Can Sympathetic Nerves Be Reconnected After Surgery?

Q: Can Sympathetic Nerves Be Reconnected After Surgery?

Hello： In Taiwan, hand sweat surgery has been regulated for many years, requiring careful preoperative evaluation and approval from health insurance units before proceeding. <br>This is due to the fact that many patients experience similar issues, such as compensatory sweating. <

Can the sympathetic nerves in the chest be reconnected?

I underwent T4 sympathetic nerve resection for hyperhidrosis in June of this year, which has resulted in severe compensatory sweating and weakness in my hands and feet.
After resting for three months, I returned to work, but after just three days, I experienced heat exhaustion and dehydration every day.
By the fourth day, I could only manage half a day before I was unable to continue.
I was hospitalized due to heat exhaustion and severe dehydration.
For several months post-surgery, I have been unable to work outside, and I have experienced significant compensatory sweating on my chest and back.
After just 15 minutes outside, my entire upper body is soaked.

I kindly request your assistance in reconnecting my sympathetic nerves, as I am currently unable to work and feel incapacitated.
I deeply regret undergoing the nerve resection surgery.
Please advise me on which hospital and department can perform nerve reconnection surgery.
Since I am in Hong Kong, I need to ensure I find the right physician to assist me before seeking treatment in Taiwan.
I sincerely appreciate your help with this urgent matter, as I am struggling to work and live.

moip, 40~49 year old female. Ask Date: 2017/10/15

Dr. Lai Zhaokang reply Neurosurgery

Hello: In Taiwan, hand sweat surgery has been regulated for many years, requiring careful preoperative evaluation and approval from health insurance units before proceeding.
This is due to the fact that many patients experience similar issues, such as compensatory sweating.
If you initially had the procedure done using clamps, it might be possible to attempt a thoracoscopic surgery to remove the clamps.
However, if the surgery involved resection via thoracoscopy, it would be more complicated and may require open chest surgery to reconnect or transplant new nerves.
Additionally, postoperative observation for 3-6 months is necessary to allow for nerve regeneration, and there is no guarantee of effectiveness.
If you wish to explore this option, you can consult the Department of Neurosurgery or the Department of Reconstructive and Plastic Surgery at Linkou Chang Gung Memorial Hospital in Taiwan.
Best wishes.
// Neurosurgeon Dr.
Lai Chao-Kang

Reply Date: 2017/10/15

More Info

The question you raised about the possibility of reconnecting sympathetic nerves after surgery is a complex one, particularly in the context of your experience following the T4 sympathetic nerve resection for hyperhidrosis (excessive sweating). It’s understandable that you are feeling frustrated and regretful about the outcomes of your surgery, especially given the severe compensatory sweating and weakness you are experiencing.

To address your primary concern: once sympathetic nerves are cut, the ability to reconnect them is limited. The sympathetic nervous system, which is part of the autonomic nervous system, does not regenerate in the same way that peripheral nerves do. While peripheral nerves can sometimes heal and reconnect if they are not completely severed, the sympathetic nerves, particularly those involved in the regulation of sweating, do not have the same regenerative capacity.
After a sympathetic nerve block or resection, patients often experience compensatory sweating in other areas of the body, as you have noted. This phenomenon occurs because the body attempts to maintain homeostasis and thermoregulation despite the loss of function in the original area. Unfortunately, this compensatory sweating can be more distressing than the original condition.

In terms of treatment options, there are a few avenues you might consider:
1. Rehabilitation and Physical Therapy: Engaging in a structured rehabilitation program may help improve your overall strength and functional capacity. While this won't reconnect the nerves, it can help your body adapt to the changes and improve your quality of life.

2. Medications: There are medications that can help manage symptoms of excessive sweating, such as anticholinergics. However, these come with their own side effects and should be discussed with your healthcare provider.

3. Botulinum Toxin Injections: In some cases, botulinum toxin (Botox) injections can be used to treat excessive sweating in areas that are problematic. This treatment may help alleviate some of the discomfort associated with compensatory sweating.

4. Surgical Options: While reconnecting the sympathetic nerves is not typically feasible, some patients explore other surgical options, such as a different type of sympathectomy or procedures aimed at reducing compensatory sweating. Consulting with a specialist in autonomic disorders or a surgeon who specializes in nerve surgeries may provide additional insights.

5. Psychological Support: Given the significant impact this condition has had on your quality of life, seeking psychological support or counseling may also be beneficial. Coping with chronic symptoms can be challenging, and mental health support can help you navigate these feelings.

If you are considering further surgical intervention, it is crucial to consult with a specialist who has experience in treating complications from sympathetic nerve surgeries. In Hong Kong, you may want to look for a surgeon who specializes in autonomic nervous system disorders or a multidisciplinary clinic that focuses on hyperhidrosis and its complications.

In summary, while reconnecting sympathetic nerves after a resection is not typically possible, there are various management strategies that can help alleviate symptoms and improve your quality of life. It’s important to have open discussions with your healthcare providers about your symptoms, treatment options, and any potential referrals to specialists who can assist you further.

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