Sympathicotomy affects cutaneous blood flow, temperature, and sympathicus-mediated reflexes.
OBJECTIVE
To study the sympathetically mediated effects of transthoracic endoscopic sympathicotomy (TES) in the treatment of severe primary palmar hyperhidrosis.


METHODS
The effects of TES, on sympathetic ganglia at the thoracic level of 2-3, finger blood flow, temperature, and on heat and cold provocation were investigated. Middle cerebral artery (MCA) blood flow velocities were studied by transcranial Doppler.


RESULTS
The finger blood flow increased by about 700% after TES and finger temperature by 7.0 +/- 0.5 degrees C. Several autonomic reflexes were dramatically affected. A finger pulp-shrinking test showed a major decrease after surgery. MCA mean blood flow velocities were not affected by TES.


CONCLUSIONS
Besides the high success rate of good clinical effect of TES on palmar hyperhidrosis, major effects on local blood flow and temperature are elicited by TES. Complex autonomic reflexes are also affected. The patient should be completely informed before surgery of the side effects elicited by TES.
Department of Pharmacology and Clinical Neuroscience, Division of Neurosurgery, University of Umeå, Sweden. Lars-Owe.Koskinen@neuro.umu.se
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D000328:Adult; D001158:Arteries / Q000294:innervation / Q000503:physiopathology; D001831:Body Temperature / Q000502:physiology; D002536:Cerebral Arteries / Q000294:innervation / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D005728:Ganglia, Sympathetic / Q000503:physiopathology / Q000601:surgery*; D015171:Ganglionectomy / Q000009:adverse effects* / Q000379:methods; D006225:Hand / Q000098:blood supply / Q000294:innervation* / Q000503:physiopathology; D006801:Humans; D006945:Hyperhidrosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D012021:Reflex, Abnormal / Q000502:physiology; D012039:Regional Blood Flow / Q000502:physiology; D012867:Skin / Q000098:blood supply / Q000294:innervation / Q000503:physiopathology; D013545:Sweat Glands / Q000294:innervation / Q000503:physiopathology; D013562:Sympathectomy / Q000009:adverse effects* / Q000379:methods; D017779:Sympathetic Fibers, Postganglionic / Q000502:physiology; D016896:Treatment Outcome