保留蒂部真皮下血管网分支修剪法根治腋臭(1)
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[摘要]目的：探讨去除腋窝顶泌汗腺时，如何最大限度地保护皮肤血供。方法：2008-09～2010-11，对115例腋臭患者予“保留蒂部真皮下血管网分支”修剪法根治：腋窝中下1/3横皱襞切口，保留蒂部真皮下血管分支，“顺行法”修剪，去除腋浅筋膜和顶泌汗腺分泌部,紧贴真皮网状层去除毛囊。结果：术后2天拆除包扎并拔除引流管，术后7天折线。10例伤口愈合不佳，经换药1～2周愈合。术后血肿7例，及时予以血肿清除术。术后7～14天内，手术区域皮肤颜色恢复正常。本组115例患者术后随访 6个月至2年，显效率100%，2例仍有轻度臭味，治愈率 98.3%。所有病例腋部瘢痕不明显，无双上肢活动受限及皮肤坏死。真皮下血管网下方常夹有一定厚度的顶泌汗腺分泌部。修剪去除顶泌汗腺时，能否保留真皮下血管网，应视部位而定。腋窝中央部位(切口两侧)区域，难以保留真皮下血管网。而在腋窝周围部位(皮瓣蒂部)，顶泌汗腺分泌部呈散在分布，且真皮下血管网分支较粗大，故可保留。结论：“保留蒂部真皮下血管网分支”修剪法根治腋臭，充分利用了腋窝顶泌汗腺和真皮下血管网的解剖学基础，保证了手术确切止血和腋窝顶泌汗腺的有效去除，同时又最大限度地保护了皮肤血供。其效果理想，并少症少，值得临床推广。
[关键词]腋窝；腋臭；真皮下血管网；顶泌汗腺；腋浅筋膜
[中图分类号]R758.74[文献标识码]A[文章编号]1008-6455(2011)05-0707-04
Radical treatment on axillary osmidrosis with the method of Retainning the Pedicle's Subdermal Vascular Network Branches and Trimming with Scissor
WANG Qing,LIU Da-lie,WANG Jin-huang,CHEN Bing,CHEN Bo-hua
(Department of Plastic and Cosmetic Surgery,Zhujiang Hospital,Southern Medical University,Guangzhou 510282,Guangdong,China)
Abstract:ObjectiveTo investigate how to protect the skin blood supply effectively after the operation of removing the axillary apocrine sweat glands.MethodsFrom September 2008 to November 2010,115 patients with axillary osmidrosis treated with new technique-"retaining the pedicle'ssubdermal vascular network branches and trimming with scissor in axillary furrow incision" were analyzed retrospectively. The clinic outcomes, complications, disadvantage and advantage of the new method were analyzed.ResultsFollow-up time was 6 months to 2 years after operation. The new technique had attained satisfactory clinic outcomes: the time of unfolding bandage was 2d,disconnecting time was 7d,the time of skin color recovery was 7～14d, hematoma complication was7(6.1%), wound late healing was10 cases(8.7%), Recovery was 113cases (98.3%) without remarkable scar or dysfunction of upper limb. There were some thickness of secretory portions of apocrine sweat glands usually under subdermal vascular network(SVN) in axillary fossa ......
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