title: Surgical treatment of systemic sclerosis--is it justified to offer peripheral sympathectomy earlier in the disease process?
abstract: OBJECTIVE
  Systemic sclerosis (SSc) is a rare connective tissue disease associated with significant digital vasculopathy. Peripheral sympathectomy is frequently offered late in the disease process after severe digital ischemia has already occurred with patients being symptomatic for numerous years. The purpose of the present study was to analyze the results of peripheral sympathectomy in patients with a confirmed diagnosis of SSc.
  
  
  METHODS
  A retrospective analysis of 17 patients (26 hands) who underwent peripheral sympathectomy between January 2003 and September 2013 was performed. Data regarding patient demographics, clinical features, and postoperative outcomes were retrieved. Of note, preoperative pain was present in all patients with a mean duration of 9.6 years prior to peripheral sympathectomy.
  
  
  RESULTS
  Pain improvement/resolution was seen in 24 hands (92.3%). Digital ulcers healed in all patients with only two patients (two hands; 7.7%) requiring surgical intervention for ulcer recurrence 6 months and 4.5 years later. Minor complications were seen in seven hands (26.9%); including infection, wound opening, and stitch abscess, but none required surgical intervention. Seven of eight patients queried would have preferred surgical treatment at an earlier point in the disease process.
  
  
  CONCLUSIONS
  Peripheral sympathectomy is a well-tolerated procedure in patients with SSc and is associated with predictable pain relief and ulcer healing in the majority of patients. In light of these findings it seems prudent to offer surgical treatment not as a last resort but rather earlier in the disease process to decrease the duration that patients suffer pain.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Arash
authors.initials: A
authors.lastname: Momeni
authors.affiliation: Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Sorice
authors.affiliation: Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Antonia
authors.initials: A
authors.lastname: Valenzuela
authors.affiliation: Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, CA.|Department of Dermatology, Stanford University Medical Center, Palo Alto, CA.
authors.forename: David F
authors.initials: DF
authors.lastname: Fiorentino
authors.affiliation: Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, CA.|Department of Dermatology, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Lorinda
authors.initials: L
authors.lastname: Chung
authors.affiliation: Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA.
authors.forename: James
authors.initials: J
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D006225:Hand / Q000294:innervation* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010525:Peripheral Nerves / Q000601:surgery*; D012189:Retrospective Studies; D012595:Scleroderma, Systemic / Q000601:surgery*; D013562:Sympathectomy; D013997:Time Factors; D016896:Treatment Outcome