To the Editor,

Bromhidrosis occurs when the apocrine glands secrete excessive amounts of sweat that produce a foul odor when exposed to skin bacteria. Over the years, we have performed hundreds of bromhidrosis surgeries and have changed our approach for postoperative wound management several times. Methods used for postoperative wound management of bromhidrosis surgery are very important. The purpose of this letter is to share our experience about postoperative wound care for patients undergoing bromhidrosis surgery with other surgeons and nurses who may be responsible for or assisting with the care of these patients.

Previously, after performing bromhidrosis surgery, we would apply a dressing composed of a sterile cotton swab moistened with saline. After this, we would apply a thin layer of gentamicin ointment and cover the wound with gauze. In most cases, it takes approximately 1-2 weeks for the wound to heal. During this period, we recommended that the patient keep the armpit (or other affected area) dry. A few days after the dressing is removed, the skin flap usually undergoes a short and unavoidable erosive phase. This is often accompanied by a malodorous smell (Qian & Wang, 2010). Although this method is simple and easy to learn, we found that because of its malodorous smell and associated tissue decay, patients often used the cotton swab to unconsciously remove the skin flap. This action injures the skin flap, prolongs wound healing, and also increases the formation of purulent granulation tissue. When granulation tissue develops, the patient must return to the clinic for electrocautery scraping.

Given these shortcomings, we began using 1% silver sulfadiazine cream. We found that patient complaints about the malodorous smell as well as the excessive cleaning behavior exhibited by the patients were significantly reduced, and this decreased the development of purulent granulation tissue.

Subsequently, we began to use Mepilex Ag antimicrobial foam dressing (Molnlycke, Gothenburg, Sweden) on our patients undergoing bromhidrosis surgery. We found that when using the Mepilex Ag, the amount of exudate was small and no dressing was required after 3 days. Because the dressing continuously releases an antimicrobial substance, the number of postoperative infections has decreased significantly and the offensive odor has been eliminated, even in cases of necrosis or poor healing of the skin flap. We have not seen any allergic reactions in our patients. The only complaint we have received about the dressing is that it produces a grayish-black stain. This phenomenon is short-lived and completely disappears within a few weeks. The Mepilex Ag dressing is an excellent product for managing wounds of patients undergoing bromhidrosis surgery.

Wen-Guo Chen, MD

Wen-Tsao Ho, MD

Ho Wen Tsao Skin Clinic

Linkou District, New Taipei City, Taiwan, R.O.C.

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