The gray rami communicantes carry postganglionic sympathetic fibres from the thoracic sympathetic chain back to the intercostal nerves for distribution to thoracic wall blood vessels, sweat glands, and arrector pili muscles. They accompany the white rami communicantes (already documented) at each thoracic level.
Gray rami communicantes are the pathway for sympathetic-mediated thoracic wall vasoconstriction and sweating. Thoracic sympathectomy severs both white and gray rami, producing compensatory hyperhidrosis in other body regions (a major complication of thoracoscopic sympathectomy for palmar hyperhidrosis). The gray rami run shorter and more variable courses than white rami.
Excessive sweating in the trunk, abdomen, or lower extremities following thoracoscopic sympathectomy due to loss of gray rami-mediated thoracic wall sweating with redistribution to other territories, affecting up to 70% of patients.
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