Abstract：
OBJECTIVE: Subcutaneous seroma formation (SF) is commonly seen after axillary bromhidrosis surgeries and its treatment can be challenging and long. Current prevention methods are not consistent, and the treatment includes repeated aspirations and drains, both are associated with higher risk for infections. The purpose of this article is to present a novel and simple technique of intraoperative hypertonic saline irrigation (IHSI) to axillary bromhidrosis subcutaneous dead space, which prevents postoperative SF and enables early drain removal due to reduced secretions.
METHODS: From 2015 to 2022, we performed the intraoperative irrigation of the cavity through normal saline in 100 patients with primary axillary bromhidrosis. Through an incision approximately 3 cm long at the central axillary crease, the entire subcutaneous tissues containing apocrine glands were initially dissected with straight scissors within the axillary area, and then, the undermined apocrine glands were removed with curved scissors. The skin was defatted to become a full-thickness skin flap. Any suspected hemorrhagic spots were immediately coagulated electrosurgically. Negative pressure drains were placed, and intraoperative irrigation of the cavity through the drains with 20 ml of NaCl 0.9% or NaCl 10% left at site for 10 min applies different saline solutions in the same patients.
RESULTS: The volume of drainage on the 1st postoperative day was 6.54±0.36 mL for the group B, which was significantly less than 15.23±0.42 mL for the group A (p < 0.05). The time of drain removal for the group B was 24 h, which was shorter than 48 h for the group A. In group B, 4 percent of axillae showed significant SF postoperatively, which was lower than the 20 percent of axillae associated with the group A (p < 0.05). The rate of incision infection for the group B was 2 percent, which was significantly lower than the 6 percent of axillae in the group A (p < 0.05). Two percent of axillae showed skin edge necrosis postoperatively in the group B, which was lower than the 10 percent of axillae associated with the group A (p < 0.05).
CONCLUSIONS: IHSI enhances adhesion formation and reduces secretion rate in subcutaneous dissection space after axillary bromhidrosis surgeries, therefore enables early drain removal and prevents SF, incision infection and skin edge necrosis. As a result, reducing the pain of patients, decreasing inconveniency and cost saving of multiple outpatient visits or additional surgery.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
METHODS: From 2015 to 2022, we performed the intraoperative irrigation of the cavity through normal saline in 100 patients with primary axillary bromhidrosis. Through an incision approximately 3 cm long at the central axillary crease, the entire subcutaneous tissues containing apocrine glands were initially dissected with straight scissors within the axillary area, and then, the undermined apocrine glands were removed with curved scissors. The skin was defatted to become a full-thickness skin flap. Any suspected hemorrhagic spots were immediately coagulated electrosurgically. Negative pressure drains were placed, and intraoperative irrigation of the cavity through the drains with 20 ml of NaCl 0.9% or NaCl 10% left at site for 10 min applies different saline solutions in the same patients.
RESULTS: The volume of drainage on the 1st postoperative day was 6.54±0.36 mL for the group B, which was significantly less than 15.23±0.42 mL for the group A (p < 0.05). The time of drain removal for the group B was 24 h, which was shorter than 48 h for the group A. In group B, 4 percent of axillae showed significant SF postoperatively, which was lower than the 20 percent of axillae associated with the group A (p < 0.05). The rate of incision infection for the group B was 2 percent, which was significantly lower than the 6 percent of axillae in the group A (p < 0.05). Two percent of axillae showed skin edge necrosis postoperatively in the group B, which was lower than the 10 percent of axillae associated with the group A (p < 0.05).
CONCLUSIONS: IHSI enhances adhesion formation and reduces secretion rate in subcutaneous dissection space after axillary bromhidrosis surgeries, therefore enables early drain removal and prevents SF, incision infection and skin edge necrosis. As a result, reducing the pain of patients, decreasing inconveniency and cost saving of multiple outpatient visits or additional surgery.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
摘要：
目的：皮下血清肿形成（SF）常见于腋臭手术后，其治疗可能具有挑战性和长期性。目前的预防方法并不一致,治疗包括反复的抽吸和排水，两者都与较高的感染风险相关.本文的目的是提出一种新颖而简单的术中高渗盐水冲洗（IHSI）技术，以腋窝腋臭皮下死腔，这可以防止术后SF，并由于分泌物减少而实现早期引流。
方法：从2015年到2022年，我们对100例原发性腋臭患者通过生理盐水进行了腔内冲洗。通过中央腋窝折痕处大约3厘米长的切口，包含大汗腺的整个皮下组织最初在腋窝区域内用直剪刀解剖，然后,用弯曲的剪刀去除受损的大汗腺。将皮肤脱脂以变成全厚度皮瓣。任何可疑的出血点立即电手术凝固。放置负压排水管，术中通过引流管冲洗腔，在同一患者中使用20mlNaCl0.9％或10％NaCl放置10分钟。
结果：B组术后第1天的引流量为6.54±0.36mL，明显低于A组的15.23±0.42mL(p<0.05)。B组引流时间为24h,A组短于48h。B组，4%的腋窝术后表现出显著的SF，低于与A组相关的20%的腋窝(p<0.05)。B组切口感染率为2%,明显低于A组腋窝的6%(p<0.05)。B组术后有2%的腋窝表现为皮肤边缘坏死，低于与A组相关的10%的腋窝(p<0.05)。
结论：IHSI可增强腋臭腋臭手术后皮下夹层空间的粘连形成并降低分泌率，因此，可以早期去除排水口并防止SF，切口感染和皮肤边缘坏死。因此,减轻患者的痛苦，减少多次门诊就诊或额外手术的不便和成本节约。
方法：本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述，请参阅目录或在线作者说明www。springer.com/00266.
方法：从2015年到2022年，我们对100例原发性腋臭患者通过生理盐水进行了腔内冲洗。通过中央腋窝折痕处大约3厘米长的切口，包含大汗腺的整个皮下组织最初在腋窝区域内用直剪刀解剖，然后,用弯曲的剪刀去除受损的大汗腺。将皮肤脱脂以变成全厚度皮瓣。任何可疑的出血点立即电手术凝固。放置负压排水管，术中通过引流管冲洗腔，在同一患者中使用20mlNaCl0.9％或10％NaCl放置10分钟。
结果：B组术后第1天的引流量为6.54±0.36mL，明显低于A组的15.23±0.42mL(p<0.05)。B组引流时间为24h,A组短于48h。B组，4%的腋窝术后表现出显著的SF，低于与A组相关的20%的腋窝(p<0.05)。B组切口感染率为2%,明显低于A组腋窝的6%(p<0.05)。B组术后有2%的腋窝表现为皮肤边缘坏死，低于与A组相关的10%的腋窝(p<0.05)。
结论：IHSI可增强腋臭腋臭手术后皮下夹层空间的粘连形成并降低分泌率，因此，可以早期去除排水口并防止SF，切口感染和皮肤边缘坏死。因此,减轻患者的痛苦，减少多次门诊就诊或额外手术的不便和成本节约。
方法：本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述，请参阅目录或在线作者说明www。springer.com/00266.
