AgerangeofpatientstreatedsurgicallyforaxillaryAgeyearsMaleFemaleTotal000162004421254111526306121831353912364022441450114650022x159 50000 Figure1Preoperativemarkingforskinexcisionandund ID: 960898
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sessmentincludeduseoftheiodine-starchtest,asdescribedbyWeaver(6),toidentifythehyperhidroticareapresentintheaxilla.Afterobservingthatthehyperhidroticareacorrespondedwiththehair-bearingareainallcases,theiodine-starchtestwasabandoned,andthehair-bearingareawasexcised.OtherinvestigatorshavereportedsimilarfindingsSurgerywasusuallyperformedunderlocalandsometimesgeneralanesthesiainadaysurgerysetting.Noperioperativeantibioticswereadministered,becausethesenotbeenshowntoreducewoundinfectionratesfollowingsurgery(9).Atransverseellipticalincisionwasmadebetweentheanteriorandposterioraxillaryfolds.Anellipseofskinrangingfrom3×1cmto10×3cmwasexcised,dependingonthesizeofthehair-bearingarea.Underminingoftheaxillaryskindeeptothedermisfollowed,extending2to3cmfromtheexcisionsiteandadditionalsubcutaneousglandulartissuewasremoved(Figure1).Theaxillaryskinwasclosedintwolayers,andapressuredressingwasfittedtofilltheaxillarydome.Patientsreturnedthreetofivedayslaterforpostoperativeassessmentanddressingchange.Dailyshowersweresuggested,andpatientsreturnedsevento10daysaftersurgeryforsutureremoval.Shorttermfollow-upwascarriedoutatsixand12weekspostoperatively.Longtermfollow-upconsistedofaquestionnairecompletedbypatientsbetweenthreeand10yearspostoperatively.RESULTSTherewere57patientsinthestudy.Onepatientwaslosttofollow-upandwasexcludedfromthestudy.Onehundredandtwenty-fouraxillarysurgicalprocedureswerecompletedintotal(allprocedureswerebilateral;fivepatientsunderwentarepeatprocedure).Resultsof122procedureswereavailableforfollow-up.Giventhenatureofthediseaseandpatientselectioncriteria,therewasnocontrolgroup.Theaverageagewas28.5yearsforwomenand28.9yearsformen.Themaletofemaleratiowas1:2.7(Table1),whichissimilartothatreportedbyothers(9).Theareaofaxillaryskinexcisedrangedfrom3×1cmto10×3cm.Themeanareaexcisedwas8.9cminmenand9.4cminwomen(Table2).Therewerenomajorcomplications,largehematomasorskinslough(Table3).Sixaxillae(4.9%)developedhematomas,fiveofwhichrequireddrainageunderlocalanesthesia.Oneaxilla(0.8%)developedasmallseromathatdidnotrequiredrainage.Fouraxillae(3.3%)developedpostoperativewoundinfection.Allweretreatedwithoralantibioticsanddidnotrequirehospitalization.Oneaxilla(0.8%)developedanabscessthatrequiredincisionanddrainageunderlocalanesthesia.Skinedgenecrosisoccurredintwoaxillae(1.6%).Healingwasallowedtooccurbysecondaryintentionandbothpatientsstatedhavingsatisfactoryresultsthreemonthsaftersurgery.Hypertrophicscarringoccuredintwoaxillae(1.6%).Onepatienthadthescarinjectedwithasteroidandconsideredtheresultsatisfactorysevenmonthspostoperatively.Althoughsomepatientsexperienceddiscomfortonabductionofthearmsatsixweeks,norestrictioninarmmovementswasobservedthreemonthsfollowingsurgery.Functionalandcosmeticresultswereassessedsubjectivelybythepatientateachpostoperativevisitandrecordedinthechartaseithersatisfactoryorunsatisfactory.Fiftyofthe57patients(88%)weresatisfiedwiththeresultattheendofshorttermfollow-up(threemonths).Allpatientswhoexperiencedaminorcomplicationweresatisfiedwiththeresultoncethecomplicationhadbeentreated.Twopatients(3.5%)whodidnotexperienceanypostoperativecomplicationfelt268CanJPlastSurgVol7No6November/December1999KettleandFreibergTABLE1 AgerangeofpatientstreatedsurgicallyforaxillaryAge(years)MaleFemaleTotal00016-2004421-254111526-306121831-35391236-4022441-4501146-50022-9; 50000 Figure1)PreoperativemarkingforskinexcisionandunderminingforthetreatmentofaxillaryhyperhidrosisTAB
LE2 AreaofaxillaryskinexcisedforthetreatmentofaxillaryAreaexcised(cm)MaleFemaleTotal0.0-4.02574.1-8.0718258.1-12.06131912.1-16.024616.1-20.002220.1-24.0011Total174355 2 G:...Kettle.vpFri Dec 10 16:35:19 1999Color profile: DisabledComposite Default screen 0 5 25 75 95 100 0 5 25 75 95 100 0 5 25 75 95 100 0 5 25 75 95 100 thattheirperspirationlevelremainedexcessiveanddidnotreturnforfurthertreatments.Fivepatients(8.8%),oneofwhomexperiencedacomplication,feltthattheirfunctionalresultwasunsatisfactory.Theyagainunderwentexcision,andallweresatisfiedwiththeirfinalresult.Longtermresults(Table4)wereassessedbymeansofaquestionnairemailedtopatientstwoto10yearsfollowingtheoriginalsurgery.Resultsfrom12patients(21%)wereobtained.Questionnairesmailedwithpostage-paidreturnenvelopestotheremainingpatientseitherwerenotreturnedbecauseoflackofinterestinparticipatingordidnotreachthepatientsbecauseofachangeofaddress.Nineofthe12patients(75%)feltcompletelysatisfiedwiththeresultsoftheTwopatients(17%)feltthattherewassubjectiveimprovementoftheirsymptomsbutwerenotcompletelysatisfiedwiththeresult,andonepatient(8%)feltthattherewasnochange.Allpatientsfeltthatthescarswereacceptableorgood.Therewerenoreportsoflimitationofmovementofthearm.Fivepatients(42%)feltthattheimmediatepostoperativeperiodwasuncomfortableorpainfulbutstatedthattheywouldhavethesameprocedurerepeatediftheysufferedfromsimilarsymptoms.Oneof12patients(8%)reportedaprolongeddecreaseinthesensitivityintheaxilla.Elevenof12patients(92%)statedthattheywouldhavetheprocedurerepeatedandwouldrecommendtheproceduretoothers.Therearetwotypesofsweatglandspresentinthehumanskin(10).Eccrineglandsarepresentovertheentiresurfaceofthebodyandareinnervatedbycholinergicfibresofthesympatheticnervoussystem(11).Apocrineglandsarefoundintheskinoftheexternalauditorymeatus,nipple,areola,axillaandanogenitalregion.Theaxillacontainsbothtypesofglands,inanapproximate1:1ratio(11).Eightypercentoftheglandsarefoundinasmallareaofthedomeoftheaxillainthehair-bearingarea(5).Hyperhidrosisisthoughttooccurinthepresenceofhistologicallynormalglandsandnerves,althoughthesemaybepresentingreaterthannormalnumbersandmaybefunctionallyhyperactive(12).Atpresent,mostinvestigatorsattemptinitialtreatmentusingaluminumchloridehexahydrate20%to25%solutioninethanolorothertopicalagentssuchasglutaraldehyde,tannicacid,localanestheticsorformaldehyde.Theseagentsareef-fectiveinsomecases(13,14)butrequireprolongedcoursesoftreatmenttobeofanybenefit.Solutionsmustbeappliedfor6to8hoursatatimeaftermeticulouscleansinganddry-ingoftheaxilla,uptothreetofourtimesperweek.Localre-actionsareseenfrequentlyandarereportedtooccurin1.5%to55%ofcases(15).AnticholinergicmedicationsarealsousedinthetreatmentCanJPlastSurgVol7No6November/December1999269AxillaryhyperhidrosistreatmentTABLE3 ComplicationsfollowingsurgicaltreatmentofaxillaryNumberofwoundsSeroma10.9Hematoma65.5Infection43.6Abscess10.9Skinnecrosis21.8Hypertrophicscar21.8 TABLE4 Longtermfollow-upquestionnairetwoto10yearsfollowingsurgicaltreatmentofaxillaryhyperhidrosisQuestionResponseMaleFemaleTotal(n=12)1.Whatisyourpersonalevaluationoftheresultsoftheoperation?Completesatisfaction459Improvedpostoperatively022Nochange0112.ArethescarsGood358Acceptable123Unacceptable0113.Doyouhaveanylimitationsofmovementinthearm?Yes000No48124.Wastheoperativeperiodpainfuloruncomfortable?Yes134No3585.Doyouhaveanyresidualpainordiscomfortintheaxilla?Yes000No48126.Haveyouexperiencedadecreasei
nsensation?Yes011No47117.WouldyouhavetheprocedureYes4711No0118.Wouldyourecommendtheproceduretoothers?Yes4711No011 3 G:...Kettle.vpFri Dec 10 16:35:20 1999Color profile: DisabledComposite Default screen 0 5 25 75 95 100 0 5 25 75 95 100 0 5 25 75 95 100 0 5 25 75 95 100 ofaxillaryhyperhidrosisbutbenefitsaretransient(15)andunpleasantanticholinergicsideeffectsmayoccur.Glycopyr-rolateismostoftenusedandmaybecombinedwithpheno-barbitaltotreatpatientswithanemotionalaspectoftheIontophoresishasalsobeenused.Theapplicationofcon-stantvoltageandcurrentacrosstapwateroranticholinergiccompounds(poldinemethosulphateorglycopyrroniumbro-mide)appliedtothepalmsandsoleshasprovedeffectiveinsomecases(16,17).However,thetreatmentofaxillaryhy-perhidrosisusingspecialelectrodeshasprovedlesseffectiveOtherinvestigatorshaveattemptedtotreataxillaryhyperhidrosisusingelectrosurgerywithinsulatedneedles(18).Theyfeelthat,althoughthedegreeofsweatinhibitionismuchlessthanwithotherprocedures,thepaucityofsideeffectsmakethisaviableformoftherapy(18).Localradiationhasbeenusedbutcanresultinirreversibledamagetotheaxillaryskin.Thistechniquehaslargelybeenabandonedformoreeffectivetreatmentswithlessmorbidity.Sympathectomyasameansoftreatinghyperhidrosishasprovedeffectiveincasesinvolvingthepalmsbuthasbeenlesssuccessfulinreducingaxillaryeccrineglandactivity.Severalapproachesexisttofacilitateresectionofthesympatheticchain(19,20).Resectionofthesecondthoracicganglionalonehasbeenshowntobeeffectiveinreducingsweatinginpalmarhyperhidrosis,butinordertoeffectivelyreducesympatheticinnervationtotheaxilla,itisnecessarytoresectthesecond,thirdandoccasionallythefourthandfifthganglia(20).Theseproceduresaremuchmoreinvolvedandrequiregeneralanesthesiaandatwotothreedayhospitalstay.TheusualpostoperativecomplicationsexistaswellaspneumothoraxandHorner’ssyndrome.Compensatoryhyperhidrosisisreportedin18%to44%ofcases(19,20).Becausepalmarhyperhidrosisiseffectivelytreatedingreaterthan95%ofcasesandtheresultispermanent,sympathectomyisprobablybestreservedforthetreatmentofseverepalmarhyperhidrosisorhyperhidrosisexistingwithperipheralvasculardiseaseintheupperextremities.Withthetrendtominimalaccesssurgery,transaxillarysympathectomyisnowbeingperformedendoscopically.Initialreportsrevealresultsasgoodaswiththeconventionalopentechniquebutwithreducedmorbidity.Recently,severalinvestigatorshavereportedtheuseofsuctionassistedlipolysisinthetreatmentofaxillaryhyperhi-drosis(21,22).Althoughthenumberofpatientstreatedinthisfashionhasbeenlimited,theauthorsclaimpromisingre-sultsoverashortperiodoffollow-upwithlowmorbidity.Furtherevaluationisnecessarybeforeadvocatingthistech-niqueinthetreatmentofaxillaryhyperhidrosis.Cryosurgeryhasbeenadvocatedbysomeinvestigatorsinthetreatmentofaxillaryhyperhidrosis.Cyroprobetipsrangingform13×9mmto13×18mmindiameterareheldagainsttheaxillaryskinfor2minsinmultipleareasafterinfiltrationwithlocalanesthetic.Limitedtrialswithshortfollow-uphavedemonstratedsomesuccess.However,upto50%ofpatientscontinuetohaveexcessiveaxillarysweating.Fullthicknessskinlossoccursinupto25%ofpatients.Latesequelaeincludedepigmentationanddepilation(23).Proceduresforthesurgicaltreatmentofaxillaryhyperhidrosismaybedividedintothosethatexciseaxillaryskinandthosethatincisetheskintogainaccesstounderlyingglands.Theseproceduresmaybefurtherdividedaccordingtovascularskinflapsoravasculargraftsareusedforclosure.Sincethedescriptionofthefirstsurgicalprocedurefortreati
ngaxillaryhyperhidrosisbySkoogin1962(24),numeroussurgicalprocedureshavebeendeveloped(Figure2,3).Surgeryforhyperhidrosisresultsinareductioninthenumberofsweatglandspresentintheaxilla.Ideally,allactiveglandsshouldberemovedfromthesubcutaneoustissuesanddeepdermis.Ifskinisnotexcisedwiththeglands,thesubdermalvascularplexusmaybescrapedundertheflapsatthetimeofsurgeryandmayresultinreducedglandularactivity.Thiseffectistemporarybecauseglandfunctionincreaseswithreinnervation.270CanJPlastSurgVol7No6November/December1999KettleandFreiberg Figure2)Surgicaltechniquesusingskinexcisionfortreatmentofaxillaryhyperhidrosis Figure3)Surgicaltechniquesusingskinexcisionfortreatmentofaxillaryhyperhidrosis 4 G:...Kettle.vpColor profile: DisabledComposite Default screen 0 5 25 75 95 100 0 5 25 75 95 100 0 5 25 75 95 100 0 5 25 75 95 100 SkoogandThyresson’s(24)originalprocedureinvolvedcreatingfourvascularizedflapsofaxillaryskinviaanoffsetcruciateincision.Thesubdermalvascularplexuswasleftintact.Thedeepersweatglandswereexcised,butnumerousmoresuperficialglandsremainedintheaxilla.Althoughpatientsexperiencedasignificantreductioninsweating,theycontinuedtohaveepisodesofembarrassingsweatingwhenunderemotionalstress.JemecandHansen(25)performedsubcutaneousglandcurettagethroughasingleincisionleavingvascularizedskinflaps.Kappesser(26)createdasingleincisiontransverselyintheaxillaryskinandusedahousedrazorbladetotrimtheundersurfaceofthedermis,includingthesubdermalplexus.Heessentiallycreatedavascularflaps(grafts).Yoshikataetal(8)advocatedasimilartechniquewhereoneortwoparallelincisionsaremade,theskinreflectedbackandtheundersurfacetrimmedusingscissors,alsoexcisingthesubdermalplexusandlowerthirdofthederHurleyandShelly(27)describedtheexcisionofatransverseellipseofaxillaryskinwithsubcutaneousglandsin1963.Latertheyaddedtheunderminingofadjacentaxillaryskin,presumablybecausepatientscontinuedtoexperienceexcessiveperspiration(5).Attentionwasfocusedonthedomeoftheaxilla,whichcontains70%to80%ofglandsintheaxilla.Numerousotherinvestigatorsdescribedsimilarprocedures.Weaver(6)subsequentlydescribedtheellipticalexcisionandsubcutaneousclearanceofglandsfromunder-minedvascularskinflaps.Inthisfashion,sweatglandswereremovedfromadjacenttissuesanddenervated;however,su-perficialglandsremainedwithinthevascularflaps.Rigg(3)advocateduseofasimilarellipticalskinexcision,buttore-movethesuperficialglands,hecreatedavascularflaps(grafts)thatfacilitatedclosure.Bretteville-Jensenetal(28)excisedalargerellipseofaxillaryskincontainingtheentirehair-bearingportionoftheaxillawithsubcutaneousclearanceofglands.AZ-plastywasusedduringskinclosure.EldhandFogdestam(29)performedasimilarprocedurebutclosedtheskininanMorVshape.InthispaperamethodofglandularexcisionsimilartoHurleyandShelly,andWeaverisoutlined.Thehair-bearingareaoftheaxillaisexcised,withunderminingofvascularflaps,andsimpleclosure.Radicalexcisionofaxillarysweatglandsisachievedwithnoincreaseincomplicationrateswhencomparedwithothertechniques.Scarsintheaxillamaybecomeraisedandspreadinitiallybutflattenandsoftenwithtime(Figure4).Althoughsomepatientswithaxillaryhyperhidrosiscanbetreatedconservatively,manyrequiresurgeryforadequateresolutionoftheirsymptoms.Numeroussurgicaltechniqueshavebeendevelopedyieldinggoodresults.Theidealsurgi-calprocedurewouldresultintheremovalofalloftherespon-siblesweatglandswhileallowingfornormalestheticsandfunctionoftheaxilla.Therearetwobroadcategoriesforre-movalofthegl
andularmaterial:thoseinvolvingincisionoftheskinonlyandthosewhereanellipseofskinisexcisedwiththeglands.Radicalexcisionofthehair-bearingareaoftheaxillaisarelativelysimpletechniquethatcanbeusedeffectivelytotreataxillaryhyperhidrosis.Patientsatisfactionishighpostoperativelywithverylittlemorbidity.1.AdarR,KurchinA,ZweigA,MozesM.Palmarhyperhidrosisanditssurgicaltreatment:areportof100cases.AnnSurg1977;186:34-41.2.JepsonRP,HarrisJD.Surgicalaspectsofhyperhidrosis.AustralasJDermatol1976;17:90-1.3.RiggB.Axillaryhyperhidrosis.PlastReconstrSurg1977;59:334-42.4.ByrneJ,WalshTN,HerdermanWP.Endoscopictransthoracicelectrocauteryofthesympatheticchainforpalmarandaxillaryhyperdidrosis.BrJSurg1990;77:1046-9.5.HurleyHJ,ShelleyWB.Axillaryhyperhidrosis.BrJDermatol6.WeaverPC.Axillaryhyperhidrosis.BrMedJ1970;1:48.7.EllisH.Axillaryhyperhidrosis:failureofsubcutaneouscurettage.BrMedJ1977;2:301-2.8.YoshikataR,YanaiA,TakeiT,ShionomeH.Surgicaltreatmentofaxillaryosmidrosis.BrJPlastSurg1990;43:483-5.9.MaS,ChiangSS,FangRH.Prophylacticantibioticsinsurgicaltreatmentofaxillaryhyperhidrosis.AnnPlastSurg1989;22:436-9.10.KunoY.Humanperspiration.Springfield:CCThomas,1956.11.RechardtL,WarisT,RintalaA.Innervationofhumanaxillarysweatglands.Histochemicalandelectronmicroscopicstudyofhyperhidroticandnormalsubjects.ScandJPlastReconstrSurg1976;10:107-12.12.PetersW.Treatmentofaxillaryhyperhidrosis.Cutis1982;29:366,368.13.JohlinL,EversH,BrobergF.Inhibitionofhyperhidrosisbytopicalapplicationofalocalanestheticcomposition.ActaDermVenereol(Stockholm)1979;59:556-9.14.BrandrupF,LarsenP.Axillaryhyperhidrosis:localtreatmentwithaluminiumchloridehexahydrate25%inabsoluteethanol.ActaDermVenereol(Stockholm)1978;58:461-5.15.ScholesKT,CrowKD,EllisJP,HarmanRR,SaihanEM.Axillaryhyperhidrosistreatedwithalcoholicsolutionofaluminiumchloridehexahydrate.BrMedJ1978;2:84-5.16.ElgartML,FuchsG.Tapwateriontophoresisinthetreatmentofhyperhidrosis.UseoftheDrionicdevice.IntJDermatol17.MidtgaardK.Anewdeviceforthetreatmentofhyperhidrosisbyiontophoresis.BrJDermatol1986;114:485-8.CanJPlastSurgVol7No6November/December1999271Axillaryhyperhidrosistreatment Figure4)Typicalscarthreemonthsaftersurgicaltreatmentofaxillary 5 G:...Kettle.vpFri Dec 10 16:35:21 1999Color profile: DisabledComposite Default screen 0 5 25 75 95 100 0 5 25 75 95 100 0 5 25 75 95 100 0 5 25 75 95 100 18.KobayashiT.Electrosurgeryusinginsulatedneedles:treatmentofaxillarybromhidrosisandhyperhydrosis.JDermatolSurgOncol19.AustinJJDoobayB,SchatzS.Transaxillaryendoscopiclasersympathectomy.CanJSurg1992;35:414-6.20.ThuseMG.Axillaryskinexcisionforaxillaryhyperhidrosis.BrJClinPract1981;35:353-5.21.ChristJE.Theapplicationofsuction-assistedlipectomyfortheproblemofaxillaryhyperhidrosis.SurgGynecolObstet22.ShenaqSM,SpiraM,ChristJ.Treatmentofbilateralaxillaryhyperhidrosisbysuction-assistedlipolysistechnique.AnnPlastSurg23.AshbyEC,WilliamsJL.Cryosurgeryforaxillaryhyperhidrosis.BrMedJ1976;2:1173-4.24.SkoogT,ThyressonN.Hyperhidroissoftheaxilla:amethodofsurgicaltreatment.ActaChirScand1962;124:531-8.25.JemecB,HolmHansenB.Follow-upofpatientsoperatedonforaxillaryhyperhidrosisbysubcutaneouscurettage.ScandJPlastReconstrSurg1978;12:65-7.26.KappesserHJ.Theuseofahousedrazorbladeinthesurgicalmanagementofaxillaryhyperhidrosis.JDermatolSurgOncol27.HurleyHJ,ShelleyWB.Asimplesurgicalapproachtothemanagementofaxillaryhyperhidrosis.JAMA1963;186:109-12.28.Bretteville-JensenG,MossingN,AlbrechtsenR.Surgicaltreat
mentofaxillaryhyperhidrosisin123patients.ActaDermVenereol(Stockholm)1975;55:73-7.29.EldhJ,FogdestamI.Surgicaltreatmentofhyperhidrosisaxillae.ScandJPlastReconstrSurg1976;10:227-9.272CanJPlastSurgVol7No6November/December1999KettleandFreiberg 6 G:...Kettle.vpFri Dec 10 16:35:21 1999Color profile: DisabledComposite Default screen 0 5 25 75 95 100 0 5 25 75 95 100 0 5 25 75 95 100 0 5 25 75 95 100 AxillaryhyperhidrosistreatmentbysimpleskinexcisionandunderminingCharlesKettleMDFRCSC,ArnisFreibergMDFRCSCFACSDivisionofPlasticSurgery,TheTorontoHospital,WesternDivision,Toronto,Ontarioxillaryhyperhidrosisisaconditioncharacterizedbyanexcessive,usuallyunprovoked,productionofsweat.Initsidiopathicformitaffects0.6%to1.0%ofthepopulation(1),andmaybeconfinedtotheaxillaorinvolvethepalmsandsoles.Italsooccurssecondarilyasafeatureofothersystemicdiseases(ie,thyrotoxicosis,hypoglycemia).Sweatingoccursinbursts,usuallyassociatedwithemotionalsituations,butmaybespontaneous(2).Whenpresent,axillaryhyperhidrosiscanbethecauseoftremendousembarrassmenttothepatientand,whensevere,mayevencauseclothestorot(3,4).Itismorecommoninwomen,usuallypresentinginthelateteensorearly20s.Thereappearstobeanincreasedincidenceamongfamilymembers,implicatingageneticpredisposition.Axillaryhyperhidrosisismorecommoninindividualssufferingfromhyperhidrosisofthepalmsofthehandsand/orsolesofthefeet.Theredoesnotappeartobeanincreaseintheincidenceofbromidrosisassociatedwithaxillaryhyperhidrosis(5).Mostpatientspresentformedicalorsurgicaltreatment.Thispaperreviewscurrentpracticesanddemonstratesaneffective,simplesurgicalprocedureforthetreatmentofaxillaryhyperhidrosis.PATIENTSANDMETHODSDuringthe13yearstudyperiod,57consecutivepatientsaged17to48underwentexcisionoftheaxillarysweatglands.Thepatientswerereferredbyfamilyphysicians,dermatologistsorotherpatients.Patientsinthisstudywereassessedasre PAPERSANDARTICLES Correspondenceandreprints:DrArnisFreiberg,TheTorontoHospital,WesternDivision,399BathurstStreet,EdithCavellWing4-034,Toronto,OntarioM5T2S8.Telephone416-603-5691,fax416-603-5297e-mailafreiberg@torhosp.toronto.on.ca CKettle,AFreiberg.Axillaryhyperhidrosistreatmentbysimpleskinexcisionandundermining.CanJPlastSurg1999;7(6):267-272.Thecurrentliteratureofaxillaryhyperhidrosisisreviewed.Excisionofthegland-containingskinoftheaxillahasbeenamainstayinthetreatmentofaxillaryhyperhidrosisformanyyears.Aretrospectivestudywasperformedusingdataaccumulatedfrom56consecutivepatientswhounderwentasurgicalproceduremodifiedfromthatoriginallydescribedbyHurleyandShelley.Excisionofthehair-bearingportionoftheaxillawithunderminingoftheadjacentskinandsimpleclosurewasperformedunderlocalorgeneralanesthesia.Ninety-twopercentofpatientsweresatisfiedwiththeresults.Fivepatientswishedtoundergoasecondprocedure,eitherbecausetheystillhadexcessiveperspirationorbecausetheywereunhappywiththeirscars.Complicationrateswerelowandwerecomparedwithotherseries.Thus,thedescribedprocedureprovidesasimple,safeandeffectivemodalityforthetreatmentofaxillaryhyperhidrosis.KeyWords:Axilla;Hyperhidrosis;Surgery;SweatglandsTraitementdel’hyperhidroseaxillaireparsimpleexcisiondelapeauetdécollement RÉSUMÉ:Lalittératurecourantesurl’hyperhidroseaxillaireestpasséerevue.L’excisiondelapeaudel’aissellecontenantlesglandesa 1 G:...Kettle.vpFri Dec 10 16:35:19 1999Color profile: DisabledComposite Default screen 0 5 25 75 95 100 0 5 25 75 95 100 0 5 25 75 95 100 0 5 25 75 9