Unilateral thoracic sympathectomy in patients with palmar hyperhidrosis causes a skin temperature drop in the contralateral hand. A cross-inhibitory effect by the post-ganglionic neurons innervating hands is postulated as a mechanism of contralateral vasoconstriction. The purpose of our study was to evaluate whether this cross-inhibitory effect also occurs in the feet. Twenty patients scheduled for thoracoscopic sympathicotomy due to palmar hyperhidosis were studied. Right T3 sympathicotomy was performed first, followed by left T3 sympathicotomy. The thenar skin temperatures of both hands and feet were continuously monitored using a thermometer and recorded before induction of anesthesia, during the operation, 4 hr after and 1 week later. Following right T3 sympathicotomy, the skin temperature of the ipsilateral hand gradually increased, however the skin temperature of the contralateral hand gradually decreased. Immediately after bilateral sympathicotomy, the skin temperature differences between hands and feet increased, but these differences decreased 1 week later. Our results show that cross-inhibitory control may exist in feet as well as in the contralateral hand. Thus, the release of cross-inhibitory control following T3 sympathicotomy results in vasoconstriction and decrease of skin temperature on the contralateral hand and feet. One week later, however, the temperature balance on hands and feet recovers.
Thoracoscopy ; Sympathectomy/*methods ; *Skin Temperature ; Male ; Hyperhidrosis/physiopathology/*surgery ; Humans ; Hand/physiology/*surgery ; Foot/physiology ; Female ; Body Temperature Regulation ; Adult ; Adolescent

This study examined the net changes in temperature at various regions of the lower extremities in an attempt to identify the regions demonstrating the most significant temperature changes following a lumbar sympathetic ganglion block (LSGB). Thermography was performed before and after the LSGB in 26 sympathetic nerve system disorder cases. The inspection points were the anterior and posterior surfaces of the thigh, the knee and leg, and the dorsal and plantar surfaces of the feet. The net increases in skin temperature following the LSGB (deltaT (net) ) at the plantar and dorsal surfaces of the feet, were 6.2 +/- 2.68 degrees C (mean +/- SD) and 3.9 +/- 1.89degrees C, respectively, which were higher than those observed in the other regions of the lower extremities (p < 0.05). The areas, in order of decreasing deltaT (net), are as follows: the plantar surface of the foot, the dorsal surface of the foot, the shin, the anterior surface of the knee, the calf, the posterior surface of the knee, the anterior surface of the thigh, and the posterior surface of the thigh. There was one case of orthostatic hypotension during the thermography procedure. In conclusion, thermographic imaging is a useful method for demonstrating the success of a LSGB in various diseases. An evaluation of the deltaT (net) on the plantar surface of the feet using thermographic imaging is the most effective, simple, and safe method for assessing a successful LSGB.
Adult ; Aged ; *Autonomic Nerve Block ; Back Pain/surgery ; Body Temperature ; Complex Regional Pain Syndromes/physiopathology ; Female ; *Ganglia, Sympathetic ; Human ; Hyperhidrosis/physiopathology ; Infrared Rays/*diagnostic use ; Leg/physiopathology ; Lumbosacral Region ; Male ; Middle Aged ; Syndrome ; *Thermography ; Treatment Failure