Applicative anatomy study of upper thoracic sympathetic trunk for clinical sympathictomy

To study the value of different intra or extra structures the upper thoracic sympathetic trunk in the clinical procedure of sympathicotomy,and establish an optimal secure approach.Methods In 31 adult cadavers with 60 sympathetic trunks available were studied.The thoracic cavity was thoroughly exposed.Sympathetic ganglion and its affiliated ramus were skeletonized with the aid of microscopic instruments.Emphasis was laid on the relative locality of each ganglion with the corresponding rib.Results The lower border of stellate ganglion was beneath the upper border of the second rib in 33.3% (20/60) cases,while the rami between stellate ganglion and the first thoracic spine nerve was higher in all cases.T2～T5 ganglions localized most frequently at the corresponding intercostal space.Bypass fibers exist at any level,but most frequently around the second rib.Fiber rising from the second intercostal nerve to T1 spine nerve was the most common type (63.3%,38/60).Conclusion Sympathicotomy performed at rib level should be the ideal choice for clinical surgical treatment of palmar or craniofacial hyperhidrosis,which means less denervation scope and more definite therapeutic effect.14 refs,1 fig,1 tab.