Treatment of axillary bromhidrosis through a mini-incision with subdermal vascular preservation: a retrospective study in 396 patients

A Retrospective Cohort Study Comparing the Clinical Outcomes of the Hydrosurgery System and Traditional Single-Incision Surgery for Axillary Osmidrosis

PURPOSE

To compare the postoperative scarring, complication rates, and efficacy between the hydrosurgery system and traditional single-incision surgical techniques for treating axillary osmidrosis.

METHODS

A retrospective collection was conducted of all patients who underwent radical surgery for axillary osmidrosis at the Day Surgery Unit of the Department of Plastic Surgery at the First Affiliated Hospital of the Army Medical University from January 2023 to January 2024. Patients were screened based on inclusion and exclusion criteria and divided into the hydrosurgery group and the traditional surgery group. The evaluation was done through medical records, follow-up records, electronic questionnaires, and photographs. Assessments included 6-month postoperative scarring conditions, comprehensive effectiveness scores, postoperative odor/hair/sweating scores, postoperative dermatological life quality scores, and complication rates.

RESULTS

A total of 73 patients completed this study: 34 in the hydrosurgery group and 39 in the traditional surgery group. 6 months postoperatively, the hydrosurgery group had significantly lower scores of the Vancouver Scar Scale (VSS), 0.5 (range 0.0-2.0) compared with 1.5 (range 0.5-3.0) in the traditional surgery group (p = 0.018). The incidence of complications such as subcutaneous hematoma, epidermal necrosis, and wound dissidence was also lower (26.5% vs. 51.3%, p = 0.031). Additionally, the surgical incision length in the hydrosurgery group was significantly smaller than in the traditional surgery group (1.200 cm (1.000, 1.275) vs. 2.500 cm (2.500, 3.000), p < 0.001). There were no significant differences between the two groups regarding comprehensive effectiveness scores, postoperative odor/hair/sweating scores, postoperative dermatological life quality index, and surgical duration.

CONCLUSION

Compared with traditional single-incision surgical techniques, patients in the hydrosurgery group exhibited lower scar scores 6 months postsurgery, required smaller surgical incisions, and had lower rates of surgical complications. Thus, the hydrosurgery is suitable for the minimally invasive surgical treatment of axillary osmidrosis, offering a safe, effective, and aesthetically superior treatment method.

Advances in the treatment of axillary bromhidrosis

BACKGROUND

Bromhidrosis, characterized by foul-smelling sweat, is a prevalent condition that significantly affects patients' social and psychological well-being.

METHODS

This review presents novel treatment approaches and discusses the pros and cons of various treatment options for axillary bromhidrosis.

RESULTS

Extensive research has explored numerous treatment modalities for bromhidrosis. This article systematically reviews both surgical and nonsurgical interventions utilized in clinical practice.

CONCLUSION

By synthesizing available evidence, this review aims to offer evidence-based recommendations for effectively managing bromhidrosis, considering factors such as treatment efficacy, safety profiles, patient preferences, and clinical outcomes.

Effect of optimizing the use of endoscope on the efficiency of microdynamic bromhidrosis removal operation

BACKGROUND

Bromhidrosis, also known as body odor, is a common disease in life, which often occurs in young adults. The histological basis of bromhidrosis is the hyperplasia of apocrine sweat glands.

OBJECTIVE

To compare the effects of different methods of endoscopy in microdynamic axillary osmidrosis removal on curative effect, complications, and surgical efficiency.

METHODS

A total of 149 patients with axillary osmidrosis were treated in our hospital from January 2020 to December 2021. They were treated with endoscopic assistance in the whole process of operation (Group A) and endoscope-assisted exploration after blind rotary cutter suction (Group B), respectively, and the curative effect, complication rate, and surgical efficiency were evaluated.

RESULTS

There was no significant difference in the curative effect and complication rate between the two groups, but the endoscope-assisted exploration group after suction with rotary cutter (Group B) had higher surgical efficiency.

CONCLUSION

On the basis of professional use of rotary cutter, it is efficient to choose endoscope to check the excision of sweat gland in the operation area and stop bleeding in time after blind suction.

Clinical analysis of tumescent anesthesia technique combined with superficial fascia rotational atherectomy in axillary bromhidrosis

Axillary bromhidrosis, which involves the apocrine sweat glands, severely affects adolescents. The present study aimed to evaluate the effect of tumescent anesthesia technique combined with superficial fascia rotational atherectomy treatment for axillary bromhidrosis. The present retrospective study included a total of 60 patients with axillary bromhidrosis. These patients were divided into experimental and control groups. Patients in the control group were treated using the tumescent anesthesia technique combined with conventional surgery, while patients in the experimental group were treated using the anesthesia technique combined with superficial fascia rotational atherectomy. The intraoperative blood loss, operation time, histopathological examination and dermatology life quality index (DLQI) score were used to assess the treatment effect. The intraoperative blood loss and operation time were significantly lower in the experimental group compared with the control group. The histopathological results revealed that the sweat gland tissues in experiment group significantly decreased compared with that in control group. Furthermore, there was a significant improvement in axillary odor degree for postoperative patients, and the DLQI scores in experiment group were significantly lower compared with those in control group. The tumescent anesthesia technique combined with superficial fascia rotational atherectomy is a promising approach to treating patients with axillary bromhidrosis.

Long-Term Use of Antiperspirant is Associated with a Low Risk of Postoperative Complications in Patients with Axillary Osmidrosis

Purpose

Many patients with axillary osmidrosis (AO) cannot tolerate the local irritation of strong antiperspirants and discontinue AO use within a short time. This study evaluates the effect of long-term antiperspirant use on postoperative complications after osmidrosis surgery.

Patients and Methods

A total of 116 females (66 antiperspirant and 50 non-antiperspirant cases) who underwent osmidrosis surgery were retrospectively reviewed. Postoperative complications were compared between the 2 groups.

Results

Patients with long-term antiperspirant use had a lower risk of full-thickness skin necrosis compared with those who did not use antiperspirants (odds ratio [OR] = 0.048, 95% confidence Interval [CI]: 0.006–0.392, p = 0.005). Patients with antiperspirants use also had a lower risk of moderate-to-severe erythema compared to those without antiperspirants use (moderate vs mild erythema: OR = 0.351, 95% CI: 0.129–0.959, p = 0.041; severe vs mild erythema: OR = 0.161, 95% CI: 0.047–0.550, p = 0.004). Patients who used antiperspirants also had a lower risk of severe skin erosion compared to those who did not use antiperspirants (severe vs mild skin erosion: OR = 0.164, 95% CI: 0.037–0.725, p = 0.017). There was a trend of lower risk in moderate skin erosion in patients with antiperspirant use compared to those without antiperspirant use, but it was not statistically significant (moderate vs mild epidermal damage and peeling: OR = 0.406, 95% CI: 0.158–1.043, p = 0.061).

Conclusion

Postoperative complications in patients with AO who undergo osmidrosis surgery are lower in those with a long-term antiperspirant use compared to patients who did not use antiperspirants.

Treatment of Axillary Osmidrosis by Rebalancing Skin Microecology With Lactobacillus bulgaricus

Corynebacterium accounts for around 20% of the armpit microbiome and plays an essential role in axillary osmidrosis (AO). In this study, the effects of Lactobacillus bulgaricus treatment on the microecological environment of armpits and its efficacy in the treatment of AO were investigated. A total of 10 AO patients were enrolled in this study. The patients were treated with L. bulgaricus mixed with saline on the left armpit (experimental group) and pure saline on the right armpit (control group) for 28 days. After treatment, AO severity showed a significant decrease (p = 0.013) in the experimental group compared with the control group, and the Corynebacterium abundance also showed a corresponding significant decrease (p < 0.01). Moreover, no significant variation in Staphylococcus abundance was found between these two groups. The microbe diversity is not disturbed in the treatment. Accordingly, our study demonstrates that L. bulgaricus can serve as an effective probiotic microbe for AO treatment by reducing the abundance of Corynebacterium and rebalancing the microecological environment.

Thoracic sympathectomy for the treatment of primary axillary hyperhidrosis: systematic review and proportional meta-analysis

INTRODUCTION

Primary hyperhidrosis is a disorder that involves excessive sweat production, which has a negative impact on the quality of life.

OBJECTIVE

To evaluate the effectiveness and safety of video-assisted thoracoscopic sympathectomy (VATS) for treating primary axillary hyperhidrosis (PAH) and determine which level of ganglion resection offers the best outcome.

METHOD

This was a systematic review and proportional meta-analysis of observational studies. The result was evaluated for satisfaction, control of symptoms, compensatory sweating and complications. A subgroup analysis was performed to compare the sympathetic trunk resection at high and low levels.

RESULTS

Thirteen studies were selected with a total of 1463 patients. The satisfaction rate was 92% (95% CI = 88-95%, I2=47.5%), the symptom control rate was 96% (95% CI = 93-99%, I2=48.2%), and the presence of compensatory sweating could not be assessed because of high heterogeneity among studies. The complications were rare.

CONCLUSION

This review demonstrated that thoracic sympathectomy by VATS is a viable and safe option for the treatment of PAH. There was no difference between high and lower levels of resection. However, the estimation of the effect is quite uncertain because the quality of evidence was extremely low.Key messagePure axillary hyperhidrosis has great potential to compromise quality of life.Surgery should be indicated only when clinical treatment fails.Thoracic sympathectomy by video-assisted thoracoscopy is a viable and safe option for the treatment of primary axillary hyperhidrosis.

Effectiveness and safety of the improved mini-incision surgery for osmidrosis treatment

BACKGROUND

As the mainstream treatment of axillary osmidrosis, surgical treatment is still limited by various complications, such as paresthesia, scars, local infection, hematoma, flap necrosis, and long recovery time. In this study, we tried to adopt the improved mini-incision surgery for osmidrosis treatment.

OBJECTIVES

The paper aims to evaluate the clinical effectiveness and safety of the improved mini-incision surgery for axillary osmidrosis treatment.

PATIENTS/METHODS

Clinical series of patients underwent improved mini-incision surgery were retrospectively reviewed. Dates of complications, including paresthesia, scars, infection, hematoma, skin necrosis, and recurrence were analyzed.

RESULTS

Among 61 cases, 58 cases had a preoperative osmidrosis score of 3 and 3 cases had a preoperative score of 2; while 13 cases had a postoperative osmidrosis score of 0, 43 cases had a postoperative score of 1 and 5 cases had a postoperative score of 2, significantly lower than that before (p < 0.001). A total of 12 axillae complications occurred, 2 axillae (1.6%) had paresthesia; 5 axillae (4.1%) had hematoma; 2 axillae (1.6%) had local flap necrosis due to hematoma; and 3 axillae (2.4%) had hypertrophic scars.

CONCLUSIONS

The results showed that the improved mini-incision surgery was safe and effective for osmidrosis treatment.

Tumescent Liposuction Combined with Power-Assisted Dermal Curettage Through Small Incisions for Axillary Osmidrosis

BACKGROUND

Osmidrosis is a troublesome disease characterized by excessive bodily malodor. Invasive surgical treatments have proven effective and permanent in treating this disease. This study sets out to evaluate the effect of tumescent liposuction with power-assisted dermal curettage for the treatment of axillary osmidrosis.

METHODS

Twenty-eight patients with axillary osmidrosis (56 axillae) were treated with tumescent liposuction and power-assisted dermal curettage between January 2016 and May 2019. Patients were followed up and evaluated using survey questionnaire at least 3 months after the procedure.

RESULTS

Twenty-four (85.7%) patients responded excellent for malodor elimination, 4 (14.3%) patients evaluated it as good and no patients evaluated it as fair or poor. One patient reported mild pigmentation in the axilla after the procedure. No recurrence and no serious side effects were reported.

CONCLUSION

Tumescent liposuction with power-assisted dermal curettage is a safe and effective surgical treatment of axillary osmidrosis with high patient satisfaction, rapid recovery time and minimal complications or recurrences.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Shortening of Incision by "Pinch and Turn-Over Technique" in the Treatment of Axillary Osmidrosis

BACKGROUND

The pinch and turn-over technique was developed to minimize the incision in the manual subdermal excision of apocrine glands in axillary osmidrosis for the best cure and fewest complications.

METHODS

Through a 2-cm-long incision, peripheral subdermal tissue was excised by the technique under direct vision using intravenous anesthesia and tumescent technique. Ninety-nine axillae in 50 patients including seven secondary cases were operated on from 2009 to 2018. Long-term follow-up (average 30.3 months) could be done on 40 patients with questionnaires consisting of four-point ordinal-scale questions regarding osmidrosis grade, hyperhidrosis grade and satisfaction. For systematic review regarding incision length, 220 articles from 1962 to 2018 were reviewed with the search terms "osmidrosis" or "bromhidrosis."

RESULTS

Thirty-five and 30 of 40 respondents (87.5% and 75.0%) had excellent or good postoperative results in osmidrosis and hyperhidrosis grade. Postoperative improvement of osmidrosis grade (from 2.53 to 0.80) and hyperhidrosis grade (from 1.88 to 0.95) was statistically significant (p < 0.01). Thirty-four patients (85.0%) reported very satisfactory or satisfactory. Hematoma (2.0%), hyperpigmentation (5.0%), infection (5.0%) and noticeable scar (2.5%) were rare. Necrosis of flap margins was frequent (27.3%) but necessitated revision in two cases (2.0%). Among eleven articles found to describe incision length in pure manual subdermal excision, this technique provided the shortest incision compared with eight direct subdermal excision methods with an average incision length of 5.0 cm.

CONCLUSIONS

This technique offers an open, direct and selective approach with a short incision. It could maintain the best efficiency while neutralizing negative side effects of conventional manual subdermal excision for axillary osmidrosis.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266 .