Sympathicotomy for Palmar Hyperhidrosis: The Association between Intraoperative Palm Temperature Change and the Curative Effect

Abstract

Purpose: To investigate the association between intraoperative palm temperature change and the curative effect of sympathicotomy.Methods: 49 patients with palmar hyperhidrosis were treated with bilateral endoscopic sympathicotomy. Ipsilateral palm temperature was monitored before and at 3–5 min increments after the sympathetic trunk was transected. The maximum temperature elevation (Tmax) was calculated and used to evaluate the effect on postoperative cure rates. Results: Forty-nine patients underwent 98 sympathicotomies. There were 77 T4 sympathicotomies, 15 T4 + T5 sympathicotomies, and six T3 sympathicotomies due to pleural adhesions or neurovascular proximity. The Tmax was ≤1°C in 49 (50.0%), 1–1.5°C in 17 (17.3%), and >1.5°C in 32 (32.7%) palms. Ninety-two palms of 46 patients were followed with complete efficacy, and three patients were lost to follow up. Cure was achieved in 86 palms (93.4%). Of the 71 palms which underwent T4 sympathicotomy, cure was achieved in 67 palms (94.3%). In those palms which did not achieve cure, the Tmax was less than 1°C in each case, while in palms with a Tmax ≤1°C, 32 of 36 (88.9%) were cured. Conclusion: There is an association between intraoperative palmar temperature change and curative effect. However, palmar temperature change cannot be used to predict cure or guide surgical approach.