Osmidrosis surgery is still recognized as one of the best ways to treat body odor,
- Shin J.Y.
- Roh S.G.
- Lee N.H.
- Yang K.M.
Osmidrosis treatment approaches: a systematic review and meta-analysis.
especially the liposuction assisted curettage due to the relatively small incision
that does not leave any scars, which, nevertheless, may still cause many complications.
One of the most common complications is the erosion of the skin flap, where the necrosis
of the flap incision edge is about 4%.
Ablation of apocrine glands with the use of a suction-assisted cartilage shaver for
treatment of axillary osmidrosis: an analysis of 156 cases.
Therefore, physicians who perform such surgeries often observe varying degrees of
manifestations, some of which are relatively common superficial erosions (Figure 1
) and some of which are proportionately deep erosions. Superficial erosions may disappear
within a few days to a few weeks and heal completely whereas deep erosion, a kind
of skin necrosis, is more likely to occur at the site of the incision. This necrosis
easily leads to the appearance of scar tissue. Cutaneous microcirculation exists in
the skin flap,
The cutaneous microcirculation.
which is organized as two horizontal plexuses. One is distributed 1–1.5 mm below
the skin surface and the other is distributed between the dermal-subcutaneous junction.
Microcirculation refers to the blood circulation in the microvessels between the arterioles
and the venules, where the blood and tissue cells exchange substances. The basic function
of the microcirculation is to realize the material substitution and transport of oxygen,
nutrients and metabolites to the cells various tissues. However, in the process of
rotating knife scraping, the continuous friction in the skin flap easily damages the
microcirculation, which is especially prone to occur in the pursuit of the complete
clearance of the apocrine gland and, thus, leading to the serious damage of the skin
flap. The pursuit for better clearance and the well preservation of the microcirculation
of the skin flap often put clinicians in a dilemma. To improve this situation, our
study aimed to achieve the best of both worlds; that is, to reduce the possibility
of erosion or necrosis. Excessive friction or poor healing of the flap can also lead
to pigmentation, thus affecting the appearance of the skin in the future. We performed
hyperbaric oxygen treatment on 2 Fitzpatrick-skin-type-3 patients in Taiwan before
and after osmidrosis surgery. There is a one-person MEDICONET Hyperbaric Oxygen Chamber
One H810/H750) in Taiwan which, under the laws and regulations of Taiwan, does not
require hyperbaric oxygen specialists. The three patients received hyperbaric oxygen
treatment at 1.5 ATA dosages for 45 minutes before the operation, three days post
operation following the yarn removal, and five days post operation following the quilting
suture removal, respectively. It was later discovered that the recovery of the flaps
treated with hyperbaric oxygen was healthier than the earlier observed patients who
underwent general surgery with a recovery time of about one week earlier (Figure 2
). It is, therefore, believed that the administration of hyperbaric oxygen treatment
before surgery has a considerable effect in the improvement of the relative hypoxia
of the skin flap during the surgery. This clinical phenomenon is consistent with the
findings of many animal experiments mentioned in the literature. It is speculated
that HBO preconditioning effectively slows the ischemic reperfusion injury, which
is mainly through the regulating factors of apoptosis, the apoptosis signal-regulating
kinase 1 and c-Jun N-terminal kinase.
- Xiao Y.D.
- Liu Y.Q.
- Li J.L.
- Ma X.M.
- et al.
Hyperbaric oxygen preconditioning inhibits skin flap apoptosis in a rat ischemia-reperfusion
Despite the small number of subjects in our case, we want to share our observation
on the improved healing of the flaps through hyperbaric oxygen treatment. Furthermore,
we speculate that it might be helpful in the reduction of the proportion of post-inflammatory
hyperpigmentation in the future. We came to this opinion because the inflammation
in the previous process is shortened and the healing is rapid, thus pigmentation is
reduced. However, these require greater and larger studies to explore the extent of
influence of hyperbaric oxygen treatment on skin flap osmidrosis surgery.