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Surgical Treatment of Axillary Osmidrosis: A Modified Procedure for Fewer Complications

腋下狐臭之外科治療:較少副作用之改良手術

摘要


亞洲人的腋下狐臭,特別在地處濕熱亞熱帶及熱帶之東南亞,是一常見且令人困擾沮喪的問題。和西方人不同的是,問題的癥節在於異味而非多汗。有多項手術方法曾被提出以解決狐臭,而在本文中將介紹一新的改良手術用以減少術後之後遺症。首先位於腋毛分佈菱形區之三等分線切開兩道橫向平行切口,再將腋下皮膚以鈍器剝離開筋膜層之上,先隔離腺體之血流,並以剪刀小心地剪除頂漿腺,同時應謹慎保留真皮層下血管網路。仔細切除腺體後,在每片剝離皮瓣上劃開一至二道小引流口,及二至三固定縫合線,以達較佳引流及固定效果,如此不需長期的皮瓣固定,且能隨時察看傷口。在保留真皮層下血管網路與較佳引流和固定之情況下,七十二位於一九九四年五月至一九九六年二月接受此改良手術之患者中,從未有皮瓣邊緣壞死或血腫之情況發生,只有七例邊緣輕微脫皮現象。癒合傷口除有五例疤痕肥厚形成外,其餘沒有美觀上的問題。此改良手術具有三大特點:保存皮瓣之循環以減少皮膚之壞死,較佳引流和固定剝離之皮瓣以減少血腫形成,以及病人不必牢固之腋下固定而能有自由之活動。

關鍵字

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並列摘要


Axillary malodor (osmidrosis) of Asian people, especially in the warm, humid subtropical and tropical south eastern Asia, is a common, troublesome and frustrating problem. Various surgical procedures have been reported to manage the osmidrosis. In this article, a modified Skoog procedure with fewer complications is presented for the osmidrosis management. Two transverse parallel incisions were made in the first and last thirds of the elliptical area of axillary hairs. Then, undermined the axillary skin above fascia with blunt method and divided the blood supply to the glands. The bleeding during this procedure was minimal. By using scissors, the apocrine glands were meticulous excised but carefully to preserve the subdermal vascular plexus under direct vision. Then one or two small incisions for drainage and two or three anchoring sutures for fixation were made on each elevated flap. The effective fixation allowed the immediate of dressing change and observation of the wound postoperatively. The limitation of daily activities was also minimal. With preservation of the subdermal vascular plexus, good drainage and fixation, no skin flap necrosis or hematoma formation were seen in 72 patients (16 males and 56 females; operated from May 1994 to February 1996). The aesthetic results of axillary fossa were good except five cases of mild hypertrophic scars. In conclusion, the advantages of this modified operative procedure include: a better preservation of the flap circulations with less skin edge necrosis, good drainage and fixation of the axillary flaps, less hematoma formation and the patients can be free from a tight, rigid fixation of the axillary wounds.

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