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J Thorac Cardiovasc Surg 2002;124:636-638
© 2002 The American Association for Thoracic Surgery

Brief Communications

Sympathectomy for truncal hyperhydrosis after traumatic paraplegic injury

Malek G. Massad, MD, Alexander Evans, MD, Helene Rubeiz, MD, Fadi Khoury, MD, Andrew Brown, MD, Janet Karol, MSN, Janeen Hernan, MSN, Kelly Kalcevich, PA Chicago, Ill

From the Division of Cardiothoracic Surgery, Department of Surgery, The University of Illinois at Chicago, Chicago, Ill.

Received for publication Feb 25, 2002. Accepted for publication March 24, 2002. Address for reprints: Malek G. Massad, MD, University of Illinois at Chicago, Division of Cardiothoracic Surgery, 840 S Wood St, CSB Suite 417 (MC 958), Chicago, IL 60612 (E-mail: mmassad@uic.edu).

The first 20% of the full text of this article appears below.

Upper thoracic (T2-T3 or T2-T4) sympathectomy with preservation of the stellate ganglion is routinely used for treatment of palmar and axillary hyperhydrosis and also for relief of advanced cutaneous vasoconstriction of the fingers and hand in patients with Raynaud disease. Thoracic sympathectomy has also been advocated and used as a last resort for patients with refractory angina pectoris and those with sustained ventricular tachyarrhythmias that are not responsive to more standard medical and surgical therapy. To our surprise, an extensive MEDLINE search of the world literature from 1966 to date showed no published data on the use of extended thoracic sympathectomy for treatment of hyperhydrosis of the torso, particularly for patients with spinal cord injuries. In this communication we describe the surgical outcome of bilateral extended thoracic (T2-T6) sympathectomy in a man with paraplegia and hyperhydrosis of the torso.

Clinical summary

A 25-year-old man had flaccid paralysis, anesthesia below T4, and impaired vesical and anal sphincter control that developed immediately after a fall from a tree. The fall caused T4 and T5 vertebral body fractures and necessitated internal fixation of the thoracic (T3-T6) spine and surgical stabilization with two metallic rods placed through a posterior midline approach. At the time of injury the patient had a right hemopneumothorax that required a tube thoracostomy. During the course of his illness, the patient acquired hyperhydrosis over the torso below the T4 dermatome, manifesting as excessive sweating over the chest, abdomen, and back from the level of the nipples down. The hyperhydrosis was . . . [Full Text of this Article]






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