VASOMOTOR AND SUDOMOTOR FUNCTION IN THE HAND AFTER THORACOSCOPIC TRANSECTION OF THE SYMPATHETIC CHAIN - IMPLICATIONS FOR CHOICE OF THERAPEUTIC STRATEGY

The degree of sympatholysis achieved by thoracoscopic transection of t he sympathetic chain (sympathicotomy) was evaluated by measuring sudo- and vasomotor function in the hands before and after surgery in 12 pa tients with palmar hyperhidrosis. Our results show a marked reduction in sweat production and a cutaneous vasodilatation which remained unch anged during the 6 months follow-up, whereas sudo- and vasomotor refle xes normalized within this time. Skin temperature variations did not c orrelate to skin perfusion changes. Since all subjects reported dry an d warm hands throughout the follow-up period, our results indicate tha t recording reflex responses to sympathoexcitatory stimuli does not ad equately reflect clinical outcome of subtotal sympatholytic procedures performed for hyperhidrosis. Monitoring of clinical outcome should th erefore include measurement of baseline sweat production and skin perf usion. However, the normalized reflex responses highlight the incomple te sympatholysis achieved by thoracoscopic sympathicotomy, which may b e beneficial in some pathological conditions (such as hyperhidrosis) b ut detrimental in others. (C) 1998 John Wiley & Sons, Inc.