][10][11][12][13]. However, it was not clear whether the VBs of the cutaneous branch reached the DPA.…”