Approach Considerations
Again, multiple tools and techniques are available to effectively remove the sweat glands in the axilla. The technique with which the surgeon has the most experience and is readily available should be used. Some techniques may be more cost-effective based on both the patient’s and surgeon’s preferences. Results of the procedure may vary based on the technique used. [4, 8, 31, 32, 33]
Three classic methods of removing axillary sweat glands are primarily recognized. [12] Type I removes only the subcutaneous tissue of the axilla and spares the skin; type II removes the skin and subcutaneous tissue of the axilla en bloc, mostly in the hair-bearing dome of the axilla; and type III is a combination of type I and type II, removing skin and subcutaneous tissue centrally with removal of adjacent subcutaneous tissue as well. Limited en bloc resection based on sweat mapping with starch and iodine or cobalt chloride can be effective with less morbidity than total en bloc resection. Sweat mapping often reveals focal areas of hyperhidrosis amenable to excision.
A type I resection of only the subcutaneous tissue while sparing the skin is the primary focus of this technique.
Suction-Assisted Arthroscopic Shaving
After anesthetic administration and preparation of the axilla, a 1-cm incision is made in the anterior axillary fold at the marked site.
After anesthetic administration and preparation of the axilla, a 1-cm incision is made in the anterior axillary fold at the marked site.
A plane is opened and developed at the interface of the deep dermis and the subcutaneous tissue with surgical scissors (eg, Metzenbaum scissors) in a spreading motion parallel with the skin surface, leaving minimal subcutaneous tissue on the skin flap. This plane is developed underneath the entire hair-bearing skin marked preoperatively and can be done rapidly in a bloodless fashion. During elevation of the skin flap and subsequent shaving of the skin flap, assistance with traction on the skin is important to achieve a taut skin surface. This stretching of the skin aids in defining the plane of dissection and minimizing trauma or cutting of the skin flap itself.
Once the skin flap is elevated, the undersurface is debrided of remaining subcutaneous tissue with the method chosen by the surgeon. Arthroscopic cartilage shaving devices are effective in debriding the skin flap of the associated sweat glands. [28, 29, 30]
The arthroscopic shaver is a powered device consisting of 2 concentric cannulas on which the exposed inner cannula rotates at a rate of 900 rpm in an oscillating motion, debriding the flap of its subcutaneous tissue and sweat glands. The device has suction applied that simultaneously removes the debrided tissue from the area.
The arthroscopic shaver is a powered device consisting of 2 concentric cannulas on which the exposed inner cannula rotates at a rate of 900 rpm in an oscillating motion, debriding the flap of its subcutaneous tissue and sweat glands. The device has suction applied which simultaneously removes the debrided tissue from the area.
The exposed inner cannula rotates at a rate of 900 rpm in an oscillating motion, debriding the flap of its subcutaneous tissue and sweat glands.
The oscillating tip of the device is held up against the underside of the skin flap and away from the underlying deeper tissues.
The oscillating tip of the device is held up against the underside of the skin flap and away from the underlying deeper tissues. With skin traction applied, the tip is placed at the edge of the dissected plane and slowly brought back toward the incision, maintaining contact with the skin flap.
With skin traction applied, the tip is placed at the edge of the dissected plane and slowly brought back toward the incision, maintaining contact with the skin flap. This process is repeated in a radial fashion around the dissected plane until all areas of the skin flap have been debrided of subcutaneous tissue. This method minimizes trauma to the deeper subcutaneous tissue as well as the hair follicles of the skin flap.
A closed suction drain or passive drain should be placed in the surgical site to minimize any dead space or fluid accumulation. The skin incision is then closed with sutures. A soft bolster dressing should be applied overlying the skin of the axilla to provide gentle pressure over the entire site which can be secured with sutures to the skin. The surgical drain and bolster dressing should be removed on the first postoperative day. Skin sutures can be removed 1 week postoperatively.
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Both apocrine and eccrine sweat glands are present in the skin of the axilla.
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The hair bearing skin of the patient's axilla is marked in preparation for surgery.
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Local anesthetic of 0.5% lidocaine with 1/200,000 epinephrine using a 25-G or smaller needle should be injected superficially in the subcutaneous tissue to create elevation of the dermis. The entire hair-bearing area of skin in the axilla should be injected and can be done prior to sterile surgical preparation and draping of the site.
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After anesthetic administration and preparation of the axilla, a 1-cm incision is made in the anterior axillary fold at the marked site.
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The arthroscopic shaver is a powered device consisting of 2 concentric cannulas on which the exposed inner cannula rotates at a rate of 900 rpm in an oscillating motion, debriding the flap of its subcutaneous tissue and sweat glands. The device has suction applied that simultaneously removes the debrided tissue from the area.
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The exposed inner cannula rotates at a rate of 900 rpm in an oscillating motion, debriding the flap of its subcutaneous tissue and sweat glands.
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The oscillating tip of the device is held up against the underside of the skin flap and away from the underlying deeper tissues. With skin traction applied, the tip is placed at the edge of the dissected plane and slowly brought back toward the incision, maintaining contact with the skin flap.
