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 (5) Citing Articles via Google Scholar Google Scholar Articles by Crandall, C. G. Articles by Dellaria, S. M. Search for Related Content PubMed PubMed Citation Articles by Crandall, C. G. Articles by Dellaria, S. M. Related Collections Surgery Pharmacology

---

GENERAL ARTICLES

Palmar Skin Blood Flow and Temperature Responses Throughout Endoscopic Sympathectomy

Craig G. Crandall, PhD^*,, Dan M. Meyer, MD, Scott L. Davis, PhD^*,, and Suzanne M. Dellaria, MD

*Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas, Texas; and Departments of Internal Medicine, Cardiothoracic Surgery, and Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Texas

Address correspondence and reprint requests to Craig G. Crandall, PhD, Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas, 7232 Greenville Ave., Dallas, TX 75231. Address e-mail to craigcrandall{at}texashealth.org

Thoracic surgical sympathectomy is often performed to treat primary palmar and axillary hyperhidrosis. An increase in palmar skin temperature is frequently used to identify the success of the procedure. Because changes in palmar skin temperature occur secondary to changes in skin blood flow, the objective of this study was to test the hypothesis that monitoring palmar skin blood flow would provide greater temporal resolution relative to monitoring palmar skin temperature. In 11 patients with palmar and/or axillary hyperhidrosis, we measured palmar skin temperature and blood flow (via laser Doppler flowmetry) throughout the sympathectomy procedure. Five minutes after the initial cautery, skin blood flow increased from 48 ± 7 perfusion units to 121 ± 17 perfusion units (P < 0.001), whereas no significant change in temperature was observed (31.0°C ± 0.5°C to 31.3°C ± 0.5°C; P > 0.05). The time required to reach peak skin blood flow (22 ± 3 min) was significantly less than the time required to reach peak skin temperature (34 ± 0.3 min; P < 0.001). Finally at 5, 10, and 15 min after the initial cautery, skin blood flow increased to a larger percentage of the total increase in skin blood flow relative skin temperature (all P < 0.006). These data suggest that monitoring skin blood flow provides greater temporal resolution when compared with monitoring skin temperature during thoracic sympathectomy. However, the initial cautery of the parietal pleura over the ganglion may result in increases in skin blood flow before physical disruption of the ganglion. This occurrence may limit the utility of skin blood-flow measurements in identifying the success of the procedure.

IMPLICATIONS: Thoracic surgical sympathectomy is a common procedure to treat hyperhidrosis. This study revealed that palmar skin blood flow increased during cautery of the parietal pleura before the disruption of the ganglion. This observation may limit the utility skin blood-flow responses for confirming a successful sympathectomy.

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]