title: Reversal of sympathetic interruption by removal of clips.
abstract: BACKGROUND
  Sympathetic interruption offers excellent control of hyperhidrosis and facial blushing (FB), but some patients have side effects prompting a wish to reverse the procedure. Reversal when the chain has been cut is challenging, whereas reversal when the chain has been clipped is straightforward. The peripheral nerves regenerate; however, little is known about the regeneration of the sympathetic chain after clip removal. We reviewed our results with reversal of sympathetic interruption through removal of clips.
  
  
  METHODS
  An institutional review board-approved retrospective review of patients treated for hyperhidrosis and FB from November 2004 to March 2014 was performed. We analyzed those patients undergoing sympathetic interruption with clips (N = 82).
  
  
  RESULTS
  Eight patients (10%) requested and underwent reversal of the procedure between 12 days and 5.8 years (median = 73.5 days) after the initial procedure. Compensatory sweating was the most frequent complaint (n = 6), and excessive palmar dryness was second (n = 3), the latter occurring in patients without primary palmar hyperhidrosis. The interval between clip removal and follow-up ranged from 2 days to 4.5 years (median = 141 days). Five of 8 patients thus far have had their symptoms reversed through removal of clips (Table 1).
  
  
  CONCLUSIONS
  The percentage of patients requesting reversal of sympathectomy is significant and appears to most commonly result from compensatory sweating (CS); however, excessive palmar dryness also occurs in those without primary palmar hyperhidrosis. It appears that the best results with reversal are obtained when the clips are removed early after placement. We counsel our patients that ideally clips should be removed within 2 weeks for reversal.
authors.affiliation: Division of Thoracic Surgery, Georgetown University School of Medicine, Washington, DC. Electronic address: conor.f.hynes@gmail.com.
authors.forename: Conor F
authors.initials: CF
authors.lastname: Hynes
authors.affiliation: Division of Thoracic Surgery, Georgetown University School of Medicine, Washington, DC.
authors.forename: Seiji
authors.initials: S
authors.lastname: Yamaguchi
authors.affiliation: Division of Thoracic Surgery, Georgetown University School of Medicine, Washington, DC.
authors.forename: Colleen D
authors.initials: CD
authors.lastname: Bond
authors.affiliation: Division of Thoracic Surgery, Georgetown University School of Medicine, Washington, DC.
authors.forename: M Blair
authors.initials: MB
authors.lastname: Marshall
mesh_terms: D001821:Blushing; D020878:Device Removal; D005145:Face; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D012189:Retrospective Studies; D013562:Sympathectomy / Q000295:instrumentation*