Sympathetic chain clipping for hyperhidrosis is not a reversible procedure
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AutoresJ. Loscertales, Miguel Congregado, Rafael Jiménez-Merchán, G. Gallardo, Ana Triviño, S Garcia Moreno, Beatriz Loscertales, Hugo Galera‐Ruiz
Por qué importa
Este estudio experimental realizado en un modelo porcino investigó la lesión neuronal de la cadena simpática inducida por la oclusión con clips, evaluando la posibilidad de regeneración tras su retirada. Los hallazgos patológicos mostraron degeneración Walleriana evidente a los 10 días, extendiéndose y acentuándose a los 20 días. A los 30 días, persistía una importante reacción macrofágica y, tras la retirada de los clips durante 20 días, se observó una escasa presencia de fibras mielinizadas y amielinizadas. Estas observaciones sugieren la ausencia de regeneración axonal significativa tras la oclusión, lo que implica que la técnica de clipado no es reversible. Aunque la hiperhidrosis y su tratamiento no son un área directa de la odontología, la investigación sobre la reversibilidad de procedimientos quirúrgicos y la evidencia histopatológica de la lesión nerviosa pueden ofrecer perspectivas sobre la comprensión de la neuroanatomía y la cicatrización en el contexto de la práctica clínica.
Many techniques have been used to treat palmar hyperhidrosis. Compensatory sweating is a difficult adverse effect. Clipping has been proposed because of its supposed reversibility when clips are removed at a later date. The primary aims of this article are to investigate the neuronal lesion of the sympathetic chain caused by clipping and to study the possibility of regeneration after removal of the clips. We performed an experimental study at the Minimally Invasive Surgery Centre Jesus Uson in Caceres (Spain). We used a swine model, performing clipping, unclipping, and extirpation of different segments of sympathetic chain with clips and after clip removal, following a chronogram of 10, 20, and 30 days. Pathologic studies of specimens and statistics were done at the University of Seville. Ten days after clipping, all sympathetic chains displayed evident Wallerian degeneration. Twenty days after clipping, Wallerian degeneration of myelinated fibers was more widespread and also more striking. Thirty days after clipping, a very marked macrophagic reaction was visible, with multiple signs of phagocytosis of myelin debris. By 30 days post operation and 20 days after clip removal, a few residual myelin and amyelinated fibers were visible. These findings suggest that axon regeneration is not possible. There are Wallerian degeneration and axon loss 10 days after clipping. The almost total absence of myelinated and amyelinated fibers following clip removal suggests that there was no nerve regeneration, and that therefore clipping cannot be considered a reversible technique.
Loscertales J, Congregado M, Jiménez-Merchán R, Gallardo G, Triviño A, Moreno SG, et al. Sympathetic chain clipping for hyperhidrosis is not a reversible procedure. Surgical Endoscopy. 2011. doi:10.1007/s00464-011-2023-4
