Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory disease affecting the apocrine glands of the axillary, groin, and mammary regions with significant physical and psychosocial sequelae. Surgical excision of the affected tissue is the
criterion standard treatment. Advanced cases of axillary HS are associated with high
rates of recurrence and require extensive surgical resection with challenging reconstruction associated with risk of postoperative complications. The most effective
method for reconstruction of the axilla after excision of HS is yet to be identified.
Objectives: The aim of the study was to evaluate the results of the use of pedicled
thoracodorsal artery perforator (TDAP) flap as a method of reconstruction for axillary efect result from wide surgical excision as a line of treatment for stage II
and III HS of the axilla.
Patient and Methods: The study included 20 patients with stage II and III (Hurley
staging system) HS of the axilla, 18 male and 2 women treated by wide local excision
and reconstruction by rotational TDAP flap. At the end of follow-up, outcome is
judged by complete remission of disease, comparing preoperative shoulder function
(using Constant-Murley shoulder outcome score), and quality of life (using dermatology life quality index) with postoperative results after 1 year, plus durability of reconstruction, donor site morbidity, overall aesthetic outcome, and patient's satisfaction.
Results: The mean ± SD follow-up period was 30 ± 5.2 months (range =
12–60 months). Four patients (20%) were treated for their right side, 8 patients
(40%) for their left side, and 8 patients (40%) were treated bilaterally, so we perform 28 operations for 20 patients. The treated patients with stage II disease were
16 (57.14%) and with stage III disease were 12 (42.85%). The size of the defects
was usually approximately 10 15 cm. By the end of follow-up period, all patient
showed complete remission of the disease with improvement in both shoulder
function and quality of life, whereas 1 flap (3.57%) was complicated by bleeding
treated by reoperation, 2 flaps (7.14%) complicated by wound infection that was
treated conservatively, 3 other flaps (10.71%) showed wide scare at insight of the
flaps, and 1 flap (3.57%) developed hypertrophic scare at donor site of the flap.
Conclusions: Surgical treatment of stage II and III HS of axilla and reconstruction by rotational TDAP flap provides good aesthetic and functional results with 100% success rate in eradicating and complete remission of the
disease during follow-up period and accepted complication rate. |
