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The Differences Between Palmar and Plantar Hyperhidrosis

Most patients who suffer from palmar hyperhidrosis (excessive hand sweating) will also have excessive sweating in the feet (plantar hyperhidrosis). In the past when topical measures such as drysol, drionic or other conservative treatments did not help, patients then looked to surgical alternatives.

The Endoscopic thoracic sympathectomy (ETS) procedure is very effective for the treatment of palmar hyperhidrosis, but it is not as effective for plantar hyperhidrosis. The reason for the difference in success rates is not known. That being said, the current theory is the fact that most of the sympathetic innervation to the plantar sweat glands originates in the lower thoracic sympathetic ganglia and the first lumbar ganglia.

By performing the thoracic sympathectomy those ganglia are not affected. The sympathetic nervous system is made up of multiple sites that have different functions. The sympathetic chain in the lumbar region controls plantar sweating.

Up until a few years ago, there was some hesitation in performing the lumbar sympathectomy as well as the upper thoracic sympathectomy because of potential sympathetic dysfunction. For male patients, the side effects could also include retrograde ejaculation. Over the last few years, additional clinical work has been carried out in South America and Europe.

This research revealed that performing a lumbar sympathectomy after an upper thoracic sympathectomy does not cause sympathetic dysfunction. Instead, it offers a high rate of success for excessive plantar hyperhidrosis. By obtaining anatomic knowledge about the distribution of the sympathetic nerves in the lumbar region we now know that as long as you stay within the blockade level at or below lumbar vertebra #2, there is no influence on the male ejaculation process.

A Bilateral lumbar sympathectomy can be carried out on an outpatient basis or a very short hospital stay. It involves three small cuts on the left and right flank. The sympathetic chain at the L2-L4 level is clamped.

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