Sympathectomy; superficial palmar arch
CPT4 code
Name of the Procedure:
Sympathectomy; Superficial Palmar Arch
Common Name(s): Palmar Sympathectomy, Hand Sympathectomy
Summary
In layman's terms, a sympathectomy targeting the superficial palmar arch involves cutting or interrupting certain nerve pathways to reduce excessive sweating in the palms. It is a surgical procedure performed to alleviate symptoms caused by overactive sympathetic nerves in the hand.
Purpose
This procedure addresses excessive sweating of the palms, a condition known as palmar hyperhidrosis. The primary goal is to improve the patient's quality of life by reducing sweating and its associated discomfort and social embarrassment.
Indications
- Excessive sweating in the palms that is unresponsive to other treatments.
- Palmar hyperhidrosis causing significant social, occupational, or emotional distress.
- Patients who have failed conservative treatments like antiperspirants, oral medications, or botulinum toxin injections.
Preparation
- Patients may be instructed to fast for a certain period before the procedure.
- Prior to the surgery, the patient will undergo a medical evaluation, including blood tests and possibly imaging studies.
- Patients are advised to inform their healthcare provider about any medications, supplements, or underlying medical conditions.
Procedure Description
- Anesthesia: Administered general or local anesthesia to ensure the patient is pain-free and comfortable.
- Incision: A small incision is made near the wrist or the palm to access the sympathetic nerves.
- Nerve interruption: The surgeon identifies the specific sympathetic nerves associated with the superficial palmar arch and interrupts or cuts them.
Closing: The incision is closed with sutures, and a sterile bandage is applied.
Tools: Surgical instruments, possibly an endoscope for better visualization.
Technology: May involve nerve stimulator to identify precise nerves.
Duration
Typically, the procedure takes around 1 to 2 hours.
Setting
Performed in a hospital operating room or an outpatient surgical center.
Personnel
- Surgeon (specializing in hand or vascular surgery)
- Anesthesiologist
- Surgical nurses and assistants
Risks and Complications
- Common risks include infection, bleeding, and scarring.
- Rare complications might include nerve damage, compensatory sweating (sweating in other areas), or persistent pain.
- Management may involve antibiotics for infection, and follow-up care to address any complications.
Benefits
- Significant reduction in palmar sweating.
- Improved quality of life and social interactions.
- Benefits can often be realized within weeks after the procedure.
Recovery
- Patients may experience some pain and swelling, managed with over-the-counter pain relievers.
- Limited use of the hand for a few days.
- Full recovery and return to normal activities usually occur within 1-2 weeks.
- Follow-up appointments may be scheduled to monitor progress and address any concerns.
Alternatives
- Non-surgical treatments like strong antiperspirants, iontophoresis, oral medications, or botulinum toxin injections.
- Alternative procedures may include thoracic sympathectomy, which involves nerves higher up in the sympathetic chain.
- Pros and cons: Non-surgical methods are less invasive but may be less effective, and alternative surgical procedures may carry different risks and recovery profiles.
Patient Experience
- During the procedure, the patient will not feel any pain due to anesthesia.
- Post-procedure, patients might experience mild to moderate discomfort, swelling, and a temporary restriction in hand use.
- Pain management includes prescribed medications and at-home care instructions.
The procedure is generally well-tolerated, with patients reporting a significant improvement in symptoms and quality of life post-recovery.