Surgical subcision as a cost-effective and minimally invasive treatment for axillary osmidrosis.

BACKGROUND: Axillary osmidrosis, characterized by unpleasant odor and occasional staining of clothing, is a personal discomfort and social impairment for people who suffer from it. Various types of surgical procedures involving instrumented-assisted tools (lasers, ultrasonic, endoscope, and others) have shown relatively positive results; however, for patients in developing countries, especially in China, these treatments are inconvenient and cost-ineffective. OBJECTIVE: To introduce a minimal incision surgical procedure with skin flap treatment that removes the apocrine sweat glands in the subcutaneous tissue through a 1-cm-long incision without instrument-assisted tools. METHOD: From July 2005 to October of 2007, 108 patients (68 women and 40 men) were treated with the minimal incision and cost-effective surgical treatment by manual excision. A 1-cm-long incision is made in the axillary crease. Subcutaneous tissue and glands were removed with scissors through this incision. This procedure is repeated throughout the entire axilla until the axilla has essentially become a super-thin flap. RESULT: Malodor elimination was good in 206 out of 215 axillae (95.8%) treated, fair in nine (4.2%), and poor in zero (0%). The resulting scar is small and virtually invisible because it is only 1-cm long and located in the axillary crease. CONCLUSION: Treatment of axillary osmidrosis by manual excision through a 1-cm incision is a convenient, efficient, cost-effective, and relatively safe technique that results in high patient satisfaction and benefits patients and surgeons in developing countries. Axillary osmidrosis, a non-life-threatening condition characterized by unpleasant odor and occasional staining of clothing, is an annoying problem, particularly in Asian societies. For many people who suffer from this problem, this condition is a personal discomfort, a social impairment, and discourages patients from enjoying social or personal activities, especially young women. They are usually embarrassed by the smell during their daily activities and communication with other people.

[Treatment of scar contracture abnormality on the neck of the children with huge trapezius muscle flap expanded].

OBJECTIVE: To seek a kind of safe and effective method to treat scar contracture abnormality on the neck of the children. METHODS: We take the trunk line of transverse cervical artery as the vessel pedicle, and shift huge trapezius muscle flap expanded to the neck in order to treat scar contracture abnormality on the neck of the children. RESULTS: Clinically, we applied this method to treat ten children who suffered from contracture abnormality on the neck, and not only provide enough skin soft tissue (the length may be beyond the midline) to treat the abnormality, but also make the flap alive, obtain the satisfying postoperative effect. CONCLUSIONS: Based on the warranty of the flap blood supply, this flap is very suitable to treat scar contracture abnormality on the neck of the children.

[Rejuvenation of the forehead/temple by limited incision].

OBJECTIVE: To utilize multiplane, subcutaneous and subperiosteal, dissection through small incisions in scalp to rejuvenate aging signs of forehead/temple. METHODS: Forehead: We make four small incisions in scalp, widely separate tissues between subperiosteum skin and frontal muscle to form galea frontal muscle-periosteum flap, the flap is tightened and sutured with the galea at the posterior border of the incision. This method avoid to excise scalp. Temple: there are two small incisions in the scalp of temple at each side. Superficial temple fascia and orbicularis oculi muscle as well is dissected from deep temporal fascia and skin respectively, then tightened and sutured with the superficial part of deep temporal fascia, excising scalp is not necessary. RESULTS: Twenty patients have received this treatment, the effects are satisfying. CONCLUSIONS: Multiplane dissection through small incisions can remove wrinkles of skin, correct the prolapse of eyebrow and avoid the complications of coronary incision. This approach brings more rapid recovery of patients, it is safe and affective.

[The applications of the repetitive sub-platysmal expansion in repair the defects of skin and soft tissue in face and neck].

OBJECTIVE: To study a new effective approach which repairs large defects of skin and soft tissue in neck and face. METHOD: This procedure accomplishes repetitive sub-platysmal expansion to form large musculocutaneous flap with underlying pedicel. The surgeon slides it toward neck and face to repair the defects of skin and soft tissue. RESULT: Eleven patients, who had such defects in neck, face, cheek, chin or submental skin and soft tissue, underwent this treatment. All the flaps survive with no complications of blood supply deficiency or necrosis. The short-term and long-term results are both satisfying. CONCLUSION: This method, making repetitive sub-platysmal expansion to form musculocutaneous flap and then slide it toward neck/face to repair large defects of skin and soft tissue, proves to be safe and reliable. And appropriate cases and strict operations are important.

[Studies on factors affecting velopharyngeal functions of cleft palate patients].

OBJECTIVE: To investigate the relationship between velopharyngeal functions and factors such as age at operation, cleft type, performing procedure. METHODS: FFT technique and velopharyngeal X-ray examination were used to evaluate the velopharyngeal functions of 82 patients. The relatively important factors affecting velopharyngeal functions were searched out through regression analyse and pearson correlation. RESULTS: A significant positive correlation was confirmed between AAO(age at operation) and A1/A2(velopharyngeal incompetence), P < 0.001. AAO also showed linear regression with A1/A2. Model was significant, P < 0.001. Quotation: A1/A2(velopharyngeal incompetence) = 0.005 852 x AAO + 0.961. CONCLUSION: AAO was an important affecting factor on velopharyngeal functions. The earlier the cleft is repaired, the more normal velopharyngeal functions will be obtained.

[Experimental study on microvascular architecture of human and rabbit flaps with two methods].

OBJECTIVE: To study effective method of showing the microvascular architecture of human and rabbit skin flaps. METHODS: According to endogenous alkaline phosphatase activity, Gomori-Takamatsu method and NBT/BCIP method were used to observe the microvascular architecture. RESULTS: Both methods had capability to demonstrate the microvascular architecture of the human skin flap, whereas the examining results of rabbits were negative. CONCLUSIONS: Great difference of endogeneous alkaline phosphatase activity exists in different animals. Gomori-Takamatsu method and NBT/BCIP method are useful in study of microvascular architecture of human skin flaps.

[The dorsal fasciocutaneous island flap of the finger for the repair of volar skin defects of the same finger].

OBJECTIVE: To evaluate a new fasciocutaneous island flap for the repair of volar skin defects of the same finger. METHODS: A fasciocutaneous island flap, 0.5 cm distal to the volar skin defect, was formed on the dorsal side of the same finger. The proximal fascial pedicle was dissected long enough so that the flap could be transposed to the volar wound freely. One dorsal vein was kept undisturbed to safeguard the venous drainage of the distal part of the finger. When the side of the flap was so big that bilateral dorsal veins were included within the flap, the non-pedicle side of the flap was elevated first superior to the fascia until the dorsal vein was excluded from the flap, and the rest of the flap was dissected deep to the fascia. The donor side of the flap was covered with split skin graft. RESULTS: Six cases were treated. All flaps survived well. CONCLUSION: The dorsal fasciocutaneous island flap of the finger can be used safely for the repair of volar skin defect of the same finger.

[Anatomical division and electromyographic assessment within latissimus dorsi].

OBJECTIVE: To evaluate the anatomical division within latissimus dorsi and its electromyographic change as shoulder articulation movement. METHODS: Using anatomical observation, projection of trophic vessel and nerve of latissimus dorsi was marked in the surface of skin. Electromyographic assessment of different area of latissimus dorsi was measured. RESULTS: The latissimus dorsi was mainly supplied by thoracodorsal and its interior and external branches. The latissimus dorsi can be divided three area based on these anatomical result. Electromyographic amplitude in the three areas of muscle are different. CONCLUSION: Lastissimus dorsi can be divided into three areas by thoracodorsal vessel and nerve. The third area fibres were utilized preferentially when subjects performed six kinds of movements of the shoulder joint.