ETS Reversal for Hyperhidrosis

As in any other operation the sympathectomy can cause some side effects that are worse than the original problem. In the past no solution was given to those patients who had sympathectomy done with resection or coagulation. Due to the pioneering work done by Dr.Telaranta progress has been made with regard to nerve graft reversal. In this case a nerve is harvested from the ankle and implanted in the site where the previous sympathectomy was done. This is a very new procedure, and the world wide experience is some what limited but offers a definite hope for those were done with the cutting method and are unhappy with the results. In Los Angeles Dr.Reisfeld has performed this type of procedure with limited success. For those patients who had the clamping method for the sympathectomy the reversibility is much simpler to do. In this type of situation the clamps are removed with a much better chance of resumption of nerve activity. In a certain amount of cases where the clamps were taken out reduction of the compensatory sweating and the return of the original symptoms was noted.

There are basically two method to establish continuity in those cases where the nerve was cut. The first method is the harvesting of piece from the sural nerve (a sensory nerve located in the ankle region) and to implant it in the place where the missing segment is located. The second method is intercostals nerve grafting (ICNG) and here a segment from the intercostals nerve is used to establish continuity. A new possibility is now available to restore the continuity of the sympathetic trunk in the chest by using an available pre-treated harvested nerve graft that can bridge the missing segment. This nerve graft taken from human cadavers is prepared in a way that the basic structures are maintained without any immune response from the recipient's body. Clinical experience is still limited but the easy access for this nerve graft segments prevents the added difficulties of harvesting the nerve from the patient's body. It is somewhat difficult to explain it in a written form is the patient is encouraged to talk directly with the surgeon about these two possibilities.

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