title: Thoracic sympathetic nerve reconstruction for compensatory hyperhidrosis: the Melbourne technique.
abstract: BACKGROUND
  Compensatory hyperhidrosis (CH) is a potential complication following endoscopic thoracic sympathectomy (ETS) in the management of primary hyperhidrosis. CH is considered a permanent condition with significant psychosocial impacts but with few treatment options. Various reversal surgical techniques, aimed at reconstituting sympathetic pathways, have been developed but results have been inconsistent.
  
  
  OBJECTIVE
  We present two case reports of a novel technique of reversal surgery, the Melbourne technique, which was employed to treat severe CH that developed within 3-5 months following ETS. Both patients were followed-up to 8 years.
  
  
  METHODS
  The Melbourne technique employs an endoscopic approach to expose previously sympathectomized or sympathotomized thoracic sympathetic chains. In these two cases it was performed on the right side only. Instead of an interpositional nerve graft, an autogenous vein graft was simultaneously harvested and used as a nerve conduit to bridge the secondary nerve defect after neuroma excision. Long-term outcomes were assessed using the dermatology life quality index (DLQI) and the quality of life (QoL) questionnaires, which are validated for hyperhidrosis.
  
  
  RESULTS
  In both cases, patients reported postoperative improvements in QoL scores. However, the improvement was more marked in one case compared with the other. There were no significant immediate and long-term postoperative complications.
  
  
  CONCLUSIONS
  The Melbourne technique shows promise as an alternative to interpositional nerve grafts or nerve transfers employed in other endoscopic reversal surgeries for CH.
authors.affiliation: 1 Plastic & Reconstructive Surgery, Monash Health, Melbourne, Australia ; 2 LapSurgery Australia, Melbourne, Australia.
authors.forename: Hye-Sung
authors.initials: HS
authors.lastname: Park
authors.affiliation: 1 Plastic & Reconstructive Surgery, Monash Health, Melbourne, Australia ; 2 LapSurgery Australia, Melbourne, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Hensman
authors.affiliation: 1 Plastic & Reconstructive Surgery, Monash Health, Melbourne, Australia ; 2 LapSurgery Australia, Melbourne, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Leong
keywords: Reversal surgery; autogenous venous nerve conduit (AVNC); compensatory hyperhidrosis (CH); endoscopic thoracic sympathectomy (ETS); sympathetic nerve reconstruction