This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Eisenach, J. H. Articles by Charkoudian, N. Search for Related Content PubMed PubMed Citation Articles by Eisenach, J. H. Articles by Charkoudian, N. Related Collections Surgery Pharmacology

---

GENERAL ARTICLES

A Comparison of Peripheral Skin Blood Flow and Temperature During Endoscopic Thoracic Sympathotomy

John H. Eisenach, MD^*, Tasha L. Pike^*, Diane E. Wick^*, Niki M. Dietz, MD^*, Robert D. Fealey, MD, John L. D. Atkinson, MD, and Nisha Charkoudian, PhD

Departments of *Anesthesiology, Neurology, Neurosurgery, and Physiology, Mayo Clinic College of Medicine, Rochester, Minnesota

Address correspondence and reprint requests to John H. Eisenach, MD, Mayo Clinic, Department of Anesthesiology, 200 First St. S.W., Rochester, MN 55905. Address e-mail to eisenach.john{at}mayo.edu

The assessment of sympathetic denervation to the upper extremities during surgery for hyperhidrosis is essential in predicting postoperative outcome, particularly for endoscopic thoracic chain sympathotomy, a recently described, minimally destructive technique that minimizes postoperative compensatory hyperhidrosis. To test the hypothesis that skin blood flow (SkBF; laser Doppler flowmetry) provides a faster and more reliable indication of denervation than temperature (temp), we prospectively compared palmar SkBF and fingertip temp in 10 patients undergoing endoscopic thoracic chain sympathotomy for essential hyperhidrosis. From baseline to peak values, palmar SkBF (mean ± SEM) increased 273.3 ± 24.7 arbitrary units and 252.4 ± 30.1 arbitrary units, whereas temp increased 0.9°C ± 0.3°C and 1.5°C ± 0.6°C on the right and left, respectively. Upon effective sympathotomy of the right thoracic chain, the time to peak SkBF was 43 ± 13 s, whereas the time to peak temp was 277 ± 53 s (P < 0.001). On the left, the time to peak SkBF was 81 ± 14 s, and time to peak temp was 305 ± 34 s (P < 0.001). All patients considered the sympathotomy successful. We conclude that laser Doppler SkBF is superior to temp in temporal resolution for assessment of denervation during sympathotomy and that it provides a superior qualitative and quantitative adjunct to monitoring denervation.

IMPLICATIONS: Termed sympathotomy, endoscopic surgical disconnection of the sympathetic chain to the upper extremities is an effective therapy for people affected with excessive sweating of the hands. Success relies on intraoperative monitoring of denervation, which can be determined rapidly by monitoring skin blood flow with laser Doppler flowmetry.

This article has been cited by other articles:

				X. Li, Y.-R. Tu, M. Lin, F.-C. Lai, J.-F. Chen, and H.-W. Miao Minimizing endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: guided by palmar skin temperature and laser Doppler blood flow. Ann. Thorac. Surg., February 1, 2009; 87(2): 427 - 431. [Abstract] [Full Text] [PDF]

				P. Maga, J. Kuzdzal, R. Nizankowski, A. Szczeklik, and K. Sladek Long-term effects of thoracic sympathectomy on microcirculation in the hands of patients with primary Raynaud disease J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1428 - 1433. [Abstract] [Full Text] [PDF]

				J. H. Eisenach, J. L. D. Atkinson, and R. D. Fealey Hyperhidrosis: Evolving Therapies for a Well-Established Phenomenon Mayo Clin. Proc., May 1, 2005; 80(5): 657 - 666. [Abstract] [PDF]