Surgical management of axillary bromidrosis--a modified skoog procedure by an axillary bipedicle flap approach.

We developed a modified Skoog procedure to treat axillary bromidrosis and hyperhidrosis that creates a bipedicle flap over the axillary fold with two parallel incisions to achieve a complete excision of the sweat glands. If necessary, the flap can be extended by making another parallel incision for a larger axillary hair-bearing area. Between 1988 and 1992, 110 patients were operated on using this method, but only 92 of the 110 patients, with an average follow-up period of 29.5 months, were available for this follow-up study. In this series, 86.9 percent of patients gave a family history of axillary bromidrosis. This follow-up review demonstrated that 93.5 percent of patients experienced no odor or occasional very mild axillary odor postoperatively. Postoperative scar formation was either nonvisible or excellent in 95.1 percent of patients, and 82.6 percent of patients reported either a hairless axilla or a marked decrease of axillary hair. Most importantly, 92.4 percent of patients reported a marked decrease in axillary sweat. Four axillary fossae developed postoperative subcutaneous hematomas, and six wounds had mild dehiscence. All of the wounds eventually healed satisfactorily after minor procedures. We concluded that for the treatment of extensive axillary apocrine bromidrosis, this new method achieves complete excision of the sweat glands and provides excellent functional and cosmetic results.