What is the best method for treating osmidrosis?

Axillary osmidrosis is caused by excessive secretion of apocrine, which causes an acrid odor and extreme social embarrassment. Elimination of the apocrine glands by a radical surgical procedure is known as the best solution for axillary osmidrosis; however, it is often accompanied by marked complications. The purpose of this study was to seek a more effective surgical procedure by comparing the various preexisting subcutaneous apocrine gland elimination methods using four parameters: odor, scar, immobilization period, and other surgical complications such as hematoma, seroma, flap necrosis, and wound dehiscence. From March 1995 to March 2000, a total of 189 patients underwent surgery for axillary osmidrosis via manual subdermal shavings (N = 117), liposuction curettage (N = 32), CO2 laser vaporization (N = 18), and ultrasonic aspiration (N = 22). Of these procedures, manual shaving had the lowest recurrence rate for malodor. However, the disadvantages of this procedure included wide scar, a long immobilization period, and moderate cases of surgical complications. CO2 laser vaporization had results similar to manual shaving except for a clinically higher recurrence rate. Liposuction had advantages such as small invisible scars, a short-term immobilization period, and the least number of surgical complications, but it had a high rate of dissatisfaction in postoperative malodor (46.9%). Ultrasonic aspiration offered better results such as short surgical scar and relatively low recurrence rate, but it had some surgical complications (3 of 44 axillas). Therefore, removal of subcutaneous apocrine glands by manual subdermal shaving is the treatment of choice for axillary osmidrosis, with a low recurrence rate (7.7%). Other adjuvant procedures were effective in achieving short scars and low surgical complications, but there was dissatisfaction in the rate of recurrence.     

四种方法治疗腋臭临床分析

目的：通过分析治疗腋臭的四种方法及疗效，探讨合理的治疗方法。方法：自1999年6月至2004年2月，分别采用95％酒精注射，肿胀抽吸，腋部皮肤梭形切除z整形，小切口皮下修剪加搔刮等术式共治疗132例腋臭患者，经过6个月至5年随访，比较各种方法的疗效及并发症。结果：腋部皮肤梭形切除和小切口皮下修剪加搔刮术治疗的有效率要高于其他两种方法，血肿、感染和坏死等并发症少。结论：对腋臭轻重程度不同，要求不一的惠者，可选择合适的治疗方法。小切口皮下修剪加搔刮术是值得推荐的方法。     

皱襞切口修剪加CO2激光汽化大汗腺治疗腋臭

目的:总结皱襞切口修剪加CO2激光汽化大汗腺治疗腋臭的疗效。方法:对55例腋臭患者实施皱襞切口剪除皮下大汗腺,同时用CO2激光汽化凝固位于真皮深层的大汗腺。结果:55例患者术后分离区周围皮下瘀斑3例,无一例切口感染,皮瓣缺血坏死。术后随访1￣48个月,闻不到异味,所有患者对治疗效果均感满意。结论:采取手术修剪皮下大汗腺与CO2激光汽化真皮层内的大汗腺相结合,符合彻底去除腋窝大汗腺治疗腋臭要求,实践证明该方法疗效肯定,且设备条件要求低,操作简单,不失为一种较为彻底根治腋臭的方法,值得临床推广应用。     

大汗腺盲视下刮除和直视下剔除两种方式治疗腋臭的临床对比研究

目的:比较和分析大汗腺盲视下刮除术与直视下剔除术治疗腋臭的临床效果及安全性.方法:2006年1月至2009年7月间在我科行腋臭微创手术并成功随访的346名患者共692侧,按手术方式分为盲视下刮除组和直视下剔除组,统计并比较各组近远期并发症和两年后异味残留情况.结果:盲视下刮除组106侧中,出现并发症10侧(9.4％),其中近期并发症有血肿(7侧)和伤口延迟愈合(1侧),远期并发症为皮下包块形成伴感染(2侧);直视下剔除组586侧中,出现并发症共119侧(20.3％),其中近期并发症有血肿(56侧)、伤口裂开(18侧)、皮肤坏死(9侧)和伤口延迟愈合(11侧),远期并发症有皮下包块形成伴感染(8侧)、瘢痕增生(16侧)和肩关节活动受限(1侧),直视下剔除术并发症发生率高(P＜0.01).上述并发症通过及时处理后皆愈合良好.术后两年随访,仍有异味残留者中,盲视下刮除术组(26侧,24.5％)较直视下剔除术组(43侧,7.3％)多(P＜0.01).结论:两种方法对腋臭的治疗都是安全有效的,盲视下刮除术并发症发生率低,但直视下剔除术远期效果好,术后并发症通过合理而及时的措施都可以得到有效的预防和处理.     

负压引流在小切口根治腋臭术中的应用

目的:在众多腋臭治疗方法中,探索出一种能有效根治腋臭且并发症少的治疗方案。方法:利用小切口,肿胀麻醉,把带有汗腺及毛囊的皮肤修剪薄至全厚及中厚皮片厚度,术毕放置负压引流,使皮肤与基底贴合良好,并加压包扎。结果:本法共治疗32例腋臭患者,其中其他方法治疗复发者11例。除2例术后有轻微气味外,其余均得到根治,术后瘢痕不明显。结论:负压引流在小切口根治腋臭中可有效减少并发症,提高治愈率。     

微创单纯抽吸术与皮下组织剥离剪除术治疗腋臭的临床效果对比

目的 通过对腋毛区两种术式治疗腋臭的疗效对比,探索一种更好地治疗腋臭的手术方法.方法 对72例腋臭患者随机分为两组,36例行微切口单纯抽吸术（A组）,另36例经腋皱襞切开行皮下组织剥离剪除术（B组）,对两组的手术时间、疗效、并发症、瘢痕、恢复时间等进行总结对比分析.结果 经6～12个月随访,两组患者腋臭治疗总有效率100％.A组在手术时间、术后并发症、恢复时间、瘢痕、腋毛存活等方面明显优于B组,两组差异有统计学意义（P＜0.05）.结论 微创单纯抽吸术治疗腋臭疗效可靠,安全便捷,瘢痕更小而隐匿,并发症少,恢复快,更易被患者接受.     

顺腋纹小切口超薄皮瓣法腋臭根治术

目的:探讨顺腋纹小切口超薄皮瓣腋臭根治术的方法.方法:2002年1月～2008年4月,对我科60例腋臭患者,采用局部肿胀麻醉方法,沿腋纹做两个小切口,彻底修剪皮下毛囊以及大小汗腺组织,修剪成为超薄皮瓣,达到腋臭根治目的.并对患者进行随访4个月～1年.结果:58例患者Ⅰ期愈合,切口极其隐蔽,切口瘢痕很小,腋臭气味消失.1例患者切口超薄皮瓣下少量积血,清除积血后愈合.1例患者切口感染裂开后约为1cm,经过抗感染和换药后Ⅱ期愈合.结论:顺腋纹小切口超薄皮瓣法根治腋臭的方法,手术切口隐蔽,术后切口瘢痕小,效果好,并发症发生率低,患者对术后切口外形满意率较高.     

改良的顺腋纹小切口法腋臭根治术

目的:探讨一种改良的小切口腋臭根治术的方法。方法:从2006年1月至2007年1月我们改良了顺腋纹小切口法腋臭根治术,治疗50例腋臭患者,所有患者均进行随访。结果:49例I期愈合,切口隐蔽,瘢痕不明显,气味消失。1例切口中间裂开1mm,加强换药一次后愈合。结论:改良的小切口腋臭根治术是一种切口隐蔽,无附加痕迹,操作方便,效果确切,并发症发生率低的术式。     

改良"S"形切口腋臭根治术

目的:探讨一种改良“S”形切口腋臭根治术的方法。方法:从1999年1月至2004年12月我们应用改良“S”形切口腋臭根治术治疗88例腋臭患者(女性52例,男性36例),所有患者均获随访,最短时间为6个月。结果:84例患者获得满意效果,3例出现皮肤边缘坏死(<5mm),1例发生单侧血肿。结论:改良“S”形切口腋臭根治术具有较高成功率和较低并发症率的优点。     

改良的小切口双层剥离法腋臭根治术

目的：探讨双层剥离法腋臭根治术的小切口改良方法。方法：对60例患者采用小切口改良的双层剥离法治疗腋臭,先剥离皮下组织层,形成与双层剥离法厚度相同的皮肤脂肪瓣,再用修剪法将真皮皮下组织瓣完整修剪去。结果：60例患者均顺利康复,其中42例术后随访2年,10例术后随访半年,效果满意。结论：小切口改良的双层剥离法治疗腋臭是一种可行的方法。     

小切口修剪顶泌汗腺治疗腋臭的技术要点探讨

目的：探讨小切口修剪顶泌汗腺治疗腋臭的技术要点。方法：从2005年1月至2009年6月笔者应用小切口修剪顶泌汗腺治疗腋臭128例（女性88例,男性40例）,所有患者均获随访,最短时间为6个月。结果：128例中,117例患者获满意疗效,5例出现切口边缘5mm以内皮肤坏死,3例发生单侧血肿,3例单侧气味残留。术后组织病理学检查显示：顶泌汗腺主要位于皮下浅层,少量位于真皮深层。结论：小切口修剪顶泌汗腺治疗腋臭不仅可获得满意的疗效,而且有良好的形态效果。     

Experience of Tumescent Liposuction in the Treatment of Osmidrosis

BACKGROUND: Tumescent liposuction is a safe procedure for removal of subcutaneous fat tissue. Because apocrine glands are located deep in the fat, surgical removal of these glands by nontumescent liposuction has been utilized for treating osmidrosis. OBJECTIVE: To evaluate the effect of tumescent liposuction in the treatment of osmidrosis and to compare the efficacy of simple tumescent liposuction and combined tumescent liposuction and curettage. METHODS: A total of 20 patients with osmidrosis (all female, age 16-44 years) were included in this study. Ten patients were treated by simple tumescent liposuction, the other 10 patients were treated by tumescent liposuction combined with curettage. The aspirates were sent for pathologic examination. At a follow-up visit, the improvement of symptoms was graded by the patient as satisfied when the odor decreased> 75%, partially satisfied when it decreased >/=50% to 相似文献   

Radical treatment of axillary osmidrosis by subdermal excision of apocrine glands: a prospective study in 31 cases.

Axillary osmidrosis is a troublesome and distressing problem. Medical treatment is only temporally effective. From March 2003 to November 2004, 36 patients with axillary osmidrosis (nine cases combined with axillary hyperhidrosis) have been treated by excision of the subcutaneous glands via a small transverse incision, of which 31 cases could be followed up for a minimum of 3 months (average 7.3 months). In terms of malodour elimination, 30 cases had good results, one had fair result, and none had a poor result. All patients reported significant reducing of sweating, especially those with hyperhidrosis. Postoperative complications were minor, including small haematoma (one axillae), small seroma (two axillae), and superficial epidermal necrosis (21 axillae) which were all spontaneously healed within a week. Twenty-nine (93.5%) patients were very satisfied with the procedure and two (6.5%) patients satisfied, with none regretful. The operation has the advantage of a high success rate in radical elimination of the malodour with minor complications.     

采用腋皱襞小切口微创组织瓣剥离法治疗腋臭157例报告

目的对采用腋皱襞小切口微创组织瓣剥离法治疗腋臭的手术方法进行临床评估,并对治疗效果进行探讨和分析。方法用腋部小切口微创法治疗157例腋臭患者。用解剖剪刀在真皮下层与皮下组织交界处锐性分离,切开包含有毛囊和大汗腺的腋浅筋膜层(皮下脂肪浅层)直至腋深筋膜深层。将腋浅筋膜层组织瓣从腋深筋膜浅面剥离掀起并完全切除。随访6个月～1年。结果157例患者术后随访6～12个月,术后腋部瘢痕不明显,上肢活动无影响。结论腋部小切口微创组织瓣剥离法治疗腋臭术是清除大汗腺最彻底的方法。本方法治疗效果持续可靠,创伤口小、瘢痕不明显,是治疗腋臭的一种好方法。     

Very Superficial Ultrasound-Assisted Lipoplasty for the Treatment of Axillary Osmidrosis

Treatment of axillary osmidrosis has been mainly concerned with surgical excision of glandular tissues and involved major surgical procedures with high morbidities and many complications. Search for a less invasive procedure for axillary osmidrosis resulted in the use of liposuction. However, there have been controversies over the efficacy of this method. The problem was that liposuction could not effectively remove the apocrine gland located in the dermis and dermosubcutaneous junction. A high rate of residual malodor and dissatisfaction were reported. The author used ultrasound-assisted lipoplasty (UAL) in the very superficial plane to remove the apocrine gland located in the dermis and dermosubcutaneous junction. The purpose of this study was to prove the efficacy of the very superficial UAL (VSUAL) for the treatment of axillary osmidrosis. From December 1998 to December 1999, 21 consecutive patients underwent UAL in their axilla for axillary osmidrosis. The follow-up period ranged from 2 to 12 months (mean: 8 months). UAL was performed in the very superficial plane with an amplitude of 40%. The very superficial UAL (VSUAL) was done mainly in a withdrawing manner with the tip of the cannula against the skin. The UAL (VSUAL) was done aggressively until the skin changed slightly erythematous. The results were assessed subjectively and objectively, and classified as excellent, good, fair, and poor. Nineteen patients were graded as excellent and one patient as good. The total satisfaction rate was 95.2%. One patient complained of residual malodor in her left axilla. There were no cases of skin necrosis, hematoma, or seroma. Histology showed partial removal of the subcutaneous layer and deep dermis, and degenerative epithelial changes in the apocrine glands in the residual deep dermis. These microscopic findings meant near-total functional ablation of the apocrine gland in the axilla comparable to ``flap-to-graft conversion' or surgical excision of axillary skin. The UAL (VSUAL) for axillary osmidrosis has the advantages of a high success rate with minimal complications. Rapid recovery, less restriction of movement, and tiny scars were other major benefits of this technique. Therefore, UAL (VSUAL) is a viable option for treatment of axillary osmidrosis.     

Treatment of Osmidrosis with the Cavitron Ultrasonic Surgical Aspirator

BACKGROUND: Axillary osmidrosis is an uncomfortable condition that can be a personal or social handicap. OBJECTIVE: The objective was to present the treatment of osmidrosis with the Cavitron ultrasonic surgical aspirator (CUSA). MATERIALS AND METHODS: Fifteen patients (3 males and 12 females) underwent surgery for bilateral axillary osmidrosis with the CUSA. RESULTS: The outcome of this operation with the CUSA was evaluated by the patients themselves according to the following criteria. Postoperative improvement was evaluated as good when the odor was decreased by >75%, fair when it was decreased by > or =50 and < or =75%, and poor when it was decreased by <50%. A total of 15 patients (3 males and 12 females) were evaluated. Eight patients (53.3%) had a good result, 6 patients (40%) had a fairly good result, and 1 patient (6.7%) had a poor result. None of the patients experienced any complications, such as skin necrosis, infection, or serous cyst. One dissatisfied patient underwent reoperation and achieved a good result after the second procedure. CONCLUSIONS: This treatment of osmidrosis with the CUSA achieves satisfactory therapeutic efficacy.     

探讨腋臭治疗三种方法效果比较

目的 评价小切口切除术、肿胀麻醉下吸刮术与肉毒毒素注射治疗腋臭的临床效果.方法 2006年9月至2009年4月收治的腋臭患者350例,其中180例采用小切口切除治疗,120例肿胀麻醉下吸刮术治疗,50例行肉毒毒素注射治疗;对3组手术治疗的效果与并发症情况进行回顾性分析并做比较.结果 经术后3～24个月的随访,3组治愈率分别为90.6%、84.8%和84.2%,有效率均达到100%.结论 小切口切除术、吸刮术、肉毒毒素注射均为治疗腋臭的有效方法,但小切口切除对异味的祛除能更彻底.如考虑到术后的并发症,术后美观及恢复期短的等原因,对局部异味轻中度的患者,肉毒毒素注射治疗更适合;对中、重度的局部异味患者,可采用吸刮术.     

Endoscopic shaver with liposuction for treatment of axillary osmidrosis

Axillary osmidrosis is a distressing problem, and in severe cases patients may seek a permanent solution. Many treatment techniques have been developed that involve destruction or removal of the apocrine and eccrine glands. Previous methods have been hampered by surgical or aesthetic concerns. From June 1999 to June 2000, 64 patients (43 women and 21 men) were treated surgically for axillary osmidrosis. A 1-cm incision is made in the axillary crease. An endoscopic shaver is inserted, extended to the edge of the axilla, and subcutaneous tissue and glands are excised as the shaver is drawn from the axillary edge to the crease. Suction connected to the shaver immediately removes excised tissue. This procedure is repeated throughout the entire axilla. Malodor elimination was good in 117 of 128 axillae (91.4%) treated, fair in 8 (6.3%), and poor in 3 (2.3%). The resulting scar is small and essentially invisible because it is located in the axillary crease. This technique results in a small, inconspicuous scar; a surgical time of only 40 minutes; patients resuming exercise and daily activities within 5 days of surgery; and high patient satisfaction.     

腋后线沿皮纹横行小切口在搔刮法腋臭根治术中的应用

目的:探讨腋臭根治术更理想的微创手术方式。方法:作者手术治疗了280例(560侧)患有双侧腋臭的患者,应用腋后线沿皮纹横行小切口搔刮法腋臭根治术140例(实验组),应用腋窝横皱襞小切口搔刮法腋臭根治术140例(对照组),观察记录每例患者双侧手术总的时间、术后有无血肿、术后有无切口边缘坏死或糜烂及治疗效果。结果:①实验组140例手术时间均值为(60±2)mi n,对照组140例手术时间均值为(110±2)mi n,两者有统计学差异(t=220.17,P<0.05);②实验组术后未出现皮下血肿,而对照组1例单侧术后出现皮下血肿,两者无显著性差异(P=0.5);③实验组术后无切口边缘坏死或糜烂,对照组6例(8侧)出现术后切口边缘坏死或糜烂,两者有显著性差异(P=0.0148);④所有患者随访1年,实验组136例治愈,4例有效,总有效率100%,治愈率97.14%;而对照组135例治愈,5例有效,总有效率100%,治愈率96.43%;两者治愈率无显著性差异(χ2=0.0094,P>0.05)。结论:应用腋后线沿皮纹横行小切口行腋臭根治术,术者手术操作方便,手术时间短,无切口边缘坏死或糜烂,并发症少,治愈率高,是值得推广的一种手术方式。     

负压抽吸联合搔刮术与腋皱襞小切口皮下修剪术治疗腋臭的效果

目的 探讨负压抽吸术联合搔刮术与腋皱襞小切口皮下修剪术对腋臭患者的临床治疗作用。 方法 选取我院2020年6月-2022年8月收治的100例腋臭患者为研究对象，采用随机数字表法将其分成观察组 和对照组，各50例。对照组采用腋皱襞小切口皮下修剪术对腋臭进行治疗，观察组在对照组基础上加用 负压抽吸术联合搔刮术，比较两组临床疗效、临床指标、疼痛情况和不良反应发生情况。结果 观察组 治疗总有效率为100.00%，高于对照组的80.00%（P＜0.05）；观察组住院时间和伤口拆线时间均短于对 照组（P＜0.05）；观察组手术后1、3、7 d VAS评分低于对照组（P＜0.05）；观察组不良反应发生率为 2.00%，低于对照组的16.00%（P＜0.05）。结论 负压抽吸联合搔刮术与腋皱襞小切口皮下修剪术联合使用 可以取得较为理想的治疗效果，可缩短住院时间、伤口拆线时间，改善患者的术后疼痛情况，减少并发症 的发生几率。