J Korean Med Sci.  2006 Oct;21(5):917-921. 10.3346/jkms.2006.21.5.917.

The Changes of Skin Temperature on Hands and Feet During and after T3 Sympathicotomy for Palmar Hyperhidrosis

• Jeong SM
• Kim TY
• Jeong YB
• Sim JY
• Choi IC

• KMID: 1781915
• DOI: http://doi.org/10.3346/jkms.2006.21.5.917

Abstract

Unilateral thoracic sympathectomy in patients with palmar hyperhidrosis causes a skin temperature drop in the contralateral hand. A cross-inhibitory effect by the post-ganglionic neurons innervating hands is postulated as a mechanism of contralateral vasoconstriction. The purpose of our study was to evaluate whether this cross-inhibitory effect also occurs in the feet. Twenty patients scheduled for thoracoscopic sympathicotomy due to palmar hyperhidosis were studied. Right T3 sympathicotomy was performed first, followed by left T3 sympathicotomy. The thenar skin temperatures of both hands and feet were continuously monitored using a thermometer and recorded before induction of anesthesia, during the operation, 4 hr after and 1 week later. Following right T3 sympathicotomy, the skin temperature of the ipsilateral hand gradually increased, however the skin temperature of the contralateral hand gradually decreased. Immediately after bilateral sympathicotomy, the skin temperature differences between hands and feet increased, but these differences decreased 1 week later. Our results show that cross-inhibitory control may exist in feet as well as in the contralateral hand. Thus, the release of cross-inhibitory control following T3 sympathicotomy results in vasoconstriction and decrease of skin temperature on the contralateral hand and feet. One week later, however, the temperature balance on hands and feet recovers.

Keyword

Hyperhidorsis; Skin Temperature; Sympathicotomy; Sympathectomy

MeSH Terms

Thoracoscopy
Sympathectomy/*methods
*Skin Temperature
Male
Hyperhidrosis/physiopathology/*surgery
Humans
Hand/physiology/*surgery
Foot/physiology
Female
Body Temperature Regulation
Adult
Adolescent

Figure

• 

  Fig. 1 (A) Time course of skin temperature difference of hands compared with baseline value during and after T3 sympathicotomy. The skin temperature of the contralateral (left) hand decreases significantly after right T3 sympathicotomy but increases as much as that of the right hand after bilateral T3 sympathicotomy. (B) Time course of skin temperature difference of feet compared with baseline value during and after T3 sympathicotomy. The skin temperature of the feet dose not change after right T3 sympathicotomy but decreases significantly after bilateral T3 sympathicotomy. Pre: before induction of anesthesia, Baseline: before sympathicotomy, 2, 4, 6, and 10: 2, 4, 6, and 10 min after right T3 sympathicotomy, respectively, Lt 10: 10 min after left T3 sympathicotomy, OSC; 4 hr after the operation in the one-day surgery center, Follow up: 1 week after the operation. *: p<0.05 compared with baseline value, †: p<0.05 compared with right side value, ‡: p<0.05 compared with OSC value.

• 

  Fig. 2 Time course of skin temperature difference between hands and feet compared with preinduction value during and after T3 sympathicotomy. The skin temperature difference on both sides are reduced significantly after induction of anesthesia but increase after sympathicotomy on each side, becoming maximal 4 hr after the operation but decreasing significantly 1 week later. Pre: before induction of anesthesia, Baseline: before sympathicotomy, 2, 4, 6, and 10: 2, 4, 6, and 10 min after right T3 sympathicotomy, respectively, Lt 10: 10 min after left T3 sympathicotomy, OSC; 4 hr after the operation in the one-day surgery center, Follow up: 1 week after the operation. *: p<0.05 compared with Pre value, †: p<0.05 compared with OSC value.

Reference

1. Doolabh N, Horswell S, Williams M, Huber L, Prince S, Meyer DM, Mack MJ. Thoracoscopic sympathectomy for hyperhidrosis: indications and results. Ann Thorac Surg. 2004. 77:410–414.

2. Dumont P, Denoyer A, Robin P. Long-term results of thoracoscopic sympathectomy for hyperhidrosis. Ann Thorac Surg. 2004. 78:1801–1807.

3. Chuang KS, Liu JC. Long-term assessment of percutaneous stereotactic thermocoagulation of upper thoracic ganglionectomy and sympathectomy for palmar and craniofacial hyperhidrosis in 1742 cases. Neurosurgery. 2002. 51:963–970.

4. Lu K, Liang CL, Lee TC, Chen HJ, Su TM, Liliang PC. Changes of bilateral palmar skin temperature in transthoracic endoscopic T-2 sympathectomy. J Neurosurg. 2000. 92:44–49.

5. Kao MC, Tsai JC, Lai DM, Hsiao YY, Lee YS, Chiu MJ. Autonomic activities in hyperhidrosis patients before, during, and after endoscopic laser sympathectomy. Neurosurgery. 1994. 34:262–268.

6. Wu JJ, Hsu CC, Liao SY, Liu JC, Shih CJ. Contralateral temperature changes of the finger surface during video endoscopic sympathectomy for palmar hyperhidrosis. J Auton Nerv Syst. 1996. 59:98–102.

7. Yoon SH, Rim DC. The selective T3 sympathicotomy in patients with essential palmar hyperhidrosis. Acta Neurochir (Wien). 2003. 145:467–471.

8. Bonjer HJ, Hamming JF, du Bois NAJJ, van Urk H. Advantages of limited thoracoscopic sympathectomy. Surg Endosc. 1996. 10:721–723.

9. Hsia JY, Chen CY, Hsu CP, Shai SE, Yang SS. Outpatient thoracoscopic limited sympathectomy for hyperhidrosis palmaris. Ann Thorac Surg. 1999. 67:258–259.

10. Satinoff E. Neural organization and evolution of thermal regulation in mammals. Science. 1978. 201:16–22.

11. Holzer P. Morris JL, Gibbins IL, editors. Control of the cutaneous vascular system by afferent neurons. The Autonomic Nervous System. Autonomic Innervation of the Skin. 1997. Vol 12. Amsterdam: Harwood Academic;213–267.

12. Hornyak ME, Naver HK, Rydenhag B, Wallin BG. Sympathetic activity influences the vascular axon reflex in the skin. Acta Physiol Scand. 1990. 139:77–84.

13. Kaya D, Karaca S, Barutcu I, Esen AM, Kulac M, Esen O. Heart rate variability in patients with essential hyperhidrosis: dynamic influence of sympathetic and parasympathetic maneuvers. Ann Noninvasive Electrocardiol. 2005. 10:1–6.

14. Wiklund U, Koskinen LO, Niklasson U, Bjerle P, Elfversson J. Endoscopic transthoracic sympathicotomy affects the autonomic modulation of heart rate in patients with palmar hyperhidrosis. Acta Neurochir (Wien). 2000. 142:691–696.

15. Janig W, Kummel H. Organization of the sympathetic innervation supplying the hairless skin of the cat's paw. J Auton Nerv Syst. 1981. 3:215–230.

16. Sellgren J, Ejnell H, Elam M, Ponten J, Wallin BG. Sympathetic muscle nerve activity, peripheral blood flows, and baroreceptor reflexes in humans during propofol anesthesia and surgery. Anesthesiology. 1994. 80:534–544.

17. Gazelius B, Stange K, Lind G, Meyerson BA, Linderoth B. Endoscopic transthoracic sympathicotomy and peripheral microcirculation: effects of electric sympathetic chain stimulation, thermocoagulation and anaesthetic agents. Acta Neurochir (Wien). 2002. 144:589–594.