Comparative Analysis of Tumescent Liposuction according to the Dermal Curettage Level for the Treatment for Axillary Osmidrosis

Lee, Sook Kyung; Seo, Jong Won; Sung, Kee Han; Seo, Jong Keun

Abstract

BACKGROUND
The efficacy of tumescent liposuction in the treatment of axillary osmidrosis has been widely established. But there have been few studies that have conducted a comparative analysis according to the level of dermal curettage with respect to the efficacy and safety. OBJECTIVE: The aim of this study was to evaluate the clinical efficacy and complications of tumescent liposuction according to the degree of dermal curettage.
METHODS
From September 2004 through August 2009, a total of 33 patients with axillary osmidrosis (66 axillae) were included in this study. Twelve patients (24 axillae) were treated by tumescent liposuction with dermal curettage at the level of the mid-dermis (the classical technique group), and the other 21 patients (42 axillae) were treated by tumescent liposuction with dermal curettage at the level of the dermo-subcutis junction (the modified technique group). The preoperative and postoperative disease severity was measured as 0, 1, 2 and 3. The improvement of symptoms was graded by the patient as excellent, good, fair and poor. We also evaluated the postoperative complications, including skin necrosis, scar, hematoma, sensory disturbance and infection. Biopsies of the axillary skin were performed in 7 patients to confirm the level of dermal curettage and the reduction of apocrine glands after treatment.
RESULTS
The follow-up ranged from 6 to 60 months. Six months after treatment, 95.8% (23/24) of the axillae in the classical technique group and 95.2% (40/42) of the axillae in the modified technique group had reduced disease severity below 1. Among the 12 patients treated with the classical technique, 11 (91.7%) had excellent to good results, while 95.2% (20/21) of the patients treated with the modified technique had excellent to good results by the patients' own grading. The complications included skin necrosis, scar and hematoma. In the classical technique group and the modified technique group, the incidence of skin necrosis was 12.5% (3/24) and 2.4% (1/42), respectively, the incidence of scar formation was 4.2% (1/24) and 0%, respectively, and the incidence of hematoma was 8.3% (2/24) and 0%, respectively. The postoperative histologic examinations confirmed that the dermal curettage level was at the mid-dermis in the classical technique and at the dermo-subcutis junction in the modified technique. Interestingly, the histologic examination from the classical technique group revealed vacuolar alteration of keratinocytes and partial separation of the dermo-epidermal junction.
CONCLUSION
The efficacy of the modified technique is compatible with that of the classical technique, but the modified technique offers fewer complications. So, the modified technique may improve the cosmetic outcome without reducing the treatment efficacy for the patient with axillary osmidrosis.