title: Role and rationale for extended periarterial sympathectomy in the management of severe Raynaud syndrome: techniques and results.
abstract: There is no consensus regarding etiology or best surgical technique for severe Raynaud syndrome in patients with connective tissue disease. Observations after 30 years' experience in more than 100 cases led to the conclusion that an extended periarterial sympathectomy (with or without vein-graft reconstruction) and adjunctive use of Botox topically will offer benefits that exceed palliation and reduce recurrent ulcerations. In this article the rationale for this approach is reviewed, techniques and results are outlined, and a hypothesis for the mechanism of Raynaud attacks is offered.
authors.affiliation: Division of Plastic & Reconstructive Surgery, Virginia Commonwealth University, 830 East Main Street, Richmond, VA 23298, USA; Department of Plastic & Maxillofacial Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA. Electronic address: wyndell@hotmail.com.
authors.forename: Wyndell H
authors.initials: WH
authors.lastname: Merritt
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D006225:Hand / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D009465:Neuromuscular Agents / Q000627:therapeutic use; D017534:Radial Artery / Q000601:surgery*; D011928:Raynaud Disease / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D013562:Sympathectomy; D017535:Ulnar Artery / Q000601:surgery*; D058017:Vascular Grafting
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin; Evidence-based data; Extended periarterial sympathectomy; Raynaud syndrome