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P. G. Flothow, M.D.
JAMA. 1935;105(12):986-987. doi:10.1001/jama.1935.02760380062025.
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To the Editor:—  In The Journal, June 29, was an editorial on "Sympathectomy for Thrombo-Angiitis Obliterans." This editorial is timely. About a year ago an editorial appeared in The Journal in which it was stated that sympathectomy had no place in the treatment of Buerger's disease. What I wish to call attention to, however, is the statement in the last paragraph: "It must be further emphasized that the operation (lumbar sympathectomy) is not only technically difficult even for the expert neurosurgeon but likewise a formidable procedure for the patient. The most serious complication is suppuration of the wound, which is particularly frequent in cases complicated by gangrene. The mortality even in the hands of the expert is not less than 4 per cent."For years I have been advocating the use of the extraperitoneal approach to the lumbar sympathetics. Appearing in the July issue of the American Journal of Surgery


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