Hyperhidrosis is a pathologic condition characterized by abnormal sweating that is greater than normally needed for proper thermoregulation. Surgical therapy remains the only effective treatment for a definitive cure of idiopathic focal hyperhidrosis, although some controversies still exist regarding the best operation. The most significant side effect of hyperhidrosis surgery is compensatory hyperhidrosis. Although severe compensatory hyperhidrosis is the less frequent form, it results in a detrimental effect on quality of life, and restoration of the pre-surgical condition is advocated by affected patients. Sympathetic chain reconstruction represents the only surgical option for managing severe compensatory hyperhidrosis after failed sympathetic chain surgery, although without definitive results. In this review, we focus on experimental and clinical data on the use of sympathetic chain reconstruction in the treatment of severe compensated hyperhidrosis after failed sympathectomy for hyperhidrosis. Regenerative medicine, particularly tissue engineering and stem cell technology, offers new therapeutic strategies for sympathetic chain reconstruction. These strategies may improve or resolve compensatory hyperhidrosis by promoting nerve regeneration. However, there are a number of problems with current research, including inconsistency in treatment outcomes, lack of long-term follow-up data, and insufficient in-depth understanding of regenerative medicine techniques. Nonetheless, some progress has been made in experimental and clinical studies. For example, sympathetic nerve regeneration has been demonstrated in animal models, and different methods of reconstruction, including the use of autologous nerve grafts and nerve conduits, have been shown in clinical studies. These studies provide preliminary evidence for the significance of regenerative medicine in sympathetic chain reconstruction. In conclusion, the development of regenerative medicine offers new hope for patients with primary hyperhidrosis, even though current treatments have not yet achieved the desired therapeutic results. With further technological development and research, tissue engineering and stem cell technology are expected to be effective means of treating compensated hyperhidrosis, thus significantly improving the quality of life of patients.
