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Page 8 of 10 Tanaka et al. Plast Aesthet Res 2020;7:17 I http://dx.doi.org/10.20517/2347-9264.2020.12

Table 2. Reports on closed curettage by suction-assisted cartilage shaver system for axillary osmidrosis
Patients Follow-up period, Complication, n Recurrence, n Type of shaver, inner/
Ref. Mean age, year
(male:female), n month (%) (%) outer
Tung [14] 64 (21:43) NR 6-13 5/128 (3.9)* 3/128 (2.3) Serrated/open
[15]
Matsuda 77 (20:57) 27 3-36 7/154 (4.5)* 2/77 (2.6) Serrated/open + grid
[2]
Lee et al. 89 (15:74) NR 14-28 0/89 (0) 0/89 (0) Smooth/grid
Wu [16] 156 (26:130) 23 6-59 12/156 (7.7) 4/156 (2.6) Smooth/grid
[17]
Huang et al. 70 (8:62) 26 6-35 NR 1/70 (1.4) NR
Chern et al. [18] 30 (10:20) 22 3-13 1/60 (1.7)* 0/30 (0) Smooth/grid
Hsu and Wang [19] 19 (4:15) 34 3 0/38 (0)* 3/19 (15.8) NR
Tseng et al. [20] 39 (11:28) 26 12-69 0/39 (0) 0/39 (0) NR
Current study 91 (21:70) 28.2 3-60 19/182 (10.4)* 2/91 (2.2) Serrated/grid
*Evaluation by axilla. NR: not reported

are thought to be multifactorial, including subdermal space, lymphatic drainage, the use of a cauterization
[25]
device, and skin shearing . Since the axillary region is well supplied with lymph vessels, we speculate
that the mechanism involved in an axillary seroma is similar to that for an abdominal seroma. Seroma
and hematoma in SACS closed-curettage procedures as well as in abdominoplasty might be avoided
[20]
with an increased number of anchoring sutures and a longer drainage period. In fact, Tseng et al.
created multiple drainage holes and quilting sutures following the use of a shaver and did not find any
adverse events. However, such additional procedures resulted in unsightly scarring.

Efficacy
With regard to the assessment of efficacy, our study has some limitations. Postoperative efficacy was primarily
assessed based on the patient’s opinion, and complaints such as “recurrent odor”, “not improved”, or “not
effective” were further reconfirmed by our gauze test. However, the perception of satisfaction varied based
on the individual patient. Even for some patients who were satisfied with their procedure, recurrence might
have been diagnosed by the gauze test. Second, although our minimum follow-up period was three months,
[4]
which is similar to previously reported studies, the follow-up period might be too short. Wang et al.
compared the efficacy of their suction-curettage procedure with that of conventional open surgery, and
they concluded that an evaluation of the final outcomes at three months after surgery might be too early. In
fact, several authors have reported patients with axillary odor that recurred six months or longer after their
procedure [1,5,15] . Thus, the recurrence rates in this study were possibly underestimated for both treatments.

Emerging treatments
Recently, emerging treatments for axillary hyperhidrosis, such as microwave and radiofrequency
[2,5]
technologies, have been reported to have some positive effects for AO as well . Although the procedures
using these new technologies are more costly than suction curettage procedures, the procedures are non-
[5]
surgical and might provide permanent effects. Yang et al. performed a retrospective cohort study that
compared microwave technology and suction curettage and found that the recurrence rate was higher with
microwave than with suction curettage, although the complication rate after microwave treatment was
much lower than the rate after suction curettage. Further comparative studies between novel technologies
and SACS closed curettage are needed with respect to complications and recurrence, as well as regarding
cost, postoperative discomfort, recovery time, and patient satisfaction.

In conclusion, the results of previous studies have suggested that suction-curettage techniques for AO
are much safer than conventional open surgery, but are inferior regarding recurrence rate. This study
found that SACS closed curettage was as safe as other suction-curettage techniques, and as effective as
conventional open surgery. In addition, the periods of discomfort due to dressings and limited range
of motion in patients undergoing SACS closed curettage were half as long compared to those periods