Background The optimal treatment for hypertrophic scar and keloid remains controversial. Therefore, the aim of this systematic review and meta-analysis was to compare the effectiveness of intralesional injection of botulinum toxin type A compared with placebo and intralesional injection of corticosteroid compared with placebo in patients with hypertrophic scar and keloid. Material/Methods Six databases were searched using Medical Subject Headings (MeSH) keywords and included Web of Science, PubMed, EMBASE, the Cochrane Library, WanFang, and CNKI from their inception to March 1 2019, without language restriction. Randomized controlled trials (RCTs) and prospective controlled trials (PCTs) were identified that compared intralesional injection of botulinum toxin type A with placebo and corticosteroid with placebo in hypertrophic scar and keloid. The quality of controlled trials was assessed by the Newcastle-Ottawa Scale (NOS). Results Comparison of intralesional botulinum toxin type A and corticosteroid showed significant differences in the Visual Analog Scale (VAS) (P<0.001) (WMD, −4.30; 95% CI, −4.44 to −4.16) and effective rate (P=0.012) (RR=0.82; 95% CI, 0.70–0.96). Intralesional injection of botulinum toxin type A compared with placebo showed significant differences in the VAS (P<0.001) (WMD, 1.41; 95% CI, 1.21–1.62), the width of scar (P=0.00) (WMD, −0.15; 95% CI, −0.19 to −0.10) and Vancouver Scar Scale (VSS) (P=0.003) (WMD, −0.69; 95% CI, −1.14 to −0.23). Conclusions Systematic review and meta-analysis showed that injection of intralesional botulinum toxin type A was more effective in the treatment of hypertrophic scar and keloid than injection of intralesional corticosteroid or placebo.

It is common to treat bromhidrosis by surgery, but postoperative complications such as subcutaneous exudate and subcutaneous hematoma can occur and lead to delayed healing of the wound and eventually lead to the formation of unattractive scars. In this study, we evaluated our new surgical treatment for bromhidrosis, which we believe improves prognosis over conventional surgery. The new procedure was performed on 22 patients with bromhidrosis. Our procedure is as follows. One centimeter-long incisions are made along the skin and cleaning of the subcutaneous apocrine glands using a special serrated scraping device is completed. Then, several 0.5 cm-long drainage holes are made according to the design of the Sudoku puzzle and 4 anchoring points identified to stabilize the oil gauze. Finally, the incisions were sutured and the wound covered with a bandage. Of 44 axillas, the bromhidrosis of 42 axillas was completely cured, and greatly reduced in 2 axillas. Local epidermal necrosis occurred in 5 axillas, but there was no full-thickness skin necrosis. Subcutaneous hematoma was not observed, and postoperative scarring was minimal. We found that our modified surgery can effectively reduce the occurrence of subcutaneous hematoma, avoid delayed healing of the wound, and minimize postoperative scarring. Level II, therapeutic study.

Background: There is a continued discussion on which is the best sclerosant to treat lower extremity varicose veins. Therefore, we did this meta-analysis to determine that foam sclerotherapy versus liquid sclerotherapy, which could perform better in the treatment of lower extremity varicose veins. Materials and methods: We independently searched 5 databases from inception to February 1, 2019, for randomized controlled trials and prospective controlled trials for comparing foam sclerotherapy and liquid sclerotherapy for the treatment of lower extremity varicose veins. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies. The primary outcome and secondary outcomes were analyzed using stata 15.0. This meta-analysis was performed according to Cochrane Handbook. Results: There were significant differences in effective rate (P < .001, odd ratios = 5.64, 95% confidence interval = 3.93–8.10) and incidence rate of pain (P = .030, odd ratios = 1.52, 95% confidence interval = 1.04–2.21) between foam sclerotherapy and liquid sclerotherapy. And there were no significant differences among local inflammation (P = .896, rate difference = 0.00, 95% confidence interval = –0.03 to 0.03), thrombophlebitis (P = .90, rate difference = 0.00, 95% confidence interval = −0.02 to 0.02) and hyperpigmentation (P = .336, rate difference = 0.05, 95% confidence interval = −0.05 to 0.14). Conclusions: Although foam sclerotherapy has a higher incidence rate of complications, it could achieve a more stable clinical efficacy in the treatment of lower extremity varicose veins than liquid sclerotherapy.

Rationale: Accessory breast cancer is extremely rare among all cancerous diseases, especially in male patients. There were only few male axillary accessory breast cancer cases that have been reported in scientific literatures so far. Hereby, we would like to discuss a case of male axillary accessory breast cancer found in our hospital. Patient concerns: We report a male senile patient suffering from a painful, enlarged, and hardened right axillary mass for more than 20 years. He came for further treatments due to progressive growth of the mass for 11 months with bloody ulceration for more than 1 month. Diagnosis: Pathological examination manifested a grade II infiltrating ductal carcinoma derived from the accessory mammary gland (right axilla), with invasion of local skin. Immunohistochemical examination result: estrogen receptor (++) 90%, progesterone receptor (+++) 100%, human epidermal growth factor receptor-2 (1+), ki67 (20% positive), prostate specific antigen (−), caudal-related homeobox-2 (−), thyroid transcription factor-1 (−), Synaptophysin (+), NapsinA (1), and CK7 (−). Interventions: Modified radical mastectomy and axillary lymph nodes clearance were performed on the accessary breast cancer under general anesthesia. Postoperatively, endocrine therapy was provided for the patient, orally-taken Letrozole was recommended for the rest of the patient's life. Outcomes: The patient recovered uneventfully and was discharged 3 days after the operation. The patient continued to take Letrozole orally regularly at home and no signs of recurrence were observed. Conclusion: Axillary accessory breast cancer in males is extremely rare, with no conspicuous and typical clinical presentations, which leads to inevitable neglect by clinicians. Therefore, there is significant necessity for clinicians to be cautious with this type of disease.

Background Axillary osmidrosis (AO) is common in plastic surgery. But there is no perfect way to treat AO. We systematically compared the efficacy of 10 AO treatments with network meta-analysis in order to provide reference for the clinical treatment of axillary odor. Material/Methods Chinese and English databases were searched by computer. Some relevant studies were collected for network meta-analysis. Results We identified 56 studies, including a total of 8618 patients for meta-analysis. The network meta-analysis showed that 21 out of 45 pairs of 10 AO treatments had no statistical significance. In statistical comparison, subcutaneous curettage and swelling suction subcutaneous pruning were better than a single treatment. In addition, the effects of both laser and electric ion therapy were inferior to those of other treatments. The order of therapeutic effects predicted by surface under the cumulative ranking (SUCRA), curve was swelling aspiration+subcutaneous pruning >subcutaneous pruning >subcutaneous curettage+subcutaneous pruning >spindle excision >botulinum toxin A injection >swelling aspiration >subcutaneous curettage >YAG laser therapy >CO 2 laser therapy >electric ion therapy. Conclusions In operative treatment of AO, swelling aspiration+subcutaneous pruning is the best operative treatment, and botulinum toxin A injection is the best in non-operative treatment. Overall, the effect of surgical treatment was more significant than that of non-surgical treatment.

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