Refined tumescent liposuction-curettage with pruning in small incisions for treatment of axillary bromhidrosis

Background Axillary bromhidrosis is widespread social problem in our society. Various modalities have been developed for destruction or removal of the apocrine sweat glands to eliminate the malodor. But conventional surgical treatments often result in high complication rate and frequent recurrence. In the study, we evaluate the effect of refined tumescent liposuction-curettage with pruning in small incisions in the treatment of axillary bromhidrosis. Methods From July of 2013 to April of 2019, 110 patients (75 women and 35 men) with axillary bromhidrosis were treated by refined tumescent liposuction-curettage with pruning. The results of malodor elimination were evaluated by both the patients and doctors as very satisfied (excellent), satisfied (good), some satisfied (fair), and not satisfied (poor). Postoperative complications, including dehiscence, infection, wound contracture, cyst, subcutaneous hydrops, haematoma or seroma were evaluated as well. Preoperative and postoperative histological examinations of axillary tissue were performed in 2 patients. Results Among subjective evaluation of the 110 patients, 33 (30.0%) were graded as very satisfed results, 70 (63.6%) were satisfied, and 7 (6.4%) was some satisfied. The objective evaluation showed 43 (39.1%) were graded as excellent results and all the others were good. No serious complications were happened except three showed slightly local subcutaneous hydrops and haematoma. Histologic examinations showed the apocrine glands significant decreased or destroyed after surgery. Conclusion Refined tumescent liposuction-curettage with pruning in small incisions is an effective method for treatment of axillary bromhidrosis.

Ultrasound-Assisted Liposuction and Helium-Activated Radiofrequency Skin Tightening for Treatment of Paradoxical Adipose Hyperplasia After Cryolipolysis

Paradoxical adipose hyperplasia (PAH) following cryolipolysis is a rare but deforming complication. This likely underreported adverse event has been described as being refractory to both traditional tumescent liposuction and repeated cryolipolysis treatments. Here, we present 3 isolated cases with PAH deformity created by cryolipolysis. Management of PAH on the abdomen and flanks involved 2 key elements: ultrasound-assisted liposuction (UAL) technology and helium-activated radiofrequency (RF) energy subdermal coagulation. We observed complete resolution and definitive correction of PAH deformities at 2 weeks, 1 month, and 3 months postoperatively. UAL combined with helium-activated RF subdermal coagulation is a viable surgical modality to correct contour irregularities seen in PAH following cryolipolysis.

Does tumescent liposuction damage the lymph vessels in lipoedema patients?

Background Lymphatic insufficiency might play a significant role in the pathophysiology of lipoedema. Liposuction is up to now the best treatment. As liposuction is invasive, the technique could destruct parts of the lymphatic system and by this aggravate the lymphatic component and/or induce lymphoedema. We investigated the function of the lymphatic system in lipoedema patients before and after tumescent liposuction and thus whether tumescent liposuction can be regarded as a safe treatment. Methods Lymphoscintigraphy was performed to quantify the lymph outflow of 117 lipoedema patients. Mean clearance percentages of radioactive protein loaded after 1 min with respect to the total injected dose and corrected for decay of the radiopharmaceutical in the subcutaneous lymphatics were used as functional quantitative parameters as well as the clearance percentages and inguinal uptake 2 h post injection. The results of lymphatic function in lipoedema patients were compared with values obtained from normal healthy volunteers. We also compared 50 lymphoscintigraphies out of the previous 117 lipoedema patients before and six months after tumescent liposuction. Results In 117 lipoedema patients clearance 2 h post injection in the right and left foot was disturbed in 79.5 and 87.2% respectively. The inguinal uptake 2 h post injection in the right and left groin was disturbed in 60.3 and 64.7% respectively. In 50 lipoedema patients mean clearance and inguinal uptake after tumescent liposuction were slightly improved, 0.01 (p = 0.37) versus 0.02 (p = 0.02), respectively. This is statistically not relevant in clearance. Conclusion Lipoedema legs have a delayed lymph transport. Tumescent liposuction does not diminish the lymphatic function in lipoedema patients, thus tumescent liposuction can be regarded as a safe treatment.