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Vol 10, No 2 (2004)
Research paper
Published online: 2004-05-10

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Monitoring and assessment of effectiveness of videoscopic lumbar sympathectomy in patients with primary Raynaud’s phenomenon and hyperhydrosis by means of laser Doppler flowmetry

Stanisław Przywara, Jacek Wroński, Piotr Terlecki, Tomasz Zubilewicz, Wojciech Kobusiewicz, Witold Żywicki, Jerzy Michalak
Acta Angiologica 2004;10(2):57-66.


Background. The aim of the study was to apply the laser Doppler flowmetry method to monitor the course of videoscopic lumbar sympathectomy, and for objective evaluation of its short and long-term effects in patients with primary Raynaud's phenomenon and hyperhydrosis.
Material and methods. Twenty-one patients were included in the study and underwent unilateral, videoassisted lumbar sympathectomy. Skin blood flow and skin temperature were monitored on the plantar surface of both feet by means of laser Doppler flowmetry. Additionally, to evaluate the reactivity of microcirculation, the test of transcutaneous electrical nerve stimulation was applied. There were 4 measurements conducted: 1 day before sympathectomy, 2 hours, 24 hours and 1 month after. During surgery, skin blood flow was monitored continuously.
Results. Stimulation of sympathetic trunk evoked short-term decrease of skin blood flow. Following coagulation and segmental resection resulted in continuous elevation of blood flow values on the side of the denervated limb. The improvement in skin perfusion was stable and maintained one month after sympathectomy. The assessment of the microcirculation reactivity during transcutaneous electrical nerve stimulation showed a maximal vasodilatation in the skin of denervated extremity, pointing to the effectiveness of the procedure. Unilateral sympathectomy increased, however, not so spectacularly, skin blood flow, temperature and the level of resting vasodilatation on the contralateral, non-operated foot. This finding proves the bilateral influence of one-sided sympathectomy on the skin microcirculation, probably through the central neural control mechanisms and thermoregulatory reactions.
Conclusions. Laser Doppler flowmetry is a useful and precise tool for monitoring the course of video-assisted lumbar sympathectomy. It allows a functional identification of sympathetic trunk structures and gives the possibility to objectively assess the effects of sympathectomy in patients with primary Raynaud's phenomenon and hyperhydrosis.

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