Impact of Apocrine Gland Residue on Bromhidrosis Clinical Efficacy: A Self-controlled Case Series Study

Abstract

Background: Apocrine sweat gland excision is a successful surgical treatment for bromhidrosis used in clinical practice due to its efficacy and unobtrusive postoperative scar. However, a small quantity of apocrine sweat gland residue is an unavoidable intraoperative concern to minimize losses of the dermal vascular network induced by extensive excision of the apocrine sweat glands. However, the relationship between the degree of remaining glands and clinical efficacy is yet unknown. This study looked at the histopathology of preexcision and postexcision specimens from bromhidrosis patients to see a connection between residual apocrine sweat glands and clinical efficacy following apocrine sweat gland excision. Methods: Twenty-one patients with bromhidrosis were recruited from April 2018 to December 2020. In this study, a description self-controlled case series was applied, with the patient preoperative sample as the control. The entire axillary skin was excised before and immediately after apocrine sweat gland excision, and skin tissue hemotoxylin-and-eosin staining was conducted to assess and compare the remnant apocrine sweat glands. Furthermore, preoperative and 6-month postoperative NRS-11 odor scores were analyzed, as well as patient satisfaction after surgery. Results: All patients had variable degrees of apocrine sweat gland excision residue, but they all passed clinical cure criteria and presented a high patient satisfaction rate. Conclusions: Apocrine sweat gland excision with a small quantity of apocrine sweat gland remnant can nevertheless result in a favorable clinical outcome and high patient satisfaction of bromhidrosis.

Effect of optimizing the use of endoscope on the efficiency of microdynamic bromhidrosis removal operation

“…Previous studies in our department have also proved this point 12 . We believe that the subcutaneous tissue with a thickness of 4–5 mm under the reticular layer of the dermis, including apocrine sweat glands, should be removed to avoid the recurrence risk caused by insufficient clearance depth in moderate and severe patients 13 …”

“…12 We believe that the subcutaneous tissue with a thickness of 4-5 mm under the reticular layer of the dermis, including apocrine sweat glands, should be removed to avoid the recurrence risk caused by insufficient clearance depth in moderate and severe patients. 13 The traditional fusiform skin resection method has a large surgical wound, and too much local tissue removal often leads to incision dehiscence or poor healing, and it will leave a large scar in the patient's armpit, which may also affect the normal activities of the prone to complications such as subcutaneous hematoma, flap ulcer, ischemia, necrosis, and so on. The incision is not hidden enough and hypertrophic scar can be produced, which affects the postoperative beauty.…”

Reply to “Impact of Apocrine Gland Residue on Bromhidrosis Clinical Efficacy: A Self-controlled Case Series Study”

“…T hank you to the author for his contribution to this article. 1 At the same time, I would like to take this opportunity to give some feedback on some issues. In my clinical experience on postsurgical observation, there are a number of points that are worth exploring: first is the detectable smell, most likely due to the residue of the apocrine gland, and second is the necrosis of the dermis.…”