Laser Doppler Scanning Study of Axillary Skin before and after Liposuction Curettage in Patients with Focal Hyperhidrosis

Abstract

Background:Minimally invasive surgeries are frequently used in patients suffering from focal axillary hyperhidrosis (FAH). Sweat glands are removed surgically and the axillary skin is thinned out, with skin necrosis being a possible complication due to reduced microcirculation. Although of considerable interest, studies evaluating pre- and postoperative skin perfusion are unavailable. Objective: To evaluate the blood flow of axillary skin in patients with severe focal axillary hyperhidrosis before and after liposuction curettage (LC). Material and Methods: The blood flow in the axillary skin of 11 patients was measured by laser Doppler perfusion imaging before surgery and on days 1, 7 and 28 after LC with a rasping cannula. Skin perfusion was measured in arbitrary units (AU) with measuring points in the axillary center (AC), the operated skin 2 cm from the center (2C) and the surrounding healthy skin (HS). Results: No significant differences of preoperative skin perfusion were found (AC: 0.39 ± 0.08 AU/2C: 0.38 ± 0.07 AU/HS: 0.39 ± 0.07 AU; p > 0.05). On the first and seventh postoperative days, AC (0.2 ± 0.04 AU/0.27 ± 0.81 AU) and 2C (0.2 ± 0.03 AU/0.28 ± 0.06 AU) area were significantly less perfused, whereas the HS showed higher perfusion values (0.59 ± 0.1 AU/0.53 ± 0.09 AU). Twenty-eight days after LC the 2C (0.36 ± 0.07 AU) and HS (0.4 ± 0.06 AU) skin revealed no significant differences compared to preoperative skin perfusion (p > 0.05). The AC perfusion was still slightly reduced (0.37 ± 0.09 AU) without significant difference compared to preoperative findings. Conclusion: LC reduces the axillary skin blood flow with the axillary center being the least perfused area. However, in our collective, no correlation to possible side effects was observed.

Surgical treatment of axillary hyperhidrosis by suction-curettage of sweat glands

“…The procedure consists of two main parts: dissection of the dermis of the underlying subcutaneous cellular tissue, followed by the removal of the sweat glands of the deep dermis and dermis/ hypodermis junction. 70 …”

“…This area would have its blood supply from the surrounding skin, which has not been submitted to the procedure. 70 …”

“…Bechara et al (2008) 70 conducted a study in which they assessed the axillary blood flow of 11 patients undergoing liposuction-curettage. Patients were assessed prior to surgery and on days 1, 7 and 28 after surgery.…”

Long-Term Use of Antiperspirant is Associated with a Low Risk of Postoperative Complications in Patients with Axillary Osmidrosis

“… 19 , 20 Surgical treatment reduces microcirculation of axillary skin, resulting in the occurrence of postoperative complication (eg, skin necrosis). 22 , 23 In addition, a previous study analyzed AO patients 2 years after treatment with a mini-incision and subdermal vascular preservation, and found a low incidence of postoperative complications including hematomas, epidermal erosions, infections, necrosis, incision dehiscence, and skin ripples. 33 Based on these findings, we can assume that the antiperspirants when applied for a long period of time will cause a subclinical contact reaction resulting in local microvascular proliferation, which then may improve the skin microcirculation.…”

“…[19][20][21] Surgical treatment reduces microcirculation of axillary skin, resulting in the occurrence of postoperative complication (eg, skin necrosis). 22,23 Thus, we hypothesize that AO patients applied antiperspirants may reduce the postoperative complication due to the above effects. The purpose of this study is to investigate if the long-term use of antiperspirants has an effect on postoperative complications after osmidrosis surgery.…”