Keloids Treated with a Suction-Assisted Cartilage Shaver: A Report of Four Cases / 대한피부과학회지

Surgical excision of keloids is generally not accepted as a first treatment option, but many reports have described specialized surgical methods, such as intralesional and intramarginal excision. This operation preserves the active peripheral portion of the keloid and excises the central bulky lesion. The suprakeloidal flap technique and keloid core excision involve intralesional excision. These methods are known to be associated with a low probability of recurrence or lesion exacerbation because the remaining keloidal lesion acts as a barrier. However, several complications, such as partial necrosis and flap congestion, have been reported, especially in large lesions. We describe cases of four patients with keloids on the chest or abdomen. All patients complained of pain or itching due to the keloids. Patient age ranged from 20 years to 54 years, and the number of lesions ranged from one to seven. The largest lesion measured 10x8 cm. We treated the lesions by the dermal shaving method using a suction-assisted cartilage shaver, and the lesions were markedly flattened in all cases. Because this surgery is performed through an incision for a cannula, it allows more rapid healing and causes less postoperative pain with fewer severe complications. It also has the advantage of requiring less effort and time due to the use of motorized curettage with suction. The suction-assisted cartilage shaver using dermal shaving method seems to be an effective alternative treatment modality for reducing the lesional size of keloids.

Multiple Piloleiomyoma Treated with a Suction-Assisted Cartilage Shaver / 대한피부과학회지

Piloleiomyoma is a benign neoplasm arising from the erector pili muscle in the skin. It occurs as linear or dermatomal arrangements of firm, red to brown intradermal nodules, which are fixed to the skin but not to the deeper tissues. Although various treatments have been attempted, they have shown limited success and several complications remain. A 21-year-old male presented with 3-year history of multiple, erythematous, firm 4 mm to 3 cm sized nodules on the chest. The histopathological examination was compatible with piloleiomyoma. The lesions were removed using the dermal shaving method with a suction-assisted cartilage shaver. Each lesion were markedly flattened. This treatment was quicker and caused less subjective pain to the patient compared with those of classic surgical excision. No signs of adverse events or recurrence have been observed.

Steatocystoma Multiplex Treated with a Suction-assisted Cartilage Shaver / 대한피부과학회지

Steatocystoma multiplex is a rare autosomal-dominant disorder characterized by asymptomatic multiple, skin-colored to yellowish nodules on the trunk, proximal extremities, and axillae. Although surgical excision is the most effective method, treatment is difficult when lesions occur in multiple numbers. Therefore, various treatments such as CO2 laser therapy, needle aspiration, and oral isotretinoin have been attempted, but results are variable. A 37-year-old man presented with multiple skin-colored subcutaneous nodules on the abdomen and both axillae. A histopathological examination was consistent with steatocystoma multiplex. The lesions were removed by dermal shaving with a suction-assisted cartilage shaver. It was an effective therapeutic method for multiple lesions with no significant adverse events. Herein, we report a case of steatocystoma multiplex treated with a suction-assisted cartilage shaver.

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.

Surgical Treatment in Recurred Axillary Osmidrosis

There are several surgical or non-surgical methods for osmidrosis, which have their own merits and drawbacks. Especially, recurrence and scarring of operation site are cumbersome problems. One of the limitations of each method is recurrence of osmidrosis. The authors evaluated surgical treatments of recurrent cases. The authors experienced 14 recurrent osmidrosis cases from January 1998 to December 2003. Previous methods in recurrent cases are as follows; dermal shaving with Inaba dermal shaver(3 cases), liposuction method(10 cases), non-surgical hair removal method(4 cases). The authors managed recurrent cases with radical excision in 4 recurrent cases which had severe scar with large fibrotic tissue due to previous operations, and dermal manual resection in 10 cases. We had no recurrence in our series and no complications like hematoma, seroma, infection, wound disruption or dehiscence and brachial plexus compression. In conclusion, dermal manual resection can be applied to recurrent osmidrosis cases, and radical resection is also applicable to managing recurrent cases with severe scar with large fibrotic tissue.