Postoperative situation after axillary suction-curettage: An endoscopical view

Abstract

In the March, 2005, issue of the British Journal of Plastic Surgery Lee et al. give an in-depth view on the treatment of axillary osmidrosis with suction-assisted cartilage shaver. Another minimal-invasive technique is the axillary suction-curettage, which has been established as a safe and effective surgical treatment for focal axillary hyperhidrosis and osmidrosis. It has virtually replaced the en-bloc resection of the axillary skin with its adjacent sweat glands and subcutaneous fat as a surgical approach towards severe cases refractive to conservative therapy. 2 Tung T.C. Wei F.C. Excision of subcutaneous tissue for the treatment of axillary osmidrosis. Br J Plast Surg. 1997; 50: 61-66 Google Scholar , 5 Yoshikata R. Yanai A. Takei T. Shiomone H. Surgical treatment of axillary osmidrosis. Br J Plast Surg. 1990; 43: 483-485 Google Scholar , 7 Hafner J. Beer G.M. Axillary sweat gland excision. Curr Probl Dermatol. 2002; 30: 57-63 Google Scholar , 8 Tögel B. Greve B. Raulin C. Current therapeutic strategies for hyperhidrosis: a review. Eur J Dermatol. 2002; 12: 219-223 Google Scholar Besides the suction-curettage, a variety of different methods such as simple curettage, the use of gynaecologic curettes or the cartilage-shaver have been described in the past. 1 Lee J.C. Kuo H.W. Chen C.H. Juan W.H. Hong H.S. Yang C.H. Treatment for axillary osmidrosis with suction-assisted cartilage shaver. Br J Plast Surg. 2005; 58: 223-227 Google Scholar Patients benefit from a minimally invasive procedure which can be performed with tumescence anaesthesia in an outpatient setting, 4 Ou L.F. Yan R.S. Chen I.C. Tang Y.W. Treatment of axillary bromhidrosis with superficial liposuction. Plast Reconstr Surg. 1998; 102: 1479-1485 Google Scholar , 6 Groscurth P. Anatomy of sweat glands. Curr Probl Dermatol. 2002; 30: 1-9 Google Scholar and which has a low complication rate. The therapeutic principle is to suction eccrine and apocrine sweat glands of the dermis after prior curettage with a sharp canula. 3 Lillis P.J. Coleman 3rd, W.P. Liposuction for treatment of axillary hyperhidrosis. Dermatol Clin. 1990; 8: 479-482 Google Scholar Successful curettage requires complete detachment of subcutaneous tissue and the dermis. A clinical intraoperative inspection of sufficient curettage is done by elevating axillary skin from the remaining subcutaneous tissue. To detect remaining tissue strands, a canula can be moved in a semi-circular fashion between the dermis and subcutaneous tissue. Assessment of the immediate operative result is limited to mechanical inspection because the situs is not accessible to visual control. No in-vivo pictures of the postoperative situs have been published up to date. In order to obtain an overview of post-operative anatomy we performed an endoscopy in a patient immediately after axillary suction-curettage to verify the detachment of the dermis and the remaining subcutaneous tissue. Fig. 1 and Fig. 2 show the operative site, seen through the endoscopy. An almost bloodless operating field is seen, due to the vasoconstriction caused by the tumescence anaesthesia. Most of the situs shows a clear dissection between the dermis and the subcutaneous tissue. Some bright lucent areas of the dermis, which are sporadically lying on the subcutaneous fatty tissue, are more evident (Fig. 1). Most likely, these areas reflect an insufficient curettage of the skin or a dissection in a wrong plane. The border areas show some remaining connective tissue strands between the dermis and the subcutaneous tissue. In these areas a lack off sufficient detachment of the tissue planes can be observed. In some areas the papillary plexus of the dermis is readily visible (Fig. 2).