Effectiveness and complications of subdermal excision of apocrine glands in 206 cases with axillary osmidrosis.

Patients with osmidrosis are particularly concerned with malodour elimination after surgery. Open excision of the subcutaneous apocrine glands through a small incision seems to be the most logical and effective method available for osmidrosis. However, literature on long-term results and complications after such surgery based on large case series are rare. From January 2005 to May 2008, 256 consecutive patients with axillary osmidrosis were treated with our subcutaneous glands excision technique, of which 206 could be followed up from 3 to 40 (mean 18.1) months. Patients ranged in age from 14 to 52 (mean 23.4) years and the female to male ratio was 131:75. Among the 206 cases, 183 cases had family histories of the disease and 16 were accompanied with axillary hyperhidrosis. Postoperatively, as high as 97% of the patients achieved good results in terms of malodour elimination during the follow-up period. All patients reported reduction in axillary sweating; among them 16 patients complicated with axillary hyperhidrosis reported a significant reduction. Axillary hair growth was much reduced in most (95%) patients, and four female patients complicated with axillary hirsutism were extremely satisfied with axillary hair reduction. Early postoperative complications included haematoma (0.7%), seroma (1.2%), folding of skin flap (0.7%), pressure blister (3.6%), contact dermatitis (1%), superficial epidermis necrosis (37%), small granuloma (0.5%), wound infection (0.7%) and wound dehiscence (5.1%). Late complications included comedones (1.2%), milia (0.5%), sebaceous cyst (or with abscess) (0.7%), hypertrophic scar (1%), temporary skin pigmentation (0.5%), temporary mild lactation (0.5%) and temporary sweating outside the axillae (1%). In general, 196 patients (95%) were totally satisfied with the procedure and nine (4.4%) patients partially satisfied, with only one (0.5%) regretful. The procedure has a very high success rate with minor complications. It should become the preferred procedure for the surgical treatment of axillary osmidrosis.