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Minimally invasive dorsal sympathicotomies for the treatment of hyperhidrosis: palmar microcirculatory assessment as an intraoperative-aid

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Endoscopic transthoracic sympathicotomy has proven to be an effective and durable surgical treatment for severe primary hyperhidrosis. Anyhow, in some cases, especially in overweight patients, a thick overlying subpleural fat may obscure the sympathetic chain, precluding access to the ganglia and partial or total completion of the procedure. The aim of this study was to assess the value of palmar laser Doppler flowmetry (LDF) as an intraoperative-aid during minimally invasive dorsal sympathicotomies (T3) for the treatment of primary palmar hyperhidrosis.

Methods

The method was tested during 40 upper dorsal video-assisted minimally invasive sympathicotomies in 20 patients with bilateral palmar primary hyperhidrosis.

Results

The mean baseline LDF values were 36.05 pU (SD = 21.85 pU). The mean immediate postoperative LDF values were 75.94 pU (SD = 37.89 pU). A statistically significant difference was observed between preoperative and immediate (about 5 s after the sympathicotomies) postoperative values (p = 0.00000009).

Conclusions

According to our data, LDF allowed to obtain reliable and fast intraoperative evidence of a correct section of T3 ganglia. As such, we recommend LDF as a useful intraoperative tool when dealing with dorsal sympathicotomies for the treatment of palmar hyperhidrosis, both for the unexperienced surgeon and when the sympathetic chain is not clearly visualized.

Level of Evidence: Level IV, therapeutic study.

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Authors and Affiliations

  1. Department of Medicine and Surgery, Plastic Surgery Section, University of Parma, Parma, Italy

    Edoardo Raposio, Elisa Bellini & Michele P. Grieco

  2. Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Via Gramsci 14, 43126, Parma, Italy

    Edoardo Raposio, Elisa Bellini & Michele P. Grieco

Authors
  1. Edoardo Raposio
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  2. Elisa Bellini
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  3. Michele P. Grieco
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Correspondence to Edoardo Raposio.

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Conflict of interest

Edoardo Raposio, Elisa Bellini, Michele Grieco declare that they have no conflicts of interest.

Informed consent

All enrolled patients provided written consent before their inclusion in this study.

Ethical approval

The trial was conducted in compliance with the Declaration of Helsinski and the Guidelines for Good Clinical Practice.

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This article did not require any sources of funding.

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Patients provided written consent for the use of their images.

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Raposio, E., Bellini, E. & Grieco, M.P. Minimally invasive dorsal sympathicotomies for the treatment of hyperhidrosis: palmar microcirculatory assessment as an intraoperative-aid. Eur J Plast Surg 41, 447–450 (2018). https://doi.org/10.1007/s00238-017-1384-x

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  • DOI: https://doi.org/10.1007/s00238-017-1384-x

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