Optimizing the surgical paradigm for axillary osmidrosis: a retrospective cohort study integrating tumescent suction-curettage and direct-vision trimming

Background Axillary osmidrosis (AO) is a distressing dermatological condition driven by a complex genetic and microbiological axis. While surgical extirpation of the hyperplastic apocrine glands remains a highly effective treatment, surgeons persistently face an anatomical dilemma: achieving extensive clearance often destroys the subdermal vascular plexus, leading to severe ischemia and scarring. This study comprehensively reviews the biomolecular etiology of AO and evaluates an optimized hybrid paradigm designed to effectively address this surgical dilemma. Methods A retrospective cohort study included 86 patients with bilateral AO, comparing the modified technique by tumescent suction-curettage combined with direct-vision trimming with traditional small-incision resection. To elucidate the tissue-preserving biomechanics, the operative steps are illustrated utilizing a representative severe case (24-year-old female, Park Grade III). Efficacy, complications, and patient satisfaction at 6 months postoperatively were analyzed. Results The total effective rate was 97.67% in the modified group and 95.35% in the traditional group, demonstrating no statistically significant difference in clinical efficacy ( P = 1.000). However, the modified cohort demonstrated significantly accelerated wound healing, minimal intraoperative bleeding, and lower complication rates ( P < 0.05). Overall patient satisfaction was significantly higher in the modified group (93.02% vs. 72.09%, P < 0.05), benefiting from highly concealed scarring and the absence of flap necrosis. Conclusion By synergizing atraumatic negative-pressure defatting to safeguard microcirculation with direct-vision trimming to eliminate surgical blind spots, the modified technique achieves comparable efficacy to traditional surgery while minimizing morbidities. It translates fundamental biomolecular mechanisms into a highly reproducible clinical surgical option.