{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T13:44:38Z","timestamp":1773150278626,"version":"3.50.1"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2004,4,20]],"date-time":"2004-04-20T00:00:00Z","timestamp":1082419200000},"content-version":"vor","delay-in-days":110,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Anatomy"],"published-print":{"date-parts":[[2004,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In this clinico\u2010anatomical study, factors potentially responsible for unsuccessful upper limb sympathectomy (ULS) by the thoracoscopic route were evaluated. This study comprised two subsets: 1) in the clinical subset, 25 patients (<jats:italic>n<\/jats:italic> = 50 sides) underwent bilateral second thoracic ganglionectomy for palmar hyperhidrosis, and factors predisposing to unsuccessful ULS were identified; and 2) in the anatomical subset, the neural connections of the first and second intercostal spaces were bilaterally dissected in 22 adult cadavers (22 right, 21 left; <jats:italic>n<\/jats:italic> = 43 sides). Alternate neural pathways (ANP) were noted in 9 of 50 sides in the 25 clinical cases (18%). In three asthenic patients (5 sides), fascia overlying the longus colli muscle mimicked the sympathetic chain. The right superior intercostal vein (SIV) was located anterior to the second thoracic ganglion in 6 of 50 sides (12%) and predisposed to troublesome bleeding in 2 of 50 cases; the SIV was posterior to the ganglion in 19 of 50 sides (38%), posing no technical problem. On the left, the SIV was noted outside the field of dissection in all but one case. A successful outcome to sympathectomy was noted in all 25 patients. A spectrum of sympathetic contributions to the first thoracic ventral ramus for the first intercostal space was noted in 37 of 43 anatomical cases (86%). These were categorized according to the arrangements of the intrathoracic ramus between the second intercostal nerve and the first thoracic ventral ramus. The cervicothoracic ganglion (37\/43 cases; 86%) and an independent inferior cervical ganglion (6\/43 cases; 14%) were always located above the second rib. The second thoracic ganglion was consistently located in the second intercostal space. This study demonstrates that ANPs have little clinical significance when a second thoracic ganglionectomy is undertaken. Technical failures may be avoided if the surgeon is mindful of anatomical variations at surgery. Clin. Anat. 17:294\u2013299, 2004. \u00a9 2004 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/ca.10238","type":"journal-article","created":{"date-parts":[[2004,4,20]],"date-time":"2004-04-20T20:01:49Z","timestamp":1082491309000},"page":"294-299","source":"Crossref","is-referenced-by-count":35,"title":["Anatomical basis for a successful upper limb sympathectomy in the thoracoscopic era"],"prefix":"10.1002","volume":"17","author":[{"given":"L.","family":"Ramsaroop","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Moodley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Partab","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.S.","family":"Satyapal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2004,4,20]]},"reference":[{"key":"e_1_2_1_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1929.02700320014007"},{"key":"e_1_2_1_3_1","first-page":"111","article-title":"Sympathetic conduction pathways independent of sympathetic trunks: their surgical implications","volume":"12","author":"Alexander WF","year":"1949","journal-title":"J Int Coll Surg"},{"key":"e_1_2_1_4_1","first-page":"112","article-title":"Video thoracoscopic dorsal sympathectomy: a new approach","volume":"3","author":"Chandler KE","year":"1993","journal-title":"Surg Laparosc Endosc"},{"key":"e_1_2_1_5_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1996.85.2.0310"},{"key":"e_1_2_1_6_1","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2002.119340"},{"key":"e_1_2_1_7_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1969.30.5.0545"},{"key":"e_1_2_1_8_1","first-page":"102","article-title":"The importance of the second thoracic ganglion for the sympathetic supply of the upper extremities with a description of two new approaches for its removal in cases of vascular disease: a preliminary report","volume":"3","author":"Goetz RH","year":"1944","journal-title":"Clin Proc"},{"key":"e_1_2_1_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00310082"},{"key":"e_1_2_1_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02968182"},{"key":"e_1_2_1_11_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2168.1998.00905.x"},{"key":"e_1_2_1_12_1","first-page":"55","article-title":"Observations on the anatomy of the human thoracic sympathetic chain and its branches; with an anatomical assessment of operations for hypertension","volume":"9","author":"Jit I","year":"1960","journal-title":"J Anat Soc India"},{"key":"e_1_2_1_13_1","first-page":"37","article-title":"A ramus connecting the third and second thoracic nerves, a probable pathway through which sympathetic fibers from the third thoracic segment may enter the brachial plexus","volume":"79","author":"Kirgis HD","year":"1941","journal-title":"Anat Rec"},{"key":"e_1_2_1_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1942.01210190098011"},{"key":"e_1_2_1_15_1","first-page":"391","article-title":"Thoracoscopic sympathectomy","volume":"3","author":"Krasna MJ","year":"1993","journal-title":"Surg Laparosc Endosc"},{"key":"e_1_2_1_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1927.01130240044003"},{"key":"e_1_2_1_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(01)02852-1"},{"key":"e_1_2_1_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2230.1995.tb01308.x"},{"key":"e_1_2_1_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/00129689-200112000-00005"},{"key":"e_1_2_1_20_1","unstructured":"SinghB.2002.Personal communication: Upper limb sympathectomy in current surgical practice. MD Thesis. Nelson R Mandela School of Medicine University of Natal Republic of South Africa."},{"key":"e_1_2_1_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(47)90473-X"},{"key":"e_1_2_1_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800239022"},{"key":"e_1_2_1_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800770930"}],"container-title":["Clinical Anatomy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fca.10238","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ca.10238","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,18]],"date-time":"2023-11-18T01:25:11Z","timestamp":1700270711000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ca.10238"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,1]]},"references-count":22,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2004,1]]}},"alternative-id":["10.1002\/ca.10238"],"URL":"https:\/\/doi.org\/10.1002\/ca.10238","archive":["Portico"],"relation":{},"ISSN":["0897-3806","1098-2353"],"issn-type":[{"value":"0897-3806","type":"print"},{"value":"1098-2353","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,1]]}}}