Abstract

Objectives: There is currently no hyperhidrosis qualitative assessment tool that is validated for use in the residual limb. The Hyperhidroisis Disease Severity Score (HDSS) is a brief, single item scale that has recently been found to demonstrate a correlation with excessive sweating and impaired prosthetic function.5 Treatment of residual limb hyperhidrosis includes consideration of prosthetic components, topical, oral and injectable pharmacologic interventions. In our practice, microwave thermoablation is typically used as a last resort for refractory residual limb h Introduction: Over 50% of people with amputations report discomfort related to excessive sweating inside their prosthesis.1 Hyperhidrosis of the residual limb can compromise both skin health and function within a prosthetic device. 2,3 Despite the prevalence of excessive sweating affecting residual limbs, there are very few studies devoted to assessment or treatment of this condition in persons with amputation. Major methods used for objective assessment of sweat production include gravimetry and vapometry. Gravimetry is the measure of the mass of sweat per area per unit time. No standardized gravimetric cu Materials / method: Sweating on a patient’s residual limb is measured before and after 15 minutes of exercise on a treadmill at 60% of their max heart rate in a temperature-controlled room. Both Gravimetry and vapometry are utilized. Microwave thermoablation (miraDry) is performed on the residual limb in two consecutive treatments separating the limb by half (anterior/posterior) to avoid any theoretic possibility of compartment syndrome given the large amount of swelling associated with treatment. Treatment is conducted at level 5, a widely-accepted setting for treating hyperhidrosis. Results: We found a positive correlation between subjective scores on the HDSS and TEWL values measured after exercise. For one patient that underwent microwave thermoablation on a lower extremity residual limb there was a 96.6% reduction in sweating when compared to an untreated area 4 years after treatment as measured by vapometry. For three patients that underwent microwave thermoablation on lower extremity residual limbs there was an average reduction of 2 points in HDSS scores, or 80% reduction in sweating. Improvement was sustained 4-6 years after treatment. Conclusion: For patients with refractory residual limb hyperhidrosis, microwave thermoablation has demonstrated to be an overall good option with measurable effectiveness and long-lasting results. Our data support that patients have both objective and subjective decrease in sweating on the residual limb leading to overall satisfaction with the procedure. In our experience most of the side effects were mild, however, one of our patients had a major complication following the procedure that led to a prolonged period of time out of their prosthesis while the wounds healed.