Tumescent Anesthesia Technique And Preservation Of Axilla Superficial Fascia In Surgical Ablation Of Axillary Bromhidrosis

Objective:Comparision of conventional local infiltration anaesthesia in surgical ablation of axillary bromhidrosis with tumescent anaesthesia technique and preservation of axilla superficial fascia in surgical ablation of axillary bromhidrosis.To explore a treatment method of bromhidrosis with a shorter operation time,small trauma,fewer complications,slower recurrence,safe and effective through comparing the two methods.Methods:1.21 axillary bromhidrosis patients,including 7 males and 14 females,undergoing the inpatient surgical ablation of axillary bromhidrosis with tumescent anaesthesia technique and preservation of axilla superficial fascia from October 2015 to October 2016 were treated as treatment group.25 axillary bromhidrosis patients,including 9 males and 16 females,undergoing the inpatient surgical ablation of axillary bromhidrosis with topical infiltration anaesthesia from September 2014 to September 2015 were recruited as control group.2.Removed tissue,skin samples before and skin samples after ablation were sent for histologic examination by Hemantoxylin-Eosin staining.3.All patients were followed for at least 6 months.The operation time,bleeding volume during operation,the degree of preoperative and postoperative axillary odor,the satisfaction rate of patients and the incidence of complications were observed and statistically analyzed.Results:1.Compared with 25 patients(50 axllae)operated in the control group,21 patients(42 axllae)in the treatment group needed a shorter operation time(treatment group:81.048±3.427 min,control group:99.400±8.907 min)and their surgical bleeding volume(treatment group:11.214±1.102 ml,control group:41.100±1.109ml)was less.2.Two groups of patients after operation reduced the malodor compared with preoperation(treatment group:Z=-5.962,p=0.000<0.05,control group : Z=-5.541,p=0.000<0.05).And there was significant difference between the two groups after 6 months(Z=-2.939,p=0.003<0.05),the patients in the treatment group was better than those in the control group.3.Through The Dermatology Quality Life Index(DLQI)assessment,we indicated that the influence of axillary bromhidrosis on life quality of two groups of patients were significantly reduced(treatment group:Z=-5.935,p=0.000<0.05,control group:Z=-5.070,p=0.000<0.05),but there were more obvious improvement for the treatment group(Z=-2.735,p=0.006<0.05).4.The postoperative complications in the treatment group were lower than those in the control group(χ2=5.498,p=0.019<O.05).5.The study of histopathology observation of preoperative skin biopsy showed that a large number of sweat glands can be seen in the fat tissues of dermis reticular layer and axillary shallow superficial fascia.Compared with preoperation,no sweat gland tissue retention.The skin specimen after surgical ablation included sweat glands,hair follicles and adipose tissues.Conclusion:Tumescent anaesthesia technique and preservation of axilla superficial fascia used in surgical ablation of axillary bromhidrosis was helpful to identify the skin appendix tissue easily,which could not only effectively remove axillary apocrine gland tissue,but also reduce intraoperative hemorrhage,shorten operation time,improve life quality of bromhidrosis patients and reduce postoperative complications.It is safe and effective.