What is The Reversal Operation?

In the event that a patient is not satisfied with the procedure due to some side effects (compensatory sweating), reversal of the operation is possible. For more specific information, see our reversal section.

For those patients who received the cutting method and suffer from severe compensatory sweating, reversal is a possibility that involves a complicated procedure. In this instance, a nerve graft from the ankle is used to bridge the gap in the nerve segment. Over the last two years, Dr. Reisfeld has performed several of these nerve graft reversal operations.

The data that was accumulated from those cases show that at least 60% of the patients will benefit from this procedure in a few ways. Their compensatory sweating decreases and they start sweating in the upper shoulders, neck, and facial areas.

The theory is that once the upper body areas start to sweat the evaporation process causes cooling of the head area. From that location, signals are transmitted to the brain indicating a cooler temperature.

The return of upper body sweating could explain the lessening of compensatory sweating and the ability to better tolerate heat. For this rare and unique procedure, please talk to your surgeon.

Recently, the possibility of using collagen has been requested. Unfortunately, these nerve guides are used mainly in peripheral nerve repair where there is no gap between the cut ends of the nerve. The nerve tube serves as a protective conduit and supposedly enhances axonal regrowth across a nerve gap.

Again, this is only used in peripheral nerve repair. This tube dissolves with time. Other patients ask about the use of Schwann cell cultures which, at present, are in the experimental stage and have not yet been used in any clinical cases.

Dr. Reisfeld only performs the clipping/clamping procedure due to the fact that it is much easier to remove the titanium clips than to perform a nerve graft reversal in the rare event that it is requested. A nerve graft procedure is used for those cases where the cutting method was applied.

Dr. Reisfeld does not perform the cutting method because he believes that the clipping/clamping method is a better choice. Statistical data has not been established for either the clip removal or the nerve graft method.

Experience shows that after a reversal procedure patients will start seeing sweat return on their upper body areas (head and shoulders). As a result, compensatory sweating (compensatory hydrosis or reflex sweating) will be reduced. This process might take up to a year.

With the clipping/clamping method, less nerve tissue is destroyed. With less nerve destroyed one can assume that the recovery after clip removal would be easier and more effective. In either event, it is very important to discuss these issues, should they arise, with your surgeon.