Page 171 - Read Online

Page 2 of 10 Tanaka et al. Plast Aesthet Res 2020;7:17 I http://dx.doi.org/10.20517/2347-9264.2020.12

INTRODUCTION
Axillary osmidrosis (AO) is characterized by an offensive odor resulting from bacterial interaction with
[1]
excessive apocrine secretions . Especially in East Asian societies, AO impairs a patient’s psychosocial
[1]
functioning because of malodor and unsightly yellowish staining of clothing .

Various nonsurgical and surgical treatments have been reported for AO. Nonsurgical treatments include
the use of topical deodorant, subcutaneous injection of botulinum toxin-A, and endoscopic thoracic
sympathectomy. Surgical treatments include laser technology, axillary skin excision, suction curettage, and
[2-5]
conventional open excision of apocrine glands .
In general, less invasive treatments such as lasers have low complication rates, but are less effective. More
invasive treatments such as open surgery are more effective and have a lower recurrence rate, but they have
[2]
a higher complication rate .

Inaba and Ezaki reported that surgical treatments have been traditionally performed for patients with
[6]
AO in Japan since the 1950s. Since open excision of axillary sweat glands was first reported as a surgical
[7]
treatment for hyperhidrosis by Skoog and Thyresson in 1962, many surgeons and dermatologists have
performed similar procedures for AO. Various modifications on types of incision, drainage methods, suture
techniques, and tie-over dressings have been attempted [1,8,9] . Open excision is still commonly performed
in Asian countries because the entire procedure can be completed using a basic set of surgical instruments
that include forceps, skin hooks, dissecting scissors, and suture materials. It is also cost effective, compared
with other treatment options [1,10] .

[11]
The suction-curettage approach for AO was first introduced by the Taiwanese surgeons Ou et al. in 1998.
It has been subsequently modified by many Asian surgeons and dermatologists. The modifications include
[12]
[13]
a curette provided with a vacuum system , Fatemi/Cassio cannulae , and a suction-assisted cartilage
shaver (SACS) system [14,15] . To date, subdermal excision as an open surgical procedure and suction curettage
as a closed surgical procedure are the two major approaches for AO.

While other suction-curettage techniques manually remove sweat glands, SACS uses a double-sheathed
electric oscillating cutter to aggressively remove sweat glands. The effectiveness of SACS closed curettage
[21]
was reported to be comparable to that of open excision [14-20] . Shin et al. recently performed a meta-
analysis of the safety and efficacy of closed surgery compared with open surgery for AO and concluded that
suction curettage was safer than open surgery, but less effective than open surgery. Their analysis evaluated
more than one type of closed surgical procedure, as described in the previous paragraph, and open surgery
included not only conventional techniques but also en bloc skin excision and endoscopic surgery. To our
knowledge, no studies in the English-language literature comparing the safety and efficacy of SACS closed
curettage versus conventional open excision have been published.

Since 2006, we have used, based on the patient’s choice, either SACS closed curettage or open surgery to
[1]
treat more than 600 patients with AO . Our impression has been that SACS is preferable to open excision
regarding its safety and efficacy. The aim of this retrospective cohort study was to determine whether our
impression of the usefulness of SACS was accurate based on statistical analysis compared with conventional
open surgery.

METHODS
Patients
The Showa University Hospital institutional research board approved this study (approval No. 2928). A
retrospective chart review was conducted for consecutive patients with AO who underwent either open