Clinical observation of small incision surgery combined with multi-point skin fixation in the treatment of axillary osmidrosis / 中国医师杂志

Objective:To evaluate the efficacy and safety of small incision surgery combined with multi-point skin fixation in the treatment of axillary osmidrosis.Methods:104 patients with axillary osmidrosis who were treated in the dermatology department of the Third Hospital of Changsha from January 2017 to December 2020 were retrospectively analyzed. They were divided into the observation group (56 cases) and the control group (48 cases). Both groups were treated with small incision pruning combined with porous drainage. On this basis, the observation group was treated with multi-point skin fixation gauze compression bandage, while the control group was treated with conventional gauze stacking compression bandage. The efficacy, satisfaction, postoperative wound healing time and complication rate of the two groups were compared.Results:The effective rate of the observation group and the control group were 96.43%(54/56) and 95.83%(46/48) respectively, with no significant difference ( P>0.05). Compared with preoperative, the Visual Analogue Scale (VAS) score of patients in the two groups was significantly lower after operation, and the difference was statistically significant (both P<0.05). The satisfaction of patients in the observation group was higher than that in the control group [(4.05±1.15)points vs (3.19±1.00)points], and the difference was statistically significant ( t=4.10, P<0.05). The wound healing time in the observation group was shorter than that in the control group, and the incidence of complications was lower than that in the control group, with statistically significant difference (all P<0.05). Conclusions:Small incision surgery combined with multi-point skin fixation for the treatment of axillary osmidrosis has good curative effect, short postoperative wound healing time and fewer complications, and improved patient satisfaction, which can be popularized in clinical application.

Clinical effect of endoscopy assisted suction-cutter removal of apocrine sweat glands / 中华医学美学美容杂志

Objective To explore the clinical effect of endoscope assisted suction-cutter removal of apocrine sweat glands in treatment of osmidrosis.Methods This study generalized and analyzed the curative effects of 30 patients with axillary osmidrosis,treated with endoscopy assisted suction-cutter removal of apocrine sweat glands.The efficacy was evaluated according to the postoperative results and complications.Results In all the 30 patients,wound healed 7 to 10 days after operation,and they resumed almost normal life after treatment.From May 2015 to April 2017,the follow-up visits showed that none of them had relapse,infection or skin necrosis.Surgical scar was slight,and in all the patients,symptoms disappeared.Conclusions The operation of endoscopy assisted suction-cutter removal of apocrine sweat glands is a minimally invasive surgery.The advantages include direct vision,radical operation,well preserved dermal vascular network and lower risk of complications.

Percutaneous ethanol injection as a promising and minimally invasive treatment for axillary osmidrosis: Double-blinded randomized controlled trial

Background: Axillary osmidrosis is a common problem with a strong negative impact on the professional and social quality of life. Several options are available for its treatment. But there are no treatment guidelines. The objective of this study was to evaluate efficacy and safety of percutaneous ethanol injection for treatment of axillary osmidrosis. Methods: A randomized, double-blind, placebo-controlled clinical trial to assess clinical efficacy and postoperative complications of percutaneous ethanol injection was performed among 60 patients (12–35 years of age) with axillary osmidrosis. The active agent used in the experimental group (n = 30) was sterile 90% ethanol and the placebo used in the control group (n = 30) was sterile normal saline administered in an identical syringe. The results of malodor elimination were graded by the patients as excellent, good, fair, and poor. All patients were followed-up for 10 months. Results: Malodor elimination was graded as good by 15 (50%) patients treated with percutaneous ethanol injection. A significant difference in the improvement of axillary osmidrosis was found between the experimental and control groups (P < 0.001). The most common post-procedure complication was transient subjective skin stiffness in the experimental group, which regressed spontaneously. There were no serious permanent side effects. Limitations: Relatively short duration of follow-up; and lack of histopathological evidence of destruction of the apocrine glands after treatment in most patients. Conclusions: Percutaneous ethanol injection is an effective and safe treatment method for axillary osmidrosis and does not have permanent side effects.

Comparison between Conventional and Modified Superficial Liposuction Techniques in the Treatment of Axillary Osmidrosis / 대한피부과학회지

BACKGROUND: Axillary osmidrosis is caused by abnormal apocrine glands. Although various treatment modalities have been developed for axillary osmidrosis, there have not been sufficient studies to establish a treatment guideline. OBJECTIVE: This study aimed to evaluate the efficacy, safety, and disease recurrence rate of treatment by superficial liposuction with dermal curettage using Fatemi cannula to the level of the dermal-subcutaneous junction (modified technique) compared to dermal curettage to the level of the mid-dermis (conventional technique). METHODS: Fifty-two patients (104 axillae) underwent the modified technique and 54 patients (108 axillae) underwent the conventional technique from April 2007 to September 2014. The patients' demographic data, clinical efficacy of each treatment as evaluated using subjective satisfaction scales, postoperative complications, and recurrence rates were retrospectively reviewed, and procedures compared. RESULTS: Excellent to good outcomes were reported in 46 patients (88.5%) who underwent the modified technique and 50 patients (92.6%) who underwent the conventional technique. Recurrence occurred in 12.5% (13/104) of axillae in patients who underwent the modified technique, and 9.3% (10/108) of axillae in patients who underwent the conventional technique. There was no statistically significant difference in clinical efficacy, safety, or recurrence rates between the two techniques (p>0.05). Skin necrosis was significantly lower using the modified technique (p=0.017). CONCLUSION: Our study found that clinical results of the modified technique were comparable with those of the conventional technique. The modified technique is a convenient treatment for axillary osmidrosis, with high efficacy and low disease recurrence.

Comparative study on clinical efficacy of different surgical methods for axillary osmidrosis / 局解手术学杂志

Objective To investigate the most appropriate surgical methods,different surgical modes of osmidrosis and their clinical effi-cacy were observed. Methods Clinical data was collected from 200 cases of axillary osmidrosis from January 2011 to July 2013. These cases were divided into four groups of the traditional group,minimally invasive group,RF pen-frequency electric cautery group and improved curet-tage group. Results The traditional group(80 cases) has an average healing period of 18. 7 days for operative incision including 78 cured cases(97. 5%)and 2 significant improved cases(2. 5%). The minimally invasive group(60 cases)has an average healing time of 8. 6 days, among which there are 3 cured cases(5%),8 significant improved cases(13. 3%),16 improved cases(26. 7%),4 cases(6. 7%)with weak curative effect and 29 failed cases(48. 3%). In the RF pen-frequency electric cautery group(30 cases),there are 5 significant improved ca-ses(16.7%),8improvedcases(26.7%)and17failedcases(56.6%).Theimprovedcurettagegroup(30cases)withanaverageincision healingtimeof9.8dayscontains28curedcases(93.3%)and2significantimprovedcases(6.7%). Conclusion Thetraditionalgroup shows the best curative effect,nevertheless the incision needs a considerably amount of time to recover. The patients under the treatment of minimally invasive surgery or RF pen-frequency electric cautery can recover in short time but recrudescence always occur. The improved cu-rettage method,which is effective and safe,combines the advantages of traditional surgery and minimally invasive surgery. However,large scar left from this method still remains as its major disadvantage but the overall curative effect is satisfactory. The improved curettage is proved to be the most appropriate method for axillary osmidrosis.

Minimally Invasive Surgery for Axillary Osmidrosis Using a Combination of Subcutaneous Tissue Removal and a 1,444-nm Nd:YAG Laser

Many treatment modalities have been developed for axillary osmidrosis. It is well known that the surgical treatment has the best results. However, there is a high possibility of side effects. The 1,444-nm lipolysis laser has been recently introduced to remove the apocrine glands. So far, subdermal coagulation treatment with a 1,444-nm Nd:YAG laser may be the least invasive and most effective therapy for axillary osmidrosis. However, according to our previous experience, the recurrence rate was 20%~30%. This emphasizes the need for combination of surgical method and non-surgical method and we combined subcutaneous tissue removal and photothermocoagulation with a 1,444-nm Nd:YAG laser. Three patients for bilateral axillary osmidrosis were enrolled. After an incision of about one-third the length of the widest transverse diameter, the apocrine glands were separated from the skin. And then apocrine glands within the marked area were destroyed by irradiation with a 1,444-nm Nd:YAG laser thereafter. All patients exhibited no relapse of axillary osmidrosis and were satisfied with the treatment results. A combination of subcutaneous tissue removal and Interstitial laser photothermocoagulation with a 1,444-nm Nd:YAG laser could be an effective treatment for mild to moderate axillary osmidrosis.

Comparison of efficacy and complications among three small incision procedures in treatment of axillary osmidrosis / 中华医学美学美容杂志

Objective To treat axillary osmidrosis by using three procedures (small incision apocrine curettage,cut-off operation and aspiration surgery),to observe the postoperative complications,efficacy and the pathological changes of skin,and to explore the advantages of these three procedures.Methods Seventy-five cases of evere bilateral axillary osmidrosis were involved in this study,totally 150 axillary surgery area,which was randomly divided into different group:Group A (curettage group); Group B (cut-off group) and Group C (aspiration group).Different surgical treatment was conducted in the three groups of operation area.Results Incidence of complications was 28.30 ％ and total effective rate was 94.34 ％ in Group A; in Group B,incidence of complications was 6.38 ％,and total effective rate was 97.87 ％ ; in Group C,incidence of complications was 4.00 ％ and total effective rate was 78.00 ％.The incidence of complications was significantly different between Groups A and B and between Groups A and C,but not significant difference between Groups B and C.The cure rate and efficiency were not significant difference between Groups A and B groups,but significant difference was found between Groups A and C and Groups B and C.HE staining results showed that the dermal tissues were partially destroyed in Group A and B,and no apocrine sweat glands were not seen within the dermis and subcutaneous tissues; in Group C,the dermal tissue was rarely destroyed,and a lot of apocrine sweat glands were reserved within the dermis and subcutaneous tissues.Conclusions Efficacy of curettage and cut-off procedures is better,but that of aspiration is worse in the treatment of axillary asmidrosis.The complications of cut-off surgery and aspiration are less,but urettage has more complications.Therefore,the efficacy of cut-off operation is the best with least complications among the three procedures.

Mondor's Disease after Operation for Axillary Osmidrosis: A Case Report

Mondor's disease is a benign, self-limited process with spontaneous resolution, which is frequently caused by breast surgery, such as axillary lymph node dissection. We present a case of Mondor's disease that occurred after an axillary osmidrosis operation, which is a less invasive procedure; Mondor's disease may be considered as a possible postoperative complication following an axillary osmidrosis surgery.

Anatomy and histopathology of apocrine sweat glands in axillary fossa / 中华医学美学美容杂志

Objective To investigate the distribution range and depth of the apocrine sweat glands of the axillary fossa,in order to supply with anatomic and histopathologic basis in the treatment on axillarv osmidrosis.Methods From December 2008 to ()ctober 2010,2 biopsy samples(with axillary osmidrosis),8 biopsy samples(normal,without axillary osmidrosis),were employed into the axillarv anatomy study. 25 patients with severe axillary osmidrosis were observed both maerographicallv and microscopically by using of operation and histopathological methods.Results Secretory portion of apocrine sweat glands was seen clearly,it was pitchy millet-like granules on axillary osmidrosis corpse,and pink millet-like granules in vivo.Secretory portions distributed most within the armpit hair area,exceeded the edge of armpit hair line,but not surpassed the edge of armpit hair line 1.0 cm.The depth of the apocrine sweat glands located vertically at superficial fat tissues between the dermal reticular 1aver and superficial fascia layers which were dissected away easily.Trimming with scissors under dermaIlayer,the secretory portion of apocrine sweat glands was removed cleanly without harms to reticular laver of dermas.Secretory portions became ducts under reticular layer of dermas.White Drominence-like granules were proved to be the compomers of hair follicle and sebaceous glands through Dathological section.Conclusions In order to treat axillary osmidrosis effectively,the secretary portion should be removed away through cutting off the tissues between the dermal reticular layer and suDerficial fastia layers;the ducts of apocrine sweat glands should be handled with removing hair follicle under the reticular layer of dermas．0peration area should not exceed 1.0 cm off the edge.

Comparative Analysis of Tumescent Liposuction according to the Dermal Curettage Level for the Treatment for Axillary Osmidrosis / 대한피부과학회지

BACKGROUND: The efficacy of tumescent liposuction in the treatment of axillary osmidrosis has been widely established. But there have been few studies that have conducted a comparative analysis according to the level of dermal curettage with respect to the efficacy and safety. OBJECTIVE: The aim of this study was to evaluate the clinical efficacy and complications of tumescent liposuction according to the degree of dermal curettage. METHODS: From September 2004 through August 2009, a total of 33 patients with axillary osmidrosis (66 axillae) were included in this study. Twelve patients (24 axillae) were treated by tumescent liposuction with dermal curettage at the level of the mid-dermis (the classical technique group), and the other 21 patients (42 axillae) were treated by tumescent liposuction with dermal curettage at the level of the dermo-subcutis junction (the modified technique group). The preoperative and postoperative disease severity was measured as 0, 1, 2 and 3. The improvement of symptoms was graded by the patient as excellent, good, fair and poor. We also evaluated the postoperative complications, including skin necrosis, scar, hematoma, sensory disturbance and infection. Biopsies of the axillary skin were performed in 7 patients to confirm the level of dermal curettage and the reduction of apocrine glands after treatment. RESULTS: The follow-up ranged from 6 to 60 months. Six months after treatment, 95.8% (23/24) of the axillae in the classical technique group and 95.2% (40/42) of the axillae in the modified technique group had reduced disease severity below 1. Among the 12 patients treated with the classical technique, 11 (91.7%) had excellent to good results, while 95.2% (20/21) of the patients treated with the modified technique had excellent to good results by the patients' own grading. The complications included skin necrosis, scar and hematoma. In the classical technique group and the modified technique group, the incidence of skin necrosis was 12.5% (3/24) and 2.4% (1/42), respectively, the incidence of scar formation was 4.2% (1/24) and 0%, respectively, and the incidence of hematoma was 8.3% (2/24) and 0%, respectively. The postoperative histologic examinations confirmed that the dermal curettage level was at the mid-dermis in the classical technique and at the dermo-subcutis junction in the modified technique. Interestingly, the histologic examination from the classical technique group revealed vacuolar alteration of keratinocytes and partial separation of the dermo-epidermal junction. CONCLUSION: The efficacy of the modified technique is compatible with that of the classical technique, but the modified technique offers fewer complications. So, the modified technique may improve the cosmetic outcome without reducing the treatment efficacy for the patient with axillary osmidrosis.

The Treatment Effects of Ultrasonic Surgical Aspiration for Axillary Osmidrosis / 대한피부과학회지

BACKGROUND: Axillary osmidrosis is a distressing and uncomfortable condition that can be a serious handicap in a person's personal and social life. There are many different surgical methods to treat axillary osmidrosis. However, they have caused frequently marked complications. OBJECTIVE: The purpose of this study was to evaluate the effect of ultrasonic surgical aspiration for the treatment of axillary osmidrosis. METHODS: From January 2007 to September 2008, a total of 62 patients was treated for axillary osmidrosis using ultrasonic surgical aspiration. RESULTS: Fifty-three (85.4%) patients had excellent to good results. Postoperative complications were seen in 5 (4.1%) patients out of 124 axillae. All of them were hematoma. The axillary scars are small and nearly negligible. The average recovery period was 5 days. CONCLUSION: Ultrasonic surgical aspiration displayed satisfactory therapeutic efficacy. This operation has many advantages with a high success rate, small and short scars, a low complication rate and a rapid recovery period.

A Clinical Study of Postoperative Efficacy of Superficial Liposuction in Axillary Osmidrosis / 대한피부과학회지

BACKGROUND: Axillary osmidrosis is characterized by unpleasant odor, profuse sweating and occasionally staining of clothes. Classical surgical treatment of axillary osmidrosis may result in many complications, such as scarring, hematoma and necrosis. OBJECTIVE: The purpose of this study is to evaluate the effect of superficial liposuction in the treatment of axillary osmidrosis. METHODS: Through two 5 mm sized incisional windows, liposuction can be done in a two directional criss-cross pattern. Fifteen patients received this surgery for bilateral axillae on an outpatient basis. The follow-up period ranged from 8 months to 18 months, the mean follow-up period was 12.5 months. RESULTS: Of the 30 axillae, 28 axillae (93%) had excellent to good results. The axillary scars were short and nearly negligible (90%). Complications including one minor wound infection (3.3%) and one hematoma (3.3%), were improved with proper post-operative treatment. Four patients experienced transient fibrotic bands. All of these complications disappeared after 1~2 months. CONCLUSION: In axillary osmidrosis, superficial liposuction has the merits of high success rates, short scars, minimal postoperative care with a short term of compressive dressing and rapid recovery to normal life.

Radiofrequency Treatment of Axillary Osmidrosis

Axillary osmidrosis is caused by excessive secretion of apocrine sweat gland and can cause extreme difficulty in social activities. The surgical removal of apocrine glands has been thought as an effective method. But this classical treatment results in many complications such as scarring, hematoma, skin necrosis and these complications have not been solved yet. Recently radiofrequency surgery as a minimally invasive technique is used for the treatment of snoring, benign prostate hypertrophy, hepatoma, reduction of masseter muscle and gastrocnemius muscle. From June, 2004 to March, 2005, 10 patients with axillary osmidrosis were treated by radiofrequency thermal ablation(PMC-1000). The generator was set to level 6-8 and the duration of time was 1.0 seconds. The maximum number of treatment sessions were two. The mean postoperative follow-up period was about average 6 month ranged from 2 to 9 month. The skin necrosis was developed in 2 patients. All patients were satisfied or partially satisfied with the results. Although suitable radiofrequency power and heating duration have not been defined yet, which is mandatory in order to obtain the best results, the radiofrequecy could be a safe and effective treatment modality for axillary osmidrosis with a good clinical outcome and few complications.

Clinical Study of the Surgical Excision of Subcutaneous Tissue Combined with the Assistant Subcutaneous Shaver Method for treatment of Axillary Osmidrosis and Hyperhidrosis / 대한피부과학회지

BACKGROUND: Classical surgical treatment of axillary osmidrosis and hyperhidrosis results in many complications such as scarring, hematoma and necrosis, therefore, gentle skin flap cares is needed. OBJECTIVE: In order to lessen the complications and to obtain an improved clinical outcome, a new easy-learn, surgical excision method of treating subcutaneous tissue is required. METHOD: On 16 patients, We carried out a type-1 surgical method to treat axillary osmidrosis and hyperhidrosis. This invoved major removal of the subcutaneous tissue by scissor excision, and partial removal by the subwtaneous shaver method, to minimise trauma. We then analyzed the clinical efficiency, complications, patient satisfaction, and pathologic specimens according to clinical severity. RESULTS: All 16 patients showed an improved odor or sweating pattern, and a good or very good level of satisfaction. One patient also showed that hematoma was improved with proper post- operative care. Hyperactivity of the apocrine glands in osmidrosis and eccrine gland in hyperhidrosis was seen, and various morphologic features of apoeccrine glands were found in both osmidrosis and hyperhidrosis. We observed that apocrine and eccrine glands were completely excised by following the biopsy of 2 patients. CONCLUSION: Our present method of minimal skin incision and major removal of subcutaneous fat with manual scissor excision, in combination with partial excision with the subcutaneous shaver method, showed a good clinical outcome and few complications.

A Clinical Analysis of Surgical Treatment for Axillary Osmidrosis by the Bipedicle Flap Method and CO2 Laser / 대한피부과학회지

BACKGROUND: Axillary osmidrosis is caused by excessive secretion of apocrine sweat, which causes foul odor and extreme social embarrassment. Axillary osmidrosis can be treated by a number of methods, but surgery is the treatment of choice. OBJECTIVE: The purpose of this study was to evaluate clinical results of surgical treatment for axillary osmidrosis by the bipedicle flap method and CO2 laser. METHODS: December 1995 and December 2002, 53 patients with axillary osmidrosis were treated by the bipedicle flap method and with CO2 laser. Post-operative complications and convalescent time in the patients (106 axillae) were then of evaluated. Among them, 37 patients were followed up for a minimum 6 months, and the patients were asked to complete a questionnaire on their family history, aggravation factors, association with wet ear wax or palmoplantar hyperhidrosis, degree of satisfaction, decreased sweating, decreased axillary hair, tension on motion, and scarring. RESULTS: Follow-up ranged from 6 to 84 months (mean: 41months). Thirty one (83.8%) out of 37 patients were satisfied or partially satisfied with the results. Six (16.2%) out of 37 patients were dissatisfied. Post-operative complications were seen in 27 (25.5%) out of 106 axillae. The average convalescent time was 18 days. CONCLUSION: Based on the long-term evaluation, this bipedicle flap method and CO2 laser treatment were found to be effective for axillary osmidrosis.

Surgical Treatment of Axillary Osmidrosis

Axillary osmidrosis, also referred to as bromhidrosis, is a condition of excess, abnormal, or strong acrid body odor that typically manifests itself after puberty with the enlargement of apocrine glands. This condition often causes the affected to avoid social settings and personal relationships particularly throughout puberty and into adult life. The surgical objectives for treating axillary osmidrosis are to eliminate malodor and postoperative recurrence, to reduce significant complications such as hematoma and skin flap necrosis causing scarring, to decrease the recovery time, and to reduce the surgical scars. In order to meet the objectives, I recommend to use three surgical methods such as subdermal shaving method with scissors, liposuction and curettage method, and curettage and dermal shaving with manual and electric bone rasp. The subdermal shaving method demands the surgeon to execute meticulous hemostasis in the central axilla. Quilting sutures should be placed to fixate the skin flap to the axillary base to further prevent hematoma and to shorten recovery time. A relatively simple pressure dressing is removed after a couple of days, which will allow the patients to resume their routine daily life. Liposuction and curettage method is used to remove the apocrine glands in the subcutaneous layer. Apocrine and eccrine glands in the lower dermis are removed by dermal shaving with a manual or electric bone rasp or by a suction assisted cartilage shaver.

Treatment of Axillary Hyperhidrosis; Manual Subdermal Excision Combined with the Tumescent Liposuction and Subcutaneous Tissue Shaver

BACKGROUND: Axillary osmidrosis is a distressing problem characterized by unpleasant odor, profuse sweating, and occasional wetting of clothes that may handicap those affected both socially and psychologically. A variety of surgical methods have been developed for the treatment of axillary osmidrosis. OBJECTIVE: To introduce the manual subdermal excision combined with the tumescent liposuction and subcutaneous tissue shaver for axillary osmidrosis. METHODS: Twenty-five patients with axillary osmidrosis were treated by the manual subdermal excision combined with the tumescent liposuction and subcutaneous tissue shaver. RESULTS: Twenty-one(84%) patients had good results, four(16%) fair, and none had a poor result or recurrence. Complications included one case of hematoma, two cases of partial skin necrosis. The wound complication rate was 6.0%(3/50) for the axilla and 12%(3/25) for patients. CONCLUSION: The manual subdermal excision combined with the tumescent liposuction and subcutaneous tissue shaver is effective surgical procedure for the treatment of axillary osmidrosis with a low complication rate and recurrence.

A Clinical Analysis for Surgical Treatment of Axillary Osmidrosis by Subcutaneous Tissue Remover and Carbon Dioxide(CO2) Laser / 대한피부과학회지

BACKGROUND: Axillary osmidrosis is a distressing problem characterized by and unpleasant odor, profuse sweating, and occasionally staining of clothes that may handicap those affected socially, psychologically and in the work place. Various types of surgical procedures have been developed for the treatment of axillary osmidrosis. However, it is still not clear whether which type of surgery can provide the best long-term results. OBJECTIVE: We evaluated the long-term(more than 2 years) follow-up results of subcutaneous tissue remover and Carbon Dioxide(CO2) laser for surgical treatment(Kim's operative method) of axillary osmidrosis retrospectively. METHODS: The number of patients who had been surgically operated wase 132 and among them, 62 patients were interviewed by telephone. The degree of recurrence, scar, satisfaction, the causes of dissatisfaction, and recommendation were evaluated. RESULTS: Thirty-eight of the 62 patients(61.3%) had no recurrence. Twenty-one patients(33.9%) of the 62 patients had rarely scar. Forty-five patients(72.6%) had a feeling of satisfaction. CONCLUSION: This combined method has the advantages of a high success rate, low complication rate and less scarring for the treatment of axillary osmidrosis based on the long-term evaluation.