title: Trans-axillary transpleural sympathectomy for Palmar hyperhidrosis in children--a 3 to 7 year follow-up of 9 cases.
abstract: Primary palmar hyperhidrosis can be a most unpleasant and distressing affliction. When normal daily activities, viz. writing, schoolwork, are interfered with and other treatments have failed, surgery is indicated. Between 1983-1987 9 children (6 F, 3 M), mean age 10.2 years (range 5-14 years) underwent bilateral transaxillary sympathectomy, 4 simultaneous and 5 1-4 weeks apart. On 14 sides a standard excision of dorsal ganglia (DG) 2, 3, and 4 was performed. The technique of lateral displacement of the sympathetic chain after transection distal to DG 4 and division of preganglionic fibres of DG 4, 3 and 2 was used on 5 sides. In addition to clinical evaluation a pilocarpine stimulation test was performed on the palms of the hands before and at follow-up 3-7 years after surgery. 17/18 hands appeared sympathectomised at early follow-up. One inadequate result required reoperation. Other complications included 2 Horner's syndromes--1 transient and 1 mild but permanent; 3 temporary intercostobrachial paraesthesias, 2 mild late recurrences of sweating and 2 compensatory increases in sweating. In 14 palms where sweat volume was measured before and 3-7 years after surgery there was a mean decrease in sweat of 84% (mg), those sweating the most prior to surgery having the best response. In 2 further palms insufficient sweat was obtained for testing. All but 1 considered the procedure worthwhile. Transaxillary transpleural sympathectomy is a safe, effective, and cosmetically acceptable operation to control symptoms of excessive palmar sweating.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Paediatric Surgery, University of Cape Town, South Africa.
authors.forename: A J
authors.initials: AJ
authors.lastname: Millar
authors.forename: Z
authors.initials: Z
authors.lastname: Steiner
authors.forename: H
authors.initials: H
authors.lastname: Rode
authors.forename: S
authors.initials: S
authors.lastname: Cywes
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005728:Ganglia, Sympathetic / Q000601:surgery; D006225:Hand; D006732:Horner Syndrome / Q000209:etiology; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D010862:Pilocarpine; D013546:Sweating; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*
chemical_list: D010862:Pilocarpine