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 the sympathetic chain (sympathicotomy) was evaluated by measuring sudo- and vasomotor function in the hands before and after surgery in 12 patients with palmar hyperhidrosis. Our results show a marked reduction in sweat production and a cutaneous vasodilatation which remained unchanged during the 6 months follow-up, whereas sudo- and vasomotor reflexes normalized within this time. Skin temperature variations did not correlate to skin perfusion changes. Since all subjects reported dry and warm hands throughout the follow-up period, our results indicate that recording reflex responses to sympathoexcitatory stimuli does not adequately reflect clinical outcome of subtotal sympatholytic procedures performed for hyperhidrosis. Monitoring of clinical outcome should therefore include measurement of baseline sweat production and skin perfusion. However, the normalized reflex responses highlight the incomplete sympatholysis achieved by thoracoscopic sympathicotomy, which may be beneficial in some pathological conditions (such as hyperhidrosis) but detrimental in others.