Transaxillary sympathectomy for primary hyperhidrosis palmaris in children

Abstract

Although primary palmar hyperhidrosis is uncommon in the paediatric age group, it is unpleasant and disturbing for the affected child. Both local and medical treatment often fail and only sympathetic denervation can be permanently effective. We have performed seven bilateral transaxillary preganglionic dorsal sympathectomies removing T2, T3 and T4 ganglia. More recently, the surgical technique has been changed to a preganglionic sympathectomy of T4, T3 and T2 with lateral displacement of the sympathetic chain. Four children presented from birth with excessive palmar sweating. The average age at sympathectomy was 9 years. No serious complications were encountered, but one patient developed a mild Horner syndrome, where a composite first and second dorsal ganglia was encountered at surgery, and another child had localised, compensatory, thermally induced hyperhidrosis. Pilocarpine sweat tests before and after surgery showed an 80% reduction in sweat production on stimulation, which correlated well with clinical improvement. The transaxillary approach has certain advantages since it allows for excellent exposure of the sympathetic chain, adequate denervation and minimal morbidity as well as being cosmetically acceptable. It is recommended that transaxillary sympathectomy be performed for primary palmar hyperhidrosis in children after medical treatment has failed.