Transthoracic sympathectomy.

Excision of the upper thoracic sympathetic chain can be performed effectively and safely by a transthoracic approach. The most valuable indication is for severe idiopathic hyperhidrosis of the hands for which it produces a most satisfactory and lasting relief. It is also indicated for severe Raynaud's phenomenon that does not respond to conservative measures but here there is a tendency to progressive relapse following surgery so that only about half the patients show improvement several years later.