Armpit odor is a common disease that brings a lot of inconvenience to daily life. In recent years, with the development of medical technology and people’s awareness of their own aesthetics, the traditional axillary odor removal surgery has been gradually replaced by the safe and efficient minimally invasive surgery due to the limitations of large trauma, slow recovery and many complications. Minimally invasive axillary odor surgery includes: minimally invasive suction scraping, axillary odor scraping and endoscopic assisted axillary odor scraping. In recent years, due to the continuous progress of medical technology, the traditional axillary odor removal surgery has been gradually replaced by the safe, minimally invasive, minimally invasive axillary odor surgery with short recovery period and good results. Minimally invasive axillary odor surgery mainly includes: minimally invasive scraping, axillary odor scraping and endoscopic assisted axillary odor scraping. Aspiration is the use of the principle of negative pressure liposuction, using a special scraper in the axilla to scrape the subdermal sweat glands and hair follicles, while scraping is the use of a sharp spoon to scrape the subdermal sweat glands and hair follicles, endoscopy-assisted axillary odor scraping is based on the scraping procedure, with endoscopic inspection of the surgical field to reduce residual tissue and debris. The common feature is that the operation is carried out with a small incision of 0.5cm in the axilla, which basically leaves no scar after healing and keeps the beauty of the axilla; after the operation, in addition to the destruction of the sweat glands, the growth of hair follicles is also destroyed, so that the deodorizing effect is permanent and the effect of hair removal can be achieved at the same time. It is especially favored by female patients and has been widely used in clinical practice. A, the pathological basis of axillary odor axillary odor is the secretion of odorous sweat by the axillary glands after bacterial decomposition, resulting in a special pungent odor. Unsaturated fatty acids —- butyric acid isovaleric acid is the main odor component that causes axillary odor. The axillary glands are a special kind of sweat gland, which is innervated by adrenergic nerves. It is mainly distributed in the dermis and divided into three parts: secretory, intra-dermal and intra-epidermal. The secretory part is the larger ductal gland, mainly located in the deep dermis or superficial subcutaneous tissue, is the main location for the production of odoriferous sweat. Its duct opening is within the hair follicle and has a common opening with the follicle within the hair follicle. The hair follicles, sebaceous glands, and sweat glands open together in the epidermis at the mouth of the sebaceous glands of the hair follicles. In female patients, axillary sweat glands in the menstrual cycle and lactation secretion cells increase, the glandular cavity can also be expanded, so the menstrual cycle and lactation in the axillary odor will be aggravated, and because of the role of sticky substances, axillary odor will also stick to the axillary hair or axillary skin with skin impurities, the general cleaning is also very difficult. After puberty, axillary odor will be significantly aggravated due to the increasing body hormone level and the growth and secretion of sweat glands. Accordingly, minimally invasive surgery takes the subdermis and superficial subcutaneous layer as the focus of surgery, preserving the large part of the dermis and epidermis, which not only reduces the trauma to the minimum, but also solves the problem of leaving a huge trauma after surgery. General concept 1.Minimally invasive surgery: Minimally invasive surgery for axillary odor means using a special suction device or scraping spoon to remove or scrape the subdermal layer and superficial fat through a small incision (0.5cm) in the axilla, preserving the epidermis and dermis, so as to achieve the purpose of treating axillary odor. 2.Swelling anesthesia: The concept of swelling anesthesia was proposed in 1987 and introduced in 1995 by Cui Rixiang, Gao Jingheng, etc. The swelling technique injects a large amount of low concentration (0.05%-0.1%) lidocaine into the subcutaneous fat layer to produce edema in the subcutaneous tissue and the structures between them, separating the cellular tissue gaps, compressing the tiny blood vessels to occlude them, reducing the absorption of drugs and bleeding, compressing and anesthetizing It compresses and anesthetizes the tiny nerve fibers and produces anesthetic effects. Minimally invasive surgery 1.Minimally invasive suction and scraping: using a special suction head connected to a suction tube and a negative pressure liposuction machine for operation. The suction head is similar to the liposuction tube, the difference is that the distal end of the suction head is flat, hollow and sharper, and there are two lateral holes at 0.5cm from the tip. Before surgery, the axillary area is marked with a range of axillary hair without shaving, and the area is expanded by 0.5 cm for local swelling anesthesia. About 100ml-120ml of low concentration lidocaine is injected under the dermis of each side, causing the skin in the anesthetized area to swell and protrude about 0.5cm, with localized whitening and hardening of the skin and flattening of the depression. Forearm near the axillary hair 1-2cm incision, placed in the suction head, uniform suction, to the local skin slightly blue-purple change, axillary hair can be easily removed; suction skin thickness uniform, can be with the suction tube side hole in the negative pressure depression as an indication, axillary hair extraction, and then gently suction once, check whether the suction scraping thoroughly, after surgery, large cotton pad pressure bandage fixed, 5-6 days to remove stitches. 2, axillary odor scraping: the use of special scraping spoon for operation, the distal end of the scraping spoon is ring-shaped, there are wedge-shaped sharper spatula protrusion, conducive to the separation of tissue, sharp on both sides, conducive to scratching the dermis and subcutaneous. Axillary hairs were removed before the operation and marked according to the outer edge of this range 0.5 cm, and local swelling anesthesia was applied. An incision is made at the midpoint of the posterior axillary marker line, 0.5cm-1cm long, and a spatula is inserted and scraped evenly under the skin in close proximity to the skin in sequence until the inner surface of the skin feels smooth to the touch and the skin surface is slightly bruised. After scraping, the fat, hair follicles, sweat glands and other fragments produced were extruded from the body by the incision and the cavity was repeatedly flushed. After the operation, large cotton pads with pressure bandage fixed, 5-6 days to remove the stitches. 3, endoscopic assisted axillary odor scratching: on the basis of scratching, endoscopic inspection of the surgical field to reduce residual tissue and debris. The advantage is to ensure that the surgical effect is complete, no residue in the field, the disadvantage is that the operation is relatively cumbersome, the equipment requirements are high, the cost is higher. Fourth, the application of swelling anesthesia in surgery Swelling anesthesia technique has become a fairly important part of axillary odor surgery, which, in addition to achieving anesthesia and enhancing the duration of anesthesia, also makes the axillary area firm, the tissue gap fully separated, edema, making the surgical peeling more thorough, easier, less traumatic, reducing the postoperative recurrence rate and improving the therapeutic effect. The ideal anesthetic fluid configuration should be supplemented with epinephrine (one drop of 0.1% epinephrine for every 10 ml of expansion fluid) to reduce intraoperative bleeding. Fifth, the timing of surgery 1, youth after puberty because the sweat gland development has been basically perfect, and began to be in the peak of secretion, suitable for the choice of surgery, clinically 18 years of age as the boundary, but in individual well-developed, not yet 18 years old adolescents, serious axillary odor can also choose surgery, but should not be less than 16 years old, too young, may be due to the sweat glands have not been fully developed and lead to residual, recurrence after surgery The risk of recurrence after surgery is increased. 2, women to avoid menstruation, so as not to aggravate the bleeding, the formation of hematoma. 3. If you have received laser or cryotherapy before, you should undergo minimally invasive surgery 3 to 6 months after the last treatment. VI. Important precautions 1. Axillary hair should be preserved before surgery, with a length of at least 1 cm, to ensure that it can be lifted by hand during surgery; 2. The scope of surgery should be slightly larger than the distribution of axillary hair to ensure that no residue remains from the surgery; the skin in the axillary area should not be suctioned and scraped too thinly during surgery, or repeatedly suctioned in the same area to avoid skin necrosis. 3, postoperative pressure bandage is an important part of the success of the surgery, because the axillary depression is obvious, after surgery is a large cavity left, improper bandage will make the skin necrosis, infection, or the formation of folds after healing, affecting the results of surgery, so the axillary part should be increased after surgery cotton pad pressure bandage, fixed, so that the depressed part is padded to slightly raised, the pressure is moderate, just enough to compress the hemostasis, and will not compress the axillary nerve is appropriate The pressure should be moderate enough to stop bleeding and not compress the nerves in the axilla. If the patient has no special discomfort after the operation, it is not advisable to open the bandage too early to avoid causing flap displacement. Conclusion: Minimally invasive surgery has become the direction of development of axillary odor surgical treatment. It has the significant advantages of short time, good results, fast recovery, no scarring after surgery, reducing the patient’s pain and improving the quality of life, has become the first choice of more and more patients. However, due to the lack of objective qualitative and quantitative criteria for minimally invasive surgery for the treatment of axillary odor, further improvement is still needed.