How to Prevent, Reduce, and Treat Severe Post Sympathetic Chain Compensatory Hyperhidrosis: 2021 State of the Art.

Federico Raveglia,Riccardo Orlandi,Giuseppe Cardillo,Gerardo Cioffi,Marco Scarci,Ugo Cioffi,Angelo Guttadauro

doi:10.3389/fsurg.2021.814916

Abstract

The role of thoracic surgery in the management of hyperhidrosis is well-known and thoracoscopic sympathetic interruption is commonly accepted as being the most effective treatment. However, some concerns still remain regarding the potential to develop compensatory hyperidrosis (CH), the most troublesome and frequent side effect after surgery and its management. Compensatory hyperidrosis prevention may be achieved by identifying subjects at higher risk and/or targeting nerve interruption level on the base of single patient characteristics gathered during the preoperative survey. Furthermore, the surgical treatment may consist of different techniques aimed at reversing the effects of previous sympathetic interruption. To predict CH after sympathectomy, the most interesting proposals in recent literature are a temporary thoracoscopic sympathetic block and the introduction of new and targeted preoperative surveys. If the role of nerve clipping technique vs. the definitive cutting is still intensely under debated, new approaches have been recently proposed to reduce the incidence of CH. In particular, extended sympathicotomy has been described as an alternative to overcome severe forms. Last, among the techniques developed to reverse sympathetic interruption effect, diffuse sympathicotomy (DS) and microsurgical sympathetic trunk reconstruction represent advances in this field. An all-round review of these topics is strongly needed. Our aim is to cover all the above issues point by point. Although sympathectomy represents a small part of thoracic surgery, we believe that it is worthy of interest because of the profound effect that complications for a benign condition can have on patients.

Highlights

Primary hyperhidrosis (PH) (Table 1) is a condition of abnormal sweating compared with physiological body thermoregulation consisting of excessive and uncontrollable activation in the eccrine sweat glands of definite skin areas, such as the craniofacial region, axilla, hands, and feet [1, 2]
Anatomical clipping of sympathetic nerve to reduce compensatory sweating in primary hyperhidrosis: a novel technique
This review originates form the growing interest on this topic probably due to the number of patients who resort to surgery for hyperhidrosis and patients already affected by compensatory sweating

Summary

Introduction

Primary hyperhidrosis (PH) (Table 1) is a condition of abnormal sweating compared with physiological body thermoregulation consisting of excessive and uncontrollable activation in the eccrine sweat glands of definite skin areas, such as the craniofacial region, axilla, hands, and feet [1, 2] It is not a lifethreatening disease, hyperhidrosis interest 1–3% of population worldwide determining severe trouble in the social, mental, and working life of an individual, and leading to a decreased quality of life (QoL). PH etiology is still unclear but is commonly accepted that the abnormal sweating is associated with sympathetic nervous dysfunction. The role of thoracic surgery in its management is well known and thoracoscopic sympathetic interruption is commonly accepted as the most effective and definitive treatment when conservative ones have failed [5,6,7,8]. Some deep concerns are still present and regarding, in particular, the onset and management of the most feared, troublesome, and frequent side effect that may arise after surgery: compensatory hyperidrosis (CH)

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