深浅两层顶泌汗腺处理法治疗腋臭术后并发症的分析和处理

目的分析探讨深浅两层顶泌汗腺处理法治疗腋臭,其术后并发症出现的原因和处理方法。方法对317例腋臭患者行深浅两层顶泌汗腺处理法治疗腋臭,观察术后并发症,分析原因并及时外科处理。结果 317例患者术后血肿20例(6.3%)、皮下积液12例(3.8%),皮肤瘀斑36例(11.4%),皮肤坏死5例(1.6%),切口裂开34例(10.7%),切口感染16例(5.1%),切口延期愈合71例(22.4%),切口瘢痕23例(7.3%),瘢痕挛缩12例(3.8%),异味残留11例(3.5%),腋毛脱落317例(100%);皮肤外科适当处理后效果满意。结论深浅两层顶泌汗腺处理法治疗腋臭术后并发症的发生与多种因素有关,及时恰当的处理仍可以获得满意的术后效果。     

顺腋纹平行双切口保留真皮血管网切除顶泌汗腺治疗腋臭

目的：评价肿胀麻醉下顺腋纹平行双切口保留真皮血管网的顶泌汗腺切除术根治腋臭的疗效.方法：手术顺腋纹做两个平行切口,于腋浅筋膜浅层向四周锐性分离皮下组织达腋毛边缘,翻转皮瓣直视下逐一修剪顶泌汗腺组织.结果：本组68例共136侧,所有病例切口均I期愈合,无1例发生皮瓣坏死,术后经6～12个月的随访,治愈122侧,治愈率89.71%,显效14侧,显效率10.29%,总有效率100%.术后瘢痕轻微、隐蔽,腋窝皮肤活动性好,上肢功能无影响.结论：肿胀麻醉下顺腋纹平行双切口保留真皮血管网的顶泌汗腺切除术治疗腋臭总有效率高,并发症少,瘢痕小,为目前较理想的根治腋臭的手术治疗方法.     

小切口手术治疗腋臭的并发症分析

目的探讨如何减少小切口翻转皮瓣剃除术治疗腋臭的并发症。方法对19例出现并发症患者资料进行分析总结。结果皮瓣不同程度坏死9例、血肿和积液5例、切口感染、裂开3例、残留异味2例,可能与手术操作有关。结论小切口腋臭治疗术的并发症可能与皮瓣下组织剃除过多、切口缘反复夹持损伤、边角残留大汗腺、术后加压包扎不够有关。手术中应注意这些操作细节,减少并发症的发生。     

腋窝皱襞切口薄皮瓣法治疗腋臭215例并发症分析

目的观察腋窝皱襞切口薄皮瓣法治疗腋臭术后并发症,探讨并发症的原因和预防措施。方法回顾分析2005年5月-2010年12月采用腋窝皱襞切口薄皮瓣法治疗腋臭215例(430侧)中,出现并发症的48例(69侧)患者的临床资料。结果有并发症48例(69侧),即血肿22例(35侧)、皮瓣部分坏死16例(21侧)、瘢痕增生5例(8侧)、上肢牵拉疼痛3例(3侧)、湿疹样皮炎2例(2侧)。结论术后皮瓣下积血可引起皮瓣部分坏死、瘢痕增生和湿疹样皮炎等,减少皮瓣下积血可降低并发症的发生率。     

桥式双切口顶泌汗腺修剪术治疗腋臭176例临床分析

目的评价桥式双切口顶泌汗腺修剪术治疗腋臭的疗效及不良反应。方法采用桥式双切口顶泌汗腺修剪术治疗176例腋臭患者,用视觉模拟评分法(VAS)于术后1年评估其疗效及不良反应。结果 176例患者中,治愈164例(93%),有效12例(7%),总有效率100%。其中有4例患者切口发生表浅溃疡,延期愈合,留下轻微瘢痕。全组腋毛均减少,出汗减少,皮肤质地柔软,无感染、无血肿。结论桥式双切口顶泌汗腺修剪术操作方便,切口美观,不良反应少。     

腋窝皱襞小切口皮下剥离术与双平行切口皮下修剪术治疗腋臭疗效比较

目的对比腋窝皱襞小切口皮下剥离术与双平行切口皮下修剪术治疗腋臭患者的应用效果。方法选取我院腋臭患者96例,随机数字表法分为剥离组与修剪组,每组各48例。修剪组行双平行切口皮下修剪术治疗,剥离组行腋窝皱襞小切口皮下剥离术。观察对比腋臭清除率、并发症发生率。结果术后剥离组腋臭清除率100.00%高于修剪组(83.33%,P <0.05);剥离组并发症发生率4.17%低于修剪组(18.75%,P <0.05)。结论相较于双平行切口皮下修剪术,腋窝皱襞小切口皮下剥离术应用于腋臭患者,可显著提高腋臭清除率,降低并发症发生率。     

腋后线“N”形切口大汗腺修剪术与微针射频大汗腺热凝术治疗腋臭临床对比分析

目的:对比腋后线"N"形切口大汗腺修剪术及微针射频大汗腺热凝术治疗腋臭的效果。方法:回顾性分析该院2015年10月—2016年5月采用2种方法治疗58例(116侧)腋臭患者的临床疗效。其中A组28例(56侧)予腋后线"N"形切口大汗腺修剪术;B组30例(60侧)予微针射频大汗腺热凝术。结果:治疗轻度患者时,2组疗效差异无统计学意义;治疗中、重度患者时,A组疗效显著优于B组,差异有统计学意义(P0.05)。A组并发症包括血肿2例[3.57%,95%CI(0.62%～13.38%)]、皮瓣或皮肤坏死8例[14.26%,95%CI(6.80%～26.78%)]及局部瘢痕增生11例[19.64%,95%CI(10.67%～32.84%)],合计发生并发症比例为37.50%[95%CI(25.23%～51.48%)]。B组皮瓣或皮肤坏死2例[3.33%,95%CI(0.58%～12.55%)]及局部瘢痕增生6例[10.00%,95%CI(4.13%～21.17%)],合计发生并发症比例为13.33%[95%CI(6.34%～25.14%)]。结论:微针射频热凝术适于轻度腋臭患者,且较腋后线"N"形切口修剪术术后并发症少。     

腋窝皱襞小切口大汗腺剪除术根治腋臭334例疗效观察及围手术期护理

目的观察腋窝皱襞小切口大汗腺剪除术根治腋臭的疗效,探讨其围手术期预防并发症的措施。方法入选患者均沿腋毛区外1.0cm处标记手术区域,在腋窝中央皮肤皱褶处切口,长约1.5～2.0cm,沿皮下组织浅层分离术区皮肤组织,翻转皮瓣,剪除皮肤上脂肪组织、大汗腺及毛囊,修剪成仅含皮肤全层和真皮下血管网的超薄皮瓣,再缝合切口。结果 334例患者,共治疗668侧,均有效,痊愈412侧,显效256侧,无效0侧。围手术期出现皮下血肿21侧、局部皮肤坏死6侧、切口延迟愈合11侧、局部湿疹样皮炎12侧、水疱和血疱56侧,积极对症处理后,预后良好。结论腋窝皱襞小切口大汗腺剪除术根治腋臭,疗效肯定,手术切口瘢痕不明显。围手术期应积极预防和处理各种并发症的发生。     

小切口潜行清除汗腺治疗腋臭

目的：寻求一种简便、有效治疗腋臭的外科于术方法。法：肿胀麻醉下通过1．0cm顺皮纹的小切口，于皮下脂肪层潜行分离一略大于腋毛边界的完整腔隙，用剪刀紧贴皮肤侧，剪除真皮下的脂肪浅层，清除其中的大汗腺及毛囊。果：78例患者均取得了较好的临床效果，无术后血肿、皮瓣坏死等并发症。腋部异味均消失，腋窝部仅留下1．0cm顺皮纹瘢痕。其中56例半年后随访，异味完全消失、瘢痕不明显：结论：小切口潜行清除汗腺术治疗腋臭是一种并发症少、瘢痕小、效果好的腋臭手术方法?     

小切口修剪术治疗腋臭

目的 探讨小切口顶泌汗腺非暴露修剪术治疗腋臭的可行性。 方法 对58例腋臭患者施行了小切口顶泌汗腺非暴露修剪术。 结果 随访1~12个月,除1例还有轻度异味外,其余57例治愈。每例（双侧）平均手术时间为55分钟。 结论 这是一种可广泛应用的、简便的、安全的、有良好效果的手术方式。     

腋臭患者腋区顶泌汗腺的分布特点

【摘要】 目的 检测腋臭患者腋区顶泌汗腺在深度、广度的分布,探讨其范围内的分布差异性。 方法 2010年9 - 12月间的15例腋臭患者,行直视下顶泌汗腺剪除术,切取切口处宽约2 mm的全层皮肤,深度达腋浅筋膜浅层,用于判明顶泌汗腺分布的深度。留取腋中心（点1）、距腋中心1 cm（点2）、距腋毛边缘内1 cm（点3）、腋毛边缘（点4）、距腋毛边缘外1 cm（点5）共5个标记点对应的皮下暗红色粗大的颗粒状组织,用于判明顶泌汗腺的分布范围及分布规律。 结果 顶泌汗腺分泌部主要分布于真皮网状层和皮下脂肪浅层,表皮层、真皮乳头层及腋浅筋膜浅层均无顶泌汗腺分布。顶泌汗腺广度分布与腋毛范围基本一致,腋中心部可见大量顶泌汗腺组织,腋毛边缘处仍有少量顶泌汗腺分布,腋毛边缘外1.0 cm处已无顶泌汗腺分布。5个点顶泌汗腺面积占整块组织面积的百分比平均值分别为74.1%、46.6%、25.3%、2.1%和0,相邻两点进行t检验,点1、2之间t = 29.78,P < 0.01;点2、3之间t = 9.76,P < 0.01;点3、4之间t = 20.83,P < 0.01;点4、5之间t = 1.96,P > 0.05。 结论 手术治疗腋臭时,清除范围深度达真皮网状层和浅层脂肪层,广度到腋毛范围即可,没有必要过度扩大清除范围。     

Refined tumescent liposuction‐curettage with pruning in small incisions for treatment of axillary bromhidrosis

Axillary bromhidrosis is a widespread social problem in our society. Various modalities have been developed for the destruction or removal of the apocrine sweat glands to eliminate underarm odor. However, conventional surgical treatments often result in a high complication rate and frequent recurrence. In this study, we aimed to evaluate the effect of refined tumescent liposuction‐curettage with pruning in small incisions as treatment for axillary bromhidrosis. Between July 2013 and April 2019, 110 patients (75 women and 35 men) with axillary bromhidrosis underwent refined tumescent liposuction‐curettage with pruning. The results of eliminating underarm odor were evaluated by both the patients and doctors and rated as very satisfied (excellent), satisfied (good), slightly satisfied (fair), and not satisfied (poor). Postoperative complications, such as dehiscence, infection, wound contracture, cyst, subcutaneous hydrops, hematoma, or seroma, were also evaluated. Preoperative and postoperative histological examinations of axillary tissues were performed in two patients. In the subjective evaluation of 110 patients, 33 (30.0%) were very satisfied with the results, 70 (63.6%) were satisfied, and seven (6.4%) were slightly satisfied. The objective evaluation showed that 43 (39.1%) patients graded the results as excellent, whereas others graded the results as good. No serious complications occurred, except three patients with slight local subcutaneous hydrops and hematoma. Histologic examinations showed that the apocrine glands were significantly decreased or destroyed after the surgery. Refined tumescent liposuction‐curettage with pruning in small incisions is an effective method for the treatment of axillary bromhidrosis.     

Surgical subcision as a cost-effective and minimally invasive treatment for axillary osmidrosis

Background Axillary osmidrosis, characterized by unpleasant odor and occasional staining of clothing, is a personal discomfort and social impairment for people who suffer from it. Various types of surgical procedures involving instrumented‐assisted tools (lasers, ultrasonic, endoscope, and others) have shown relatively positive results; however, for patients in developing countries, especially in China, these treatments are inconvenient and cost‐ineffective. Objective To introduce a minimal incision surgical procedure with skin flap treatment that removes the apocrine sweat glands in the subcutaneous tissue through a 1‐cm‐long incision without instrument‐assisted tools. Method From July 2005 to October of 2007, 108 patients (68 women and 40 men) were treated with the minimal incision and cost‐effective surgical treatment by manual excision. A 1‐cm‐long incision is made in the axillary crease. Subcutaneous tissue and glands were removed with scissors through this incision. This procedure is repeated throughout the entire axilla until the axilla has essentially become a super‐thin flap. Result Malodor elimination was good in 206 out of 215 axillae (95.8%) treated, fair in nine (4.2%), and poor in zero (0%). The resulting scar is small and virtually invisible because it is only 1‐cm long and located in the axillary crease. Conclusion Treatment of axillary osmidrosis by manual excision through a 1‐cm incision is a convenient, efficient, cost‐effective, and relatively safe technique that results in high patient satisfaction and benefits patients and surgeons in developing countries. Axillary osmidrosis, a non‐life‐threatening condition characterized by unpleasant odor and occasional staining of clothing, is an annoying problem, particularly in Asian societies. For many people who suffer from this problem, this condition is a personal discomfort, a social impairment, and discourages patients from enjoying social or personal activities, especially young women. They are usually embarrassed by the smell during their daily activities and communication with other people.     

Local injection of botulinum toxin A: An alternative therapy for axillary osmidrosis

The objective of this study was to investigate the efficacy of local injection of botulinum toxin A for treating axillary osmidrosis. One hundred and fifty patients with axillary osmidrosis were randomly divided to receive botulinum toxin A injection treatment (50 U of botulinum toxin A was injected intracutaneously into 6–20 different sites within each axilla, n = 74) or surgical excision of the apocrine glands (n = 76). The patients were followed up for 1–3 months to analyze the therapeutic effect and complications of the two methods. The curative effect in patients with mild and moderate axillary osmidrosis was not significantly different between the botulinum toxin A injection group and operation group. However, for patients with severe axillary osmidrosis, surgery treatment seemed to be superior to botulinum toxin A treatment (P = 0.005). There was also no significant difference in the modified Dermatology Life Quality Index between the two treatments. Two cases showed complications related to hemorrhage and incision infection in the operation group. In conclusion, local injection of botulinum toxin A is a safe, fast and effective treatment for mild and moderate axillary osmidrosis, but the long‐term effect remains to be further investigated.     

Excision of apocrine glands and axillary superficial fascia as a single entity for the treatment of axillary bromhidrosis

Background Surgical excision of apocrine glands is the effective treatment for axillary bromhidrosis. Skin necrosis, the most serious adverse result observed postoperatively, results in a prolonged wound healing and leads to unsightly scars in the axillary fossae. It is mainly caused by the skin damage during the operation and postoperative seroma or haematoma formation. Objective To investigate the effects and complications of our surgical modality for axillary bromhidrosis. Methods Sixty‐three patients with bromhidrosis were treated. An incision about two‐thirds of the length of the widest transverse diameter was made on the axillary crease. The loosened layers between the dermis and axillary superficial fascia containing apocrine glands were carefully undermined with an iris scissor. The entire apocrine glands‐axillary superficial fascia complex was dissected from the centre to the superior and inferior margins with an electrosurgical pencil. Results Of the 126 axillae, malodour was eradicated in 112 axillae and reduced sharply in 14. There were three cases of skin necroses. The Dermatology Life Quality Index score decreased significantly and the quality of life improved after the operation. Conclusion Our surgical technique can achieve minimal tissue damage and maintain no hematoma postoperatively. The rate of skin necrosis was low. Quality of life improved after the procedure in this patient population.     

单小切口与双小切口大汗腺修剪术治疗腋臭对比分析

 目的:对比分析单小切口与双小切口大汗腺修剪术治疗腋臭的疗效及并发症。方法：将111例患者随机分为A、B两组。A组(50例)行单小切口大汗腺修剪术,B组（61例）行双小切口大汗腺修剪术,比较两组治疗效果。结果：A、B两组总有效率均为100%。A组切口内侧表皮糜烂或裂开18例（36.00%）,B组切口内侧表皮糜烂或裂开11例（18.04%）,A组明显高于B组,差异有统计学意义（ X²=4.60,P<0.05）。结论：双小切口大汗腺修剪术术后并发症明显少于单小切口大汗腺修剪术。     

腋臭病因和发病机制的研究进展

腋臭的病因和发病机制至今尚在研究中。ApoD蛋白可能是腋臭发生分子机制中的核心蛋白,研究表明,顶泌汗腺的分泌物E-3M2H可能借助ApoD蛋白为载体,从体表散发出典型的辛辣气味。ApoD基因自身及其调控因素的差异可能是疾病发生的重要原因之一。在上述过程中,微生物的调控、雄激素及其受体可能在腋臭发病的过程中起了重要作用。腋臭相关基因（ABCC11）中的单核甘酸多态性（SNP很可能是患者发病的决定性因素。     

Minimally Invasive Surgery for Axillary Osmidrosis Using a Combination of Subcutaneous Tissue Removal and a 1,444-nm Nd:YAG Laser

Many treatment modalities have been developed for axillary osmidrosis. It is well known that the surgical treatment has the best results. However, there is a high possibility of side effects. The 1,444-nm lipolysis laser has been recently introduced to remove the apocrine glands. So far, subdermal coagulation treatment with a 1,444-nm Nd:YAG laser may be the least invasive and most effective therapy for axillary osmidrosis. However, according to our previous experience, the recurrence rate was 20%~30%. This emphasizes the need for combination of surgical method and non-surgical method and we combined subcutaneous tissue removal and photothermocoagulation with a 1,444-nm Nd:YAG laser. Three patients for bilateral axillary osmidrosis were enrolled. After an incision of about one-third the length of the widest transverse diameter, the apocrine glands were separated from the skin. And then apocrine glands within the marked area were destroyed by irradiation with a 1,444-nm Nd:YAG laser thereafter. All patients exhibited no relapse of axillary osmidrosis and were satisfied with the treatment results. A combination of subcutaneous tissue removal and Interstitial laser photothermocoagulation with a 1,444-nm Nd:YAG laser could be an effective treatment for mild to moderate axillary osmidrosis.