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Page 6 of 10 Tanaka et al. Plast Aesthet Res 2020;7:17 I http://dx.doi.org/10.20517/2347-9264.2020.12

Table 1. Patient characteristics and postoperative outcomes of closed curettage by the SACS and open excision for axillary
osmidrosis
Procedure SACS Open excision P
Number (male:female), n 91 (21:70) 168 (56:112) 0.09
Mean age ± SD, m 28.6 ± 7.6 28.0 ± 7.3 0.51
Odor levels, n (%)* 0.06
3 12 (13.2) 42 (25.0)
4 53 (58.2) 90 (53.7)
5 26 (28.6) 36 (21.3)
Total complications, n (%)** 19 (10.4) 70 (20.8) 0.002
Hematoma 9 (4.9) 34 (10.1) 0.06
Wound dehiscence 0 (0.0) 21 (6.3) < 0.001
Skin necrosis 3 (1.6) 11 (3.3) 0.09
Seroma 5 (2.7) 1 (0.3) 0.02
Others*** 2 (1.1) 2 (0.6) 0.28
Recurrence, n (%) 2 (2.2) 2 (1.2) 0.61
Mean patient satisfaction**** 8.5 (n = 48) 8.8 (n = 78) 0.10
*Odor levels 1 (no odor) and 2 (faint odor) were not indicative for surgery; **complications were assessed by axilla (n = 182 for SACS, n
= 336 for open excision groups); ***other rare events included infection, sensory disturbance, and arterial injury; ****patient satisfaction
was not assessed for all patients (n = 48 for SACS, n = 78 for open excision groups). SACS: suction-assisted cartilage shaver system

RESULTS
Patient characteristics
The characteristics of the patients are summarized in Table 1. A total of 188 patients underwent open
excision and 91 patients underwent closed curettage by the SACS system. The male/female ratio, mean age,
and odor levels were similar between the SACS and open-surgery patients. The duration of postoperative
follow-up was 5.2 months (minimum 3 months, maximum 64 months), and the follow-up periods were
statistically similar between the two patient groups.

Safety and efficacy of the procedures
The complication rate of the patients treated by the SACS system was significantly lower than the
complication rate of the patients undergoing open surgery (10.4% vs. 20.7%; P = 0.002). Table 1 shows
detailed comparisons, and Figure 3 shows examples of the complications. The most frequent complication
in either group was hematoma [Figure 3A], with no significant difference between the rates (P = 0.06).
Wound dehiscence [Figure 3B] was seen only in patients undergoing open surgery. Delayed wound healing
including skin necrosis and wound dehiscence was more frequently seen in patients undergoing open
surgery (P < 0.001). Seroma [Figure 3C] was significantly more frequent in the patients treated by the SACS
system (10.4%, P = 0.002).

In each treatment group, two patients had a recurrence or thought the outcome was unsuccessful,
representing 1.1% of patients undergoing SACS closed curettage and 2.2% of patients undergoing open
surgery. The difference was not significant (P = 0.614). Patient satisfaction for both procedures was very
high (8.5/10 for SACS vs. 8.8/10 for open excision), with no significant difference (P = 0.010).

DISCUSSION
Previously reported cohorts
Several retrospective cohort studies have reported the treatment options for AO. For example, Park and
[23]
Shin compared conventional open excision, liposuction, laser vaporization, and ultrasonic aspiration,
[24]
and they concluded that the best option was open excision. Chen et al. compared laser coagulation and
suction curettage, and concluded that suction curettage produced a higher incidence of complications
[5]
than laser coagulation, but was more effective than laser coagulation. Yang et al. recently compared