Modified Suction-Assisted Cartilage Shaver for Axillary Osmidrosis

Abstract

Apocrine osmidrosis (AO) is a chronic, recurrent, and disturbing disease characterized by malodorous secretion from apocrine glands. Despite various conservative and nonsurgical treatments, surgical removal of apocrine glands remains the cornerstone for AO treatment. Conventional suction-assisted cartilage shaver is effective; however, there are several risks and complications. Hence, we modified the conventional method to achieve better effectiveness and reduce complications. This paper aims to evaluate the clinical effectiveness and the complications arising from the modified suction-assisted cartilage shaver for AO. Thirty-nine patients (M/F=11/28, average age 26.3 years) received this surgical treatment for AO from 2013 to 2017 in the Department of Dermatology at Kaohsiung Chang Gung Memorial Hospital, Taiwan. A suction-assisted cartilage shaver was introduced for the ultimate removal of the subcutaneous tissue containing the apocrine glands. A 0.5 cm incision was made in the center of the identified elliptical surgical area at each axilla. After defatting, the incision was closed primarily. The defatting skin was anchored to the axillary fascia by using 4-0 sutures without drains. We then evaluated the clinical efficacy and complications. The mean duration of follow-up was 31.8 months (12-68 months). Among patients receiving the modified cartilage shaving for AO, 92.3% achieved excellent-to-good results, 5.1% had acceptable results, and 2.6% had fair results. None of them experienced poor clinical efficacy. There was no skin necrosis, hematoma, nor wound infection after the surgery. There were no recurrences in all these patients 2 years after the surgery. This modified suction-assisted cartilage shaver for AO results in good efficacy, a low complication rate, and a low recurrence rate. The method is superior to the conventional one due to tissue glue-free procedure, greater comfort in postoperative care, minimal wounds, less hematoma, and less skin necrosis. The clinical study registration number of this study is NCT03793374.

Figures

Figure 1

Blue ellipses represent the identified surgical area of the apocrine glands. We firstly make a 0.5 cm incision in the center of the area (the yellow circle), dissect the subcutaneous tissue, and then introduce the cartilage shaver from the incision. Apocrine glands at dermal-subcutaneous junction are removed radially as the white arrows indicate. The incision wound is closed primarily with 2 stitches of 4-0 polyglactin (yellow lines in the center), and there are multiple obliquely inserted drainage holes made by the 18G needle, on the defatting flap (the black dots). Finally, we anchor the defatting skin with 4-0 polyglactin sutures, which are parallel to the axillary skin crease (the white lines).

Figure 2

Clinical pictures in a 26-year-old male patient before removing the stitches 7 days after the operation. The left picture is his left axilla while the right one is his right axilla.