Dr Yanfei Wu, Foreign Language Department, College of International Studies, Jiaxing University, 899 Guangqiong Road, Jiaxing, Zhejiang 314001, P.R. China
*Contributed equally
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.
Axillary bromhidrosis is a disease that involves the apocrine sweat glands and it is characterized as a combination of wet earwax, hyperhidrosis and bromhidrosis (
The tumescent anesthesia technique combined with superficial fascia rotational atherectomy, which is a rapidly developing technology for treating axillary bromhidrosis, has been widely used for the treatment of patients with axillary bromhidrosis in the clinic and the therapy results for axillary bromhidrosis have gained the attention of physicians and patients (
The tumescent anesthesia technique and rotational atherectomy have been considered effective therapies for patients with axillary bromhidrosis, according to previous clinical studies (
A total of 60 patients (female, n=41; male, n=19) aged 16~27 with axillary bromhidrosis, who were treated in the First Hospital of Jiaxing, Jiaxing, China from January 2017 to December 2020, were included in the present retrospective clinical study. All patients had a history of axillary bromhidrosis. All protocols used for the present study were prospectively reviewed and approved by the Use Committee of the First Hospital of Jiaxing (approval no. LS-2018-117) and written informed consent was obtained from all patients.
The study inclusion criteria were: i) History of axillary bromhidrosis; ii) meeting the Park's diagnostic criteria for axillary bromhidrosis (
The study exclusion criteria were: i) Very high expectation of treatment for axillary bromhidrosis; ii) severe psychological disorder; iii) anticoagulant or antiplatelet drug therapy increasing the risk of bleeding; iv) history of surgery ≥3 times in the axillary 3-6 months before surgery; v) active or progressive heart, lung, liver or kidney disease; vi) menstruating patients; vii) breastfeeding patients; viii) allergy to anesthesia and ix) participation in other clinical trials.
The present study was retrospective. Study participants were equally distributed between the experimental and control groups (n=30/group). The tumescent anesthesia technique combined with conventional surgery was performed on the patients in the control group, while the anesthesia technique combined with superficial fascia rotational atherectomy was performed for patients in the experimental group. A set of negative-pressure suction devices was used to collect peeled tissue.
The rotational atherectomy system (Terumo Corporation), which comprises the host, perfusion lighting rod, planer head, power output line and pressurized infusion devices, was used to treat patients in the experimental group. Anesthesia perfusion solution (100 ml), which consisted of 0.5% lidocaine and 0.1% u-epinephrine, was prepared for local infiltration anesthesia. The blood routine for the two groups of patients was checked and four items of blood coagulation including platelet, prothrombin and thrombin time and fibrinogen were obtained. The presence of symptoms such as redness, swelling, ulceration and furuncle on the underarm skin was monitored. The scribe area on the axillary was 0.5 cm larger than the axillary hair area. The surgery aimed to completely remove the axillary bromhidrosis.
The patient was instructed to lie on their back, with both upper limbs abducted and raised, elbows bent and hands placed at the side of their head with palms facing up to fully expose the axillary skin. Subsequently, 40-50 ml anesthesia perfusion solution was injected above the scribe area. The incision was performed at the midpoint of the armpit. A flap was formed using vascular forceps on the subcutaneous fat layer of the incision. For patients in the experimental group, the rotational atherectomy cutter head was extended from the incision into the axillary hair area to conduct a saw-style suction. For patients in the control group, a conventional cutter head was used. A pressure suction force of 0.3-0.4 kPa was set on the negative pressure suction device, and a speed of 1,000-1,200 revolutions/min was set on the rotational atherectomy cutter head. Subsequently, subcutaneous fat, dermal apocrine sweat glands and hair follicles in the scribe area were destroyed and sucked. Finally, the thickness of the remaining flap was ~0.5 cm. The plucking was used to test the degree of destruction on the apocrine sweat glands.
Clinical data from all pretreatment patients with axillary bromhidrosis in the present study were collected, including age, sex, degree of axillary bromhidrosis odor (
After obtaining informed consent from patients, ~5 mm full-thickness tissue was cut from the preoperative and postoperative axillary incision skin and the excised tissues were fixed with 4% paraformaldehyde at 4˚C for 12 h. Subsequently, the axillary tissue was embedded in paraffin blocks, cut into 5-µm sections for conventional hematoxylin at room temperature for 5 min and eosin staining at room temperature for 5 min and tested by YS, who was blinded to the control and experimental groups. Finally, the structural components of the tissue were observed using an optical microscope (light, 200x).
The therapeutic efficacy of tumescent anesthesia technique combined with superficial fascia rotational atherectomy for patients with axillary bromhidrosis was evaluated at 6-month follow-up. The surgery was considered curative, effective and ineffective based on postoperative axillary odor scores as follows: i) Curative, the axillary odor score was grade 0 or 1 and was significantly improved compared with that in the control group; ii) effective, axillary odor score for postoperative patients significantly improved compared with that in the control group but the effect did not reach the curative standard; and iii) ineffective, axillary odor score of the experimental group was not significantly improved compared with that in the control group and the grade for postoperative patients remained at grade 2 or 3.
The dermatology life quality index (DLQI) was used to evaluate patient satisfaction. DLQI, which is a questionnaire survey, has been widely used as an evaluation for the health-related life quality of patients with skin diseases (
SPSS 19.0 software (IBM Corp.) was used for statistical analysis. Continuous data are presented as mean ± standard deviation of independent experimental repeats three times, while descriptive data are presented as percentages. Measurement data and count data, were analyzed by paired t and χ2 test, respectively. If the expected count in <20% of cells of the analyzed contingency table was >5, χ2 test was used. If the expected count in <20% of the cells of the analyzed contingency table was ≤, Fisher's exact test was used to analyze the data changes between the experimental and control group. P<0.05 was considered to indicate a statistically significant difference.
The baseline characteristics of the two groups including age, sex, family and preoperative surgery history, preoperative odor degree and DLQI were not statistically different, indicating baseline material between the two groups were relatively balanced (
For 30 patients in the experimental group and control group, the intraoperative blood loss was 7.5-11.5 and 36.5-41.0 ml, respectively; mean blood loss was 9.20±0.91 and 39.10±1.10 ml, respectively (
The pre- and postoperative images for patients who underwent anesthesia technique combined with superficial fascia rotational atherectomy for the removal of apocrine sweat glands are presented in
The comparison of axillary odor degrees at ≥6 months postoperative between the two groups is presented in
The comparison of the life quality of postoperative patients is presented in
Axillary bromhidrosis, which is a common and bothersome odor, affects individuals worldwide, especially in Asia. Various types of surgery are performed to eliminate axillary bromhidrosis, but none of these has achieved satisfactory results (
A recent study showed that non-surgical modern modalities such as microwave-based therapy exhibit promising therapy efficacy (
In the present study, the family history, preoperative surgery history, preoperative odor degree and total DLQI score of patients with axillary bromhidrosis were statistically analyzed and the results were consistent with the results reported by previous studies (
Intraoperative blood loss and operation time are used to evaluate the effect of the tumescent anesthesia technique combined with superficial fascia rotational atherectomy on patients with axillary bromhidrosis (
In the present study, the axillary odor degree and DLQI score were used to assess the effect of the tumescent anesthesia technique combined with superficial fascia rotational atherectomy. In a previous study conducted in 2019 by Van
Rotational atherectomy using smaller size burrs and lower rotational speeds is a conservative approach that provided improved immediate results, with increased safety and improved long-term outcomes. The present clinical study showed that the tumescent anesthesia technique combined with superficial fascia rotational atherectomy decreased bleeding, surgery time and DLQI score. Overall, the tumescent anesthesia technique combined with superficial fascia rotational atherectomy showed a good effect on patients with axillary bromhidrosis.
Not applicable.
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
YPS conceived the study. YPS, JHL, YWa and YWu analyzed and interpreted data. YPS and JHL confirm the authenticity of all the raw data. All authors have read and approved the final manuscript.
The present study was approved by the Ethics Committee of the Affiliated Hospital of Jiaxing University (approval Number: LS2018-117), The First Hospital of Jiaxing.
Written informed consent was obtained from all patients.
The authors declare that they have no competing interests.
Pre- and postoperative images of a patient who underwent the anesthesia technique combined with superficial fascia rotational atherectomy for the removal of apocrine sweat glands. Magnification, x200. Arrows indicate sweat gland.
Contents and scores for DLQI.
DLQI item | No effect score | Little effect score | Effect score | Severe effect score |
---|---|---|---|---|
Itching, soreness, pain or tingling of the skin | 0 | 1 | 2 | 3 |
Embarrassment or embarrassment caused by skin problems | 0 | 1 | 2 | 3 |
Impact of skin problems on your life | 0 | 1 | 2 | 3 |
Effect of your skin problems on choice of clothes | 0 | 1 | 2 | 3 |
Impact of your skin problems on your social or leisure activities | 0 | 1 | 2 | 3 |
Difficulties on skin caused by exercise | 0 | 1 | 2 | 3 |
Does the skin problem hinder your work or study? | 0 | 1 | 2 | 3 |
Does the skin problem cause problems with spouse, or good friends or relatives? | 0 | 1 | 2 | 3 |
Does your skin problem cause sexual problems? | 0 | 1 | 2 | 3 |
How big is the problem caused by skin problem treatment? | 0 | 1 | 2 | 3 |
DLQI, dermatology life quality index.
Total DLQI scoring system.
DLQI total score | Effect of axillary bromhidrosis on life quality |
---|---|
0-1 | None |
2-5 | Little |
6-10 | Moderate |
11-20 | Relatively large |
21-30 | Severe |
DLQI, dermatology life quality index.
Clinical data.
Characteristic | Experimental group | Control group | P-value |
---|---|---|---|
Mean age, years | 23.5±3.9 | 23.1±3.4 | >0.05 |
Sex | >0.05 | ||
Male, n | 8 | 11 | |
Female, n | 22 | 19 | |
Family history of axillary bromhidrosis | >0.05 | ||
Yes | 14 | 12 | |
No | 16 | 18 | |
Preoperative surgery history | >0.05 | ||
Yes | 2 | 1 | |
No | 28 | 29 | |
Preoperative odor degree | >0.05 | ||
Grade 0/1 | 0 | 0 | |
Grade 2 | 8 | 13 | |
Grade 3 | 22 | 17 | |
Preoperative dermatology life quality index score | >0.05 | ||
0-1 | 0 | 0 | |
2-5 | 0 | 0 | |
6-10 | 3 | 4 | |
11-20 | 22 | 23 | |
21-30 | 5 | 3 |
Intraoperative blood loss and operation time.
Group | Number of patients | Mean intraoperative blood loss, ml | Mean operation time, min |
---|---|---|---|
Experimental | 30 | 9.2±0.91 |
78.2±3.3 |
Control | 30 | 39.1±1.1 | 95.6±7.8 |
aP<0.05 vs. control.
Axillary bromhidrosis degree >6 months after surgery.
Grade | |||
---|---|---|---|
Group | 0/1 | 2 | 3 |
Experimental | 28 | 2 |
0 |
Control | 22 | 7 | 1 |
aP<0.05 vs. control.
DLQI score at >6 months after surgery.
DLQI score | |||||
---|---|---|---|---|---|
Group | 0-1 | 2-5 | 6-10 | 11-20 | 21-30 |
Experimental | 26 | 2 | 2 |
0 | 0 |
Control | 19 | 3 | 7 | 1 | 0 |
aP<0.05 vs. control. DLQI, dermatology life quality index.