Abstract
ABSTRACT Background:The surgical treatment of hyperhidrosis by thoracic sympathectomy has brought, in addition to symptomatic relief for many, its main adverse effect: compensatory or reflex sweating. The clipping technique in place of the sympathetic nerve section gave rise to the hope of reversibility, but the positive results showed to be quite divergent, evidencing the academic deficiency regarding the study of this phenomenon. Aim:To observe micro and macroscopic damage caused by the polymer clip on sympathetic nerve of rabbits seven days after their clipping and the findings after three weeks of clip removal. Method:In this experimental study, 20 rabbits were divided into two groups of 10, group 1 (clipping) and group 2 (de-clipping). The right cervical sympathetic nerve of all animals was clamped with polymeric clip, and in group 2 the nerve was unclipped seven days later. Group 1 rabbits were induced to death on the 7th postoperative day, and group 2 on the 21st after removal of the polymer clip. Macroscopic variables were: clip appearance, presence of discontinuity lesion, infection and adhesions around the nerve. H&E was used in the evaluation of the phases and degree of the inflammatory process and presence of necrosis, and picrosirius red F3BA for quantification of collagen. Results:The cervical sympathetic nerve was intact, without necrosis or infection in all animals of the experiment; there were adhesions in both groups, being minimal in eight animals of each group and moderate or intense in two; the clip was completely closed in all animals at the 7th postoperative day; the inflammatory process shown was chronic, with monomorphonuclear predominance. There was no significant difference between groups regarding the intensity the inflammatory process, but the amount of collagen type I and type III was significantly higher in group 2. Conclusions:The injury caused by the polymer clip on the sympathetic nerve may be reversible, allowing functional return in the areas involved in the simulated cervical sympathectomy. Clipping of the cervical sympathetic nerve using a polymer clip does not cause discontinuity injury.
Highlights
Galeno, in the 2nd century, was the author of the first description, erroneous, of the anatomy of the sympathetic trunk
Based on experimental studies that demonstrate that a permanent compression on a peripheral nerve with a force greater than 44 grams-force blocks the conduction of the nervous impulse, added to the possibility of reversing the clipping to reverse the intolerable compensatory sweat, several groups started to use the block sympathetic nervous system through clipping for the treatment of primary hyperhidrosis
Microscopic evaluation Presence of necrosis and evaluation of the inflammatory process The presence of a chronic inflammatory process was observed in all animals, with a predominance of monomorphonuclear infiltrate (Figure 3) and in none was the presence of necrosis
Summary
In the 2nd century, was the author of the first description, erroneous, of the anatomy of the sympathetic trunk. The proper anatomical description of this nerve was not defined until the end of the 18th century[14] Considering that it was the physiological tests performed by Gaskell, at the beginning of the 20th century, that enabled the anatomophysiological mapping of the autonomic nervous system, it is concluded that the sympathectomies performed before that period had their scientific obscure indications, as to treat goiter thyroid, epilepsy and glaucoma[10]. Experimental studies have been carried out; they are very scarce and with quite divergent results This lack of experiments, as well as the absence of convincing and robust responses in the literature on the reversal of the injury caused by clipping after removal of surgical clips from the sympathetic nervous system in both humans and experimental animals, motivated this research to be done
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