Sympathectomy as a therapeutic modality has been
employed for a variety of pathological states. It first
gained popularity in the 1920’s and 1930’s for improving
peripheral circulation, but soon its limitations began to be
apparent. The initial vasodilation after sympathectomy de-
creases some days after the procedure is performed. Results
for denervation of the upper extremity are not as long-lasting
as those for denervation of the lower extremity. A variety
of mechanisms have been proposed for the apparent return
of vasomotor tone, including: (1) development of intrinsic
tone in smooth muscle, (2) partial anatomical denervation
at the time of the operation, (3) post-denervation sensiti-
zation, (4) post-denervation sprouting, (5) hypertrophy of
the extraganglionic sympathetic nervous system, and (6)
cross-over of the lumbar sympathetic systems30. The pres-
ence or absence of inflow obstruction appears to be impor-
tant. The work of Rutherford and Valenta indicated that
while sympathectomy may increase flow in the resting state
and after exercise, the presence of inflow obstruction in a
patient who has a sympathectomy might actually interfere
with the increased distribution of the flow of blood to ex-
ercising muscle.
1987;69:1384-1390. J Bone Joint Surg Am.RF Davis, LC Jones and DS Hungerford
The effect of sympathectomy on blood flow in bone. Regional distribution and effect over time