Twenty-site HDSS mapping after thoracoscopic sympathectomy for primary palmar hyperhidrosis: a secondary complete-case analysis of a multicenter randomized trial.

The study compared the effects of unilateral and bilateral thoracoscopic sympathectomy for treating primary palmar hyperhidrosis using sweat mapping at twenty anatomical sites. Ninety-two patients were included in the analysis, with 36 undergoing bilateral surgery and 56 unilateral surgery. Before surgery, severe sweating was present in 182 of 184 observations on the hands, 168 of 184 on the feet, and 75 of 184 in the armpits. Six months after surgery, improvement on the hands was more pronounced after bilateral surgery (88.9% versus 52.7%) and in the armpits (72.2% versus 29.5%). Worsening of sweating occurred mainly in the abdominal, dorsal, and thoracic regions. Complete resolution of severe sweating was achieved in 47.2% of patients after bilateral surgery and 21.8% after unilateral surgery. Twenty-site sweat mapping can improve postoperative care by distinguishing true compensatory sweating from worsening of pre-existing sweating.