title: Role of surgical thoracic sympathetic interruption in treatment of facial blushing: a systematic review.
abstract: OBJECTIVE
  This paper aims to review the evidence to support the effectiveness of sympathectomy as a treatment for facial blushing in terms of relief of facial blushing, patient satisfaction, recurrence of blushing, patients regretting treatment and its associated complications.
  
  
  METHODS
  A systematic search strategy was performed in Ovid-Medline, Embase, Cochrane library and NICE. Studies reporting outcomes of sympathetic interruption in the treatment of facial blushing were retrieved.
  
  
  RESULTS
  Nine studies met the inclusion criteria with 1369 patients included in the final analysis. The age range of patients was 8 to 74 years (from 7 studies) with 56% females. Mean follow up was 21 months in 8 studies (range 6 to 30 months). The pooled proportion of patients who had good relief of facial blushing was 78.30% (95% C.I. 58.20% - 98.39%). Complete satisfaction was reported in 84.02% (95% C.I. 71.71% - 96.33%). Compensatory sweating and gustatory sweating were the commonest complications occurring in 74.18% (95% C.I. 58.10% - 90.26%) and 24.42% (95% C.I. 12.22% - 36.61%) respectively. The estimated proportion of patients regretting surgery was 6.79% (C.I 2.08% 11.50%).
  
  
  CONCLUSIONS
  Sympathetic interruption at T2 or T2-3 ganglia appears to be an effective treatment for facial blushing. However, lack of randomized trials comparing sympathetic interruption with non-surgical methods of treatment and heterogeneity of included studies with respect to assessment of outcome measures preclude strong evidence and definitive recommendations.
authors.affiliation: a Consultant in general and vascular surgery, Department of General & Vascular Surgery , Watford General Hospital , Watford , UK.
authors.forename: Girish
authors.initials: G
authors.lastname: Girish
authors.affiliation: b Consultant in general and vascular surgery, Department of Vascular Surgery , Royal Free Hospital, Royal Free London NHS Foundation Trust , London , UK.
authors.forename: Rovan E
authors.initials: RE
authors.lastname: D'souza
authors.affiliation: c Research Associate, Social Science Research Unit and EPPI-Centre , UCL Institute of Education , London , UK.
authors.forename: Preethy
authors.initials: P
authors.lastname: D'souza
authors.affiliation: d Research scholar, Department of statistics , Public Health Evidence, South Asia (PHESA), Manipal University , Manipal , India.
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Lewis
authors.affiliation: b Consultant in general and vascular surgery, Department of Vascular Surgery , Royal Free Hospital, Royal Free London NHS Foundation Trust , London , UK.
authors.forename: Daryll M
authors.initials: DM
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001821:Blushing / Q000502:physiology*; D002648:Child; D005260:Female; D015171:Ganglionectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D055815:Young Adult
keywords: Blushing; autonomic nerve block; flushing; sympathectomy