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This document discusses hyperhidrosis (excessive sweating) and bromhidrosis (body odor), their causes and types, and surgical solutions. It notes that hyperhidrosis can be genetic or related to certain races/countries and can affect different body parts. It impacts people medically, psychologically, socially and economically. Surgical options like sympathectomy aim to disable the sympathetic nervous system responsible for sweating. Newer minimally invasive techniques using small instruments have less risk of complications than open surgery. The surgery has high patient satisfaction rates and can significantly improve people's lives.
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Hyperhidrosis is a condition where excessive sweating occurs, which may be localized to certain areas like the underarms, hands, or feet, or may affect the entire body. It affects around 3% of the population. The sweating is caused by overactivity of the sympathetic nervous system which controls sweating. Treatments include prescription antiperspirants, Botox injections, oral medications, iontophoresis, and surgeries like endoscopic thoracic sympathectomy to interrupt sympathetic nerves controlling sweating. While not life-threatening, hyperhidrosis can negatively impact one's social and emotional well-being.
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- The pathophysiology involves fluid shifts from blood vessels into burned tissue, causing shock. This leads to cardiac, pulmonary, gastrointestinal, metabolic, and immune system changes.
- Burn severity is determined by depth, extent, location, and patient factors. The rule of nines and Lund & Browder charts are used to estimate burn size.
- Initial management involves stopping the burning, providing oxygen, elevating
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- In the hospital, initial care includes assessment of airway, breathing, circulation, labs, wound culture, and starting IV fluids based on the Parkland formula. Burns over 15% TBSA or with inhalation injury usually require admission.
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Презентация3
- 1. HyperhidrosisSurgical Solutions Dr. Peter Goh Singapore
- 2. Hyperhidrosis A condition of excessive sweating Genetic : 20% of Pop. May affect different parts of the body. Eg. Face, palms, underarms, feet, thorax. May result in Skin Disease Social and Occupational Hazard.
- 3. Bromhidrosis Condition characterized by unpleasant body odour May be the consequence of systemic disease Usually due to hyperactive eccrine or apocrine glands The sufferer usually does not notice the smell.
- 4. Sex and race in relation to sweating Darker races have more Hyperhidrosis and Bromhidrosis Males more than females Tropical countries: bigger problem Riding in a public bus in Nigeria can be fatal experience!
- 5. Consequence of Hyperhidrosis and Bromhidrosis Medical Psychological Social Physical Economic Sexual
- 7. Sweating can cause skin disease Sweating macerates the skin and predispose to many different infections Atheletes Foot Fungal infections Eczema Pustules Infected Blocked Glands
- 8. How to distinguish Bromhidrosis from eccrine and apocrine sweat? Reduce or kill the bacteria. If the problem is eccrine, the smell should get better If apocrine, then the smell will persist Experienced physicians can distinguish the 2 smells.
- 9. Sweating Interferes with Work! Meeting people and shaking Hands Negotiating Table Making a presentation Doing a sales pitch Delicate work Sports Demolitions Paper Work
- 10. Conservative Measures to reduce Sweating Hygiene DriChlor : Alumium Chloride Iontophoresis Botox Injections
- 11. Permanent Solutions Sympathectomy: For eccrine sweating Palms, Axilla and Face Ablation of Axillary Apocrine Glands Surgical Ablation or liposuction
- 12. Anatomy of Sympathetic System The majority of Eccrine Hyperhidrosis is caused by Sympathetic Hyperactivity Thoracic sympathetic trunk runs vertically next to the spine in the chest It runs across the neck of the ribs Can be approached easily by entering the chest cavity endoscopically Sympathetic Chain
- 13. Surgery getting less and less invasive Open Surgery : Performed in AH till recently Endoscopic-Thoracoscopic: Using big instruments and scopes. Pioneered by Wittmoser in Germany Needlescopic : 2 and 3mm instruments Pioneered in MISC at NUH in mid nineties. Needlescopic Thoracic Sympathectomy (NTS)
- 14. Needlescopic instruments Instruments are 2mm and 3mm in diameter
- 15. Facial Hyperhidrosis Previously thought to be too dangerous to do Danger of Horner’s Syndrome New technique available using titanium clips No danger to the Stellate Ganglia
- 16. Clipping under the Stellate Ganglia Stellate ganglia Titanium Clips Sympathethetic trunk
- 17. Different levels of intervention for different effects PALMS: T2 and T3 Axilla : T3 and T4 Face: Lower edge of T1 Most delicate and precise.
- 18. Complications of Sympathetectomy Pain Air in the chest Bleeding Compensatory Hyperhidrosis Horner’s Syndrome : droopy eyelids
- 19. Reversible Sympathectomy Nerves are disabled using titanium clips Clips can be removed if patient is unhappy with the result Nerve function returns in 2 to 3 months
- 21. Lower Body : Back and Front
- 22. Pelvic area
- 23. Lower limbs
- 25. The Operation Done under full general anaesthesia One lung ventilation Entry points are in the armpit 2 to 3 holes Reversible operation needs an extra hole Takes 20 minutes to an hour.
- 26. Post Operative Course Result is instant Pain is variable but bearable: last 1-2 days Chest X ray to check for full lung inflation Discharge same day or next day Back to work in 2-3 days Dating: immediate.
- 27. Satisfaction with the operation 97% are happy with the operation Compensatory hyperhidrosis is largely well tolerated 2-3% want reversal 75-80% successful Improved professional life and social life
- 28. Conclusion Sweating and Body Odour affects your health and your work. It may also affect your social life and self confidence The causes are both genetic and environmental Hygiene and conservative measures can help Surgery is the final Solution in resistant and severe cases.