RADIOTHERAPY
Has been used to treat axillar hyperhidrosis. High-dose
radiation (rads) is necessary to treat hyperhidrosis.
Such a dose causes serious dermatitis, fibrosis, skin
retraction, ending with serious functional limitation
of shoulder movements.
AXILLARY SWEAT GLAND ABLATION
An usual ellipsical area of skin and glandular tissue
is removed from the armpit and the space is closed by
Z-plasty. The results depend on the size of the area excised.
Local chronic eczematous dermatitis, keloid formation
and various late contractures may occur interfering with
the abduction of the shoulder.
AXILLAR LIPOSUCTION
Liposuction surgery of the axillar vault doesn’t
extract sweat glands. Its effect is questionable.
THORACIC ENDOSCPIC SYMPATHICOTOMY
This is the best method for the treatment of the hyperidrosis.
Activation of the sweat glands is done by the sympathetic
nervous system. When the stimulus to the gland is exaggerated,
the result is excessive sweating.
Sympathicotomy for the treatment of palmar, axillary and
facial hyperhidrosis consists of cutting at a certain
points along the sympathetic chain, which is located on
the inside of the thoracic cavity. This stops the stimulus
to the sweat glands and the sweating disappears.
Dr. Peter Kux and his late uncle, Dr. E. Kux, pioneered
the use of the endoscope for thoracic sympathicotomy in
the 1940’s. This allows the operation to be done
with 2 small punctures of the thoracic cavity, which is
far less aggressive than the conventional technique of
making large incisions in the thorax or neck. This technique,
Thoracic Sympathicotomy via endoscope, has become the
method of choice for the treatment of hyperhidrosis.
In 1992, with over 50 years of experience in the technique
of endoscopic thoracic sympathicotomy, and over 6,000
surgeries performed, Dr. Kux teamed up with Dr. João
Bosco Vieira Duarte to adapt the surgery to the video
endoscope. To include the video, technical and tactical
modifications were necessary. The procedure became even
safer and the results were improved. The technique now
used by the team treats excessive sweating of the hands,
armpits and the face. The surgical procedure is done under
general anesthesia through two incisions of 3 mm on each
side of the thorax. It lasts about 30 minutes.
The results so far are 100% of patients cured of hyperhidrosis
of the hands, 96% for the armpits and 99% for face. The
results are immediate and definitive. For patients with
hyperhidrosis of the feet in combination with hands, face
or armpits, 94% have had the condition improved or cured
completely. The surgery is performed on an outpatient
basis. The patient is discharged the same day. There is
no need to spend the night in the hospital. The recovery
is quick and the patient can return to normal activities
soon.In some cases, there is an increase of sweating in
the abdominal and lumbar areas, which disappears in a
few days. It is rarely persistent. Complications are rare
with this method.
Paliative
