Intraoperative monitoring of skin temperature changes of hands before, during, and after endoscopic thoracic sympathectomy: Using infrared thermograph and thermometer for measurement

Objective: To investigate the roles of the second and third thoracic spinal segments in the preganglionic sympathetic innervation of the hand, and to compare skin temperature changes between thenar and other parts of palm before, during, and after endoscopic thoracic sympathectomy. Design: Twelve patients, four women and eight men, with severe palmar hyperhydrosis underwent endoscopic thoracic sympathectomy. The T3 segment was identified and dissected first, followed by T2 segment extirpation. Skin temperature changes of the hand were assessed by thermograph and thermometer simultaneously before, during, and after sympathectomy. Sympathetic skin responses were undertaken 1 day preoperatively and followed up 6 months postoperatively. Setting: An electrophysiological laboratory and operating room in a national medical center. Subjects: Twelve patients who sustained a profound degree of palmar hyperhydrosis. Interventions: Skin temperature differences of the hands were measured by infrared thermograph and thermometer before, during, and after endoscopic thoracic sympathectomy. Main Outcome Measures: Group's average temperature differences, and sympathetic skin response (all or none response). Results: The T2 spinal segment is thought to be the main source of sympathetic outflow to the sweat glands of the hand. The group's average temperature changes were significantly higher at the 2nd through 5th fingers' tips than at the thenar after completion of T2 extirpation (p < .005). Conclusions: Intraoperative monitoring of palmar skin temperature, as judiciously measured by infrared thermograph, yields useful information about the locations of the sympathetic segments and confirmation of their entire ablation by endoscopic thoracic sympathectomy. (C) 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation