Upper thoracic sympathectomy for axillary osmidrosis or bromidrosis

Area of Science:

• Thoracic Surgery
• Dermatology
• Surgical Oncology

Background:

• Axillary osmidrosis (AO) and axillary bromidrosis (AB) are distinct conditions differentiated by odor intensity and sweat volume.
• Upper thoracic sympathectomy is a potential treatment for both, but clinical data on its efficacy is limited.
• Patient outcomes vary depending on the specific condition treated.

Purpose of the Study:

• To evaluate the effectiveness of upper thoracic sympathectomy in treating axillary osmidrosis (AO) and axillary bromidrosis (AB).
• To compare patient satisfaction and improvement rates for AO alone, AB (AO with axillary hyperhidrosis [AH]), and AO with palmar hyperhidrosis (PH).

Main Methods:

• A retrospective review of 108 patients undergoing upper thoracic sympathectomy for AO or AB between July 1995 and July 2002.
• Procedures included anterior subaxillary transthoracic endoscopic sympathectomy (TES) and posterior percutaneous thoracic phenol sympathicolysis (PTPS).
• Sympathectomy/sympathicolysis levels were T3-4 for AO/AB and T2-4 for AO with PH.

Main Results:

• Overall improvement and satisfaction rates were 78.6% for AO, 88.2% for AB, and 85.7% for AO with PH.
• Patient satisfaction rates were 52.4% for AO, 70.6% for AB, and 61.2% for AO with PH.
• Higher satisfaction was observed for AB and AO with PH compared to AO alone.

Conclusions:

• Upper thoracic sympathectomy appears to be a more acceptable treatment for axillary bromidrosis (AB) and axillary osmidrosis with palmar hyperhidrosis (PH) than for axillary osmidrosis (AO) solely.
• The findings support tailored therapeutic approaches based on the specific axillary condition.
• Further clinical data is warranted to fully elucidate the role of sympathectomy in managing these conditions.