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Objective:To evaluate the safety and efficacy of single incision apocrine gland excision in the treatment of children and adult patients with axillary osmidrosis.Methods:Medical records and follow-up results were reviewed for 164 patients who underwent surgical treatment in our department by the same surgeon from January 2013 to December 2016. There were 54 males and 110 females, aged 8-61 years. with a median age of 22 years. The patients were divided into the children group ( n=31) and the adults group ( n=133), and differences between the two groups were compared. Results:The end point of follow-up was December 2019, the cure and overall satisfaction rates in the third year after surgery were 77.6% (125/161) and 88.2% (142/161) for the total population, including 87.5% (27/31) and 93.5% (29/31) for the children, respectively. There were no significantly differences in the cure rate, scar, pigmentation and the patients' satisfaction between two groups during the follow-up. The cure rate, significantly improved rate and satisfaction rate in patients who became adult during the follow-up were 80.0% (20/25), 92.0% (23/25) and 96.0% (24/25), respectively.Conclusions:Single incision apocrine gland excision could be performed for children patients. Our procedure is safe, reliable and consistant, and worthy of clinical application.
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Objective:To investigate the effect of botulinum toxin type A on children with odorihidrosis.Methods:From March 2017 to February 2021, 121 children with odorihidrosis, including 48 males and 73 females, aged 13 to 17 (15.9±1.2) years, were admitted to the Burn and Plastic Surgery Department of the 980 Hospital of PLA. There were 24 cases in mild group, 50 cases in moderate group and 47 cases in severe group. Botulinum toxin A was injected into 20-50 points on each side, and 1 U was injected into each point. The total amount of botulinum toxin A was 50-100 U on both sides.Results:Three groups of children were evaluated for efficacy, 24 cases of mild group was significantly effective in 23 cases, accounting for 95.8%. In the moderate group, 46 (92.0%) of 50 cases showed obvious effect. 49 cases (98.0%) were effective; In the severe group, 40 cases (85.1%) showed obvious effect and 45 cases (95.7%) were effective. Three groups of children with different efficacy had no statistical significance ( P>0.05). The significant efficiency in mild and moderate groups was higher than that in severe group, and the difference was statistically significant ( P<0.05). Conclusions:Botulinum toxin type A is effective in the treatment of children with mild and moderate bromhidrosis, and is worthy of clinical application.
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Objective:In China, although axillary osmidrosis is common in plastic surgery, there is no standard procedure for the treatment of axillary osmidrosis. So we compared the efficacy of 6 axillary osmidrosis surgical treatments with network meta-analysis in order to provide reference for the clinical surgical treatment of axillary osmidrosis in Chinese patients.Methods:From January 2018 to December 2021, Chinese and English databases including Wanfang Database, VIP Chinese Science and Technology Periodical Full-text Database (VIP) and CNKI, PubMed, Cochrane Library, Embase were searched by the Plastic Surgery Department of Zhangqiu People′s Hospital in Jinan, Shandong province. And some relevant studies were collected for network meta-analysis.Results:47 studies including a total of 6543 subjects were identified for meta-analysis. After analysis, 4 of the 15 pairwise comparisons were not statistically significant, and the effect of swelling aspiration + subcutaneous pruning was more significant. According to the surface under the cumulative ranking curve (SUCRA), the efficacy of 6 surgical methods for the treatment of axillary osmidrosis was as follows: swelling aspiration + subcutaneous pruning > subcutaneous scratching+ subcutaneous pruning > subcutaneous pruning > fusiform skin resection > subcutaneous scratching > swelling aspiration.Conclusions:In surgical treatment of axillary osmidrosis, swelling aspiration + subcutaneous pruning is the best. It is worth popularizing in the clinical work of treating axillary osmidrosis patients. Due to the limitations of this study, the conclusion of this network meta-analysis still needs to be further confirmed by a well-designed randomized controlled trial.
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Objective:To compare clinical efficacy and safety of microwave thermotherapy versus microneedling in the treatment of axillary bromhidrosis.Methods:From May 2018 to March 2019, 116 patients with different degrees of axillary bromhidrosis were collected from Department of Dermatology, Xijing Hospital, The Fourth Military Medical University, including 56 treated with microwave thermotherapy by using a miraDry device, and 60 treated with microneedling by using a BodyTite device. These patients were followed up for 12 months after treatment, and clinical efficacy, complications and recurrence rate were evaluated.Results:After 12 months of follow-up, no significant difference in the response and recurrence rates were observed between the microwave group (94.64%[53 cases], 5.36%[3 cases], respectively) and microneedling group (93.33%[56 cases], 6.67%[4 cases], respectively; both χ2=0.088, P=0.767) . However, the incidence of postoperative complications was significantly lower in the microwave group (0) than in the microneedling group (6.67%, including 2 cases of skin burns and 2 cases of scars; χ2=3.867, P=0.049) . Conclusion:In the treatment of axillary bromhidrosis, microwave thermotherapy showed equivalent clinical efficacy with lower incidence of complications compared with microneedling.
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Objective@#To compare clinical efficacy and safety of microwave therapy versus suction-curettage through small incisions in the treatment of axillary osmidrosis.@*Methods@#Totally, 60 patients with axillary osmidrosis were enrolled from Department of Dermatology, Xijing Hospital, Fourth Military Medical University from January 2017 to February 2018. Every patient received miraDry microwave therapy on the left axillary (microwave therapy group) and suction-curettage through small incisions on the right axillary (suction-curettage group) , and operation duration was recorded. After follow-up of half a year, clinical efficacy and complications were compared between the two groups.@*Results@#After 6-month follow-up, no significant differences were observed in the response rate or recurrence rate between the microwave therapy group (93.33%[56/60], 6.67%[4/60] respectively) and suction-curettage group (96.67% [58/60], 3.33% [2/60] respectively; both P > 0.05) . However, the incidence rate of postoperative complications was significantly lower in the microwave therapy group (0) than in the suction-curettage group (6.67% [4/60], χ2 = 4.138, P = 0.042) .@*Conclusion@#Compared with suction-curettage through small incisions, microwave therapy has advantages of being non-invasive and less postoperative complications.
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Objective To compare clinical efficacy and safety of microwave therapy versus suction -curettage through small incisions in the treatment of axillary osmidrosis.Methods Totally,60 patients with axillary osmidrosis were enrolled from Department of Dermatology,Xijing Hospital,Fourth Military Medical University from January 2017 to February 2018.Every patient received miraDry microwave therapy on the left axillary (microwave therapy group) and suction-curettage through small incisions on the right axillary (suction-curettage group),and operation duration was recorded.After follow-up of half a year,clinical efficacy and complications were compared between the two groups.Results After 6-month follow-up,no significant differences were observed in the response rate or recurrence rate between the microwave therapy group (93.33％[56/60],6.67％[4/60] respectively) and suction-curettage group (96.67％ [58/60],3.33％ [2/60] respectively;both P ＞ 0.05).However,the incidence rate of postoperative complications was significantly lower in the microwave therapy group (0) than in the suction-curettage group (6.67％ [4/60],x2 =4.138,P =0.042).Conclusion Compared with suction-curettage through small incisions,microwave therapy has advantages of being non-invasive and less postoperative complications.
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Objective To explore the therapeutic effect of different doses of botulinum toxin A injections on bromhidrosis.Methods A total of 200 cases were divided into mild-to-moderate group (N=100) and severe group (N=100) based on the grade of bromhidrosis,and each group was further divided into two groups:low dose group (50 cases) were treated by botulinum toxin A injections (100 U) and high dose group (50 cases) were treated with 200 U for bilateral axillary.The total effective rate and recurrence rate in both groups were compared.Results In the mild to moderate group,after treatment for 3 months,the total effective rate of both groups had no statistical difference (P＞ 0.05),and the same with recurrence rate in 6 months follow-up (P＞0.05).In the severe group,after treatment for 3 months,the total effective rate of the high dose group (82％) was significantly higher than that of the low dose group (64％),with statistical significance (x2 =4.110,P＜0.05).After 6 months follow-up,recurrence rate in the high dose group (22％) was significantly lower than that of the low dose group (46％),with statistical significance (x2 =6.417,P ＜ 0.05).Conclusions A suitable dose of botulinum toxin A can be selected based on the severity of bromhidrosis,which is a individualized therapy for cost savings and might have potential benefits for patients with osmidrosis.
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Objective To evaluate safety and efficacy of a fractional microneedle radiofrequency device in the treatment of axillary osmidrosis.Methods A total of 24 patients with moderate to severe axillary osmidrosis were enrolled from Department of Dermatology of Peking Union Medical College Hospital between June 2015 and June 2016,and treated with the Body TiteTM fractional microneedle radiofrequency device for 1 session.Visual analogue scale (VAS) was used to evaluate the intensity of axillary odor in patients,36-item short-form health survey (SF-36) to assess health-related quality of life (HRQoL),and axillary skin tissues were resected for histopathological examination before and after the treatment.Results VAS showed that 22 of 24 patients achieved persistent remission for more than 12 weeks,and rates of decrease in odor score ranged from 50％ to 100％.However,1 patient experienced recurrence at 12 weeks after the treatment,and another 1 patient did not achieve clinical remission.SF-36 revealed that scores of social functioning (SF),role-emotional (RE) and mental health (MH) scales were all significantly increased after the treatment [M (P0-P100):100.00 (62.00-112.50),100.00 (33.30-110.00),68.00 (48.00-80.00),respectively] compared with those before the treatment [77.50 (62.50-100.00),66.67 (33.30-100.00),55.00 (48.88-72.00),respectively,all P ＜ 0.05].Histopathological examination showed obvious degeneration and necrosis of sweat gland cells in 22 cases,and epidermal damages in 2 patients after the treatment.Unilateral upper-limb pain occurred in 1 case,and small-area burn-like skin changes were observed in 2 cases after the treatment.The postoperative recovery time ranged from 7 to 14 days.Conclusion The fractional microneedle radiofrequency device has shown high clinical response rate,good safety,and favorable application prospects in the treatment of axillary osmidrosis.
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Objective To investigate therapeutic effect of bromhidrosis by botulinum toxin A injections and situation of bromhidrosis recurrence.Methods Clinical data of bromhidrosis patients were analyzed in our hospital from January 2013 to June 2014.A total of 89 cases were involved in this study and randomized into two groups:observation group (42 cases) were treated by botulinum toxin A,and patients with the control group (47 cases) were treated by small skin excision.The total effective rate,incidence of complications and recurrence rate in both groups were compared.Results After treatment for 3 months,the total effective rate of both group had no statistical difference (P＞ 0.05).After different treatment,the incidence of complications in observation group of patients was 2.38％ (1/42),and that in the control group was 14.89％ (7/47);complication rates of control group patients was significantly higher than that of the observation group,with statistical significance (x2 =4.245,P＜0.05).After 9 months follow-up,31 cases in the observation group of patients showed bromidrosis recurrence,with recurrence rate of 73.81％;2 patients in the control group showed bromidrosis recurrence,with recurrence rate of 4.26％.Log-Rank test showed that recurrence rate in observation group was significantly higher than that of control group (x2 =43.21,P ＜0.05).Conclusions Botulinum toxin A injection is an uninvasive method for the treatment of bromhidrosis with fewer complications and good effect,but the postoperative recurrence rate is higher and it needs injections for many times.
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Objective To evaluate the performance of drainage through micropores in the treatment of axillary osmidrosis with subcutaneous trimming.Methods Forty-eight patients with axillary osmidrosis were enrolled in this study,and treated by subcutaneous trimming.After removal of apocrine sweat glands and hair follicles,a scalpel was used to cut several micropores (measuring 3 mm in length) along dermal ridges in skin flaps.Then,drainage was carried out through the micropores.Subsequently,the incisions were sewed up with 3-0 sutures followed by compression bandaging with elastic bandages.Dressings were changed and incisions were examined at 24 hours after operation,and bandages were taken off and skin flap viability was evaluated at 10 days.All the patients were followed for 3 months.Results After treatment,sweating was decreased and axillary odor disappeared in all the patients with a return to normal social activities.No obvious scar formed.Conclusion Drainage through micropores performs well in the treatment of axillary osmidrosis with subcutaneous trimming.
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Objective To investigate the effect of concentrated suture fixation in subdermal vascular network flap method for treatment of axillary osmidrosis in reducing postoperative complications,increase the wound dressing effect of comfort.Methods Ninety-six cases of bilateral axillary osmidrosis patients were randomly divided into concentrated suture group (group A) and 8 bandage compression group (group B),48 cases in each group.They were cleared of sweat gland retaining subdermal vascular network skin flap method in treatment of axillary osmidrosis.Group A was treated with concentrated suture fixation after the separation of the subdermal vascular network flap by in situ,group B was treated by routine compression bandage fixation after the separation of the subdermal vascular network flap.Observation of subcutaneous hematoma,infection,necrosis of skin after operation and understood dressing comfort.To observe the peculiar smell and axillary scar,operation area 6 months postoperative growth.Results The postoperative observation:group A subcutaneous hematoma complication rate was lower in group B,the incidence of 1.04％ (1/96) vs.19.79％ (19/96),the difference was statistically significant (P ＜ 0.01).Group A postoperative dressing comfort satisfaction rate was 93.75％ (45/48),group B po or comfort,satisfaction rate was only 10.42％(5/48),the difference had statistically significant (P ＜ 0.01).After 6 months of postoperative,the total efficiency of two groups were 100.00％,no significant difference (P ＞ 0.05).Group A district scar formation rate was higher than that in group B [3.12％(3/96) vs.21.88％(21/96)] (P ＜ 0.05).The armpit hair and sweat in the two groups was significantly reduced,there was no significant difference (P ＞ 0.05).Conclusion Concentrated suture fixation method in the treatment of axillary osmidrosis by subdermal vascular network is a reliable fixation of the axillary free after the subdermal vascular network flap,and have flap high healing rate,scar,low rate of complications; postoperative dressing is simple,comfortable,living freely,overall is better than 8 bandage compression method.
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Objective To determine the distribution profile of apocrine sweat glands in axillary region of patients with axillary osmidrosis,and to compare their distribution at different sites.Methods Fifteen patients with axillary osmidrosis were enrolled in this study from September to December 2010.All the patients underwent surgical removal of apocrine sweat glands under direct vision.Full-thickness skin tissue measuring 2 mm in width was excised down to the axillary superficial fascia at the incisional surgical sites from five patients.Five points,which were at the center of axillary region (point 1),1 cm away from the center of axillary region (point 2),1 cm inside the edge of axillary hair-bearing area (point 3),the edge of axillary hair-bearing area (point 4),and 1 cm outside the edge of axillary hair-bearing area (point 5),were marked,and dark red,rough granular subcutaneous tissue was obtained at these points in 10 patients with axillary osmidrosis.Results The secretory portion of apocrine sweat glands was mainly distributed in the reticular dennis and superficial subcutaneous adipose tissue,but no apocrine sweat glands were obs erred in the epidermis,dermal papilla or axillary superficial fascia.The distribution profile of apocrine sweat glands was consistent with that of axillary hairs.There were numerous apocrine sweat glands in the center of axillary region,but only a small number at the edge of axillary hair-bearing area,and no apocrine sweat gland was observed at 1 cm outside the edge.The percentage of apocrine sweat gland area at point 1-5 was 74.1％,46.6％,25.3％,2.1％,and 0 respectively,with significant differences between point 1 and 2 (t--29.78,P＜ 0.01),point 2 and 3 (t--9.76,P＜ 0.01),point 3 and 4 (t =20.83,P＜ 0.01),but not between point 4 and 5 (t =1.96,P ＞ 0.05).Conclusions During the surgical treatment of axillary osmidrosis,the removal of apocrine sweat glands should be extended to the reticular dennis and superficial subcutaneous adipose tissue in depth and the edge of axillary hair-bearing area in width,and there is no need to blindly increase the extent of removal.
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ObjectiveTo study the curative effect of axillary osmidrosis,that incision in armpit wrinkle,orthoptic cut off the gland to thick skin flap.MethodsCollected double-sided axillary osmidrosis 163 patients,all of them accepted armpit wrinkle incision,the scope of surgical operation super the armpit hair distribute 1 cm,swelling anaesthesia,orthoptic cut off the armpit organization 5 mm under skin included apocrine sweat gland,kept the operation scope to vessel net flap under skin.Hematischesis thoroughly used a double pole electricity hemostasis,kept drainage after operation,bandaged in pressure,took out sutures after 9 days.The foul smell standard referenced the Tung-Chain standard of axillary osmidrosis curative effect evaluation.ResultsThree hundred and twenty armpits (98.16％,320/326) were cure,6 armpits (1.84％,6/326) were excellence.The armpit hair variety:obvious reduce 322 armpits(98.77％,322/326),general reduce 4 armpits(1.23％,4/326).Perspire condition:obvious reduce 324 armpits(99.39％,324/326),improve but no obvious reduce 2 armpits ( 0.61％,2/326).The average surgical operation recovery time was about 9 days.Complication:necrosis on the edge of the skin was 8 armpits,scar formation on the incision was 3 armpits,hematoma was 1 armpit,shoulder joint limitation of activity was 0 armpit.ConclusionThe method of axillary osmidrosis treatment useing thick skin flap in armpit wrinkle,which has extermination foundation of anatomy and pathology,which can cause axillary osmidrosis,this operation is simple,curative effect is credible,the wound is small,complication is little etc,utmost matching the principle of orthopedic surgery,worthy of clinical application.
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Objective To observe the effect of atropine in the treatment of bromiderosis with anhydrous alcohol injection. Methods Patients were randomly divided into two groups (A and B): the patients in Group A was injected with both anhydrous alcohol and atropine, and that in Group B was only injected with anhydrous alcohol. The effect of the operation was evaluated at 1, 3 and 6 months after the treatment. Results From August 2004 to January 2008, 72 patients were involved in this study. 37 cases were included in Group A, and 35 patients were included in Group B. The effective rate in the Group A was 83.78 %, and that in the Group B was 82.86 %. There was no statistical difference between these two groups. Conclusion Atropine has no effect on the treatment of axillary bromidrosis with anhydrous alcohol injection and it is, therefore, not necessarily included in the treatment.
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Objective To probe the advantages of BTX-A for the treatment of axillary hyper-hidrosis. Methods 42 cases were treated by BTX-A injection, 50 units per axillae, 25 sites with 2 u-nits each, 1.5 cm apart. They consisted of 24 cases of axillary hyperhidrosis, 10 cases of axillary hy-perhidrosis combined bromidrosis, and 8 cases of bromidrosis. Results All hyperhidrosis patients a-chieved good effects. Among patients with axillary hyperhidrosis combined bromidrosis, it had effects on hyperhidrosis, but only one case effected on bromidrosis. Among patients with bromidrosis, only one case had effect. Conclusions In the treatment of hyperhidrosis, BTX-A is very useful, and side effect is temporary and slight. But for bromidrosis, BTX-A is not very useful.