A paper published in the Clinical Autonomic Research Journal, authored by Dr. Rafael Reisfeld, addresses a key surgical question: where should clamps be applied when sympathectomy is performed for patients with severe palmar hyperhidrosis?
Collecting data in a clinical study based on subjective findings is inherently difficult, but several clear points emerged from the research.
First, Endoscopic Thoracic Sympathectomy should be performed only for severe cases of excessive hand sweating. Dr. Reisfeld concludes that sympathectomy should not be performed for isolated facial blushing, craniofacial sweating, or axillary hyperhidrosis.
Second, the number of cases involving severe compensatory sweating is statistically lower when clamps are applied at the T3–T4 level. Extended follow-up will be needed to more fully understand these results.
Third, gustatory sweating nearly disappeared when the clamps were placed at the correct level. Other findings included less influence on heart rate and exercise ability.
With regard to the reversal issue, two recent studies showed that reversibility after clamp removal is approximately 50%. Even though it is not a high percentage, it still offers a better chance than nerve graft reversal — which explains the global trend toward clamping over cutting or destruction methods for excessive hand sweating.Dr. Rafael Reisfeld, Clinical Autonomic Research Journal