For the last decades, the latissimus dorsi skin-muscle flap has contributed to the efficient reconstruction of the loss of skin cover (especially in breast surgery) and in long-distance tissue defects. Unfortunately, the nonuse of such an important muscle as the latissimus dorsi for the patient, as well as the resulting thickness of the flap after reconstruction, has turned it into a second choice flap. However, this flap is still indicated in the reconstruction of areas which need a great amount of cutaneous and muscular tissue. The appearance of the perforator flaps and, specifically, thoracodorsal artery perforator (TDAP) flap, has meant a radical change in relation to lower morbidity of the donor site, thus highly ranking the use of these flaps in the reconstruction for similar defects. The aim of this publication is to present our experience with the pedicled TDAP flap in a series of 17 different cases. Of those, there were 14 cases of mammary reconstruction after sparing surgery, 2 cases of axillary reconstruction following severe recurrent hidradenitis, and a case of extensive substance loss in a patient's upper limb following a severe crush injury.

Hidradenitis suppurativa is a chronic and recurrent inflammatory disease of the apocrine glands characterized by recurrent abscesses, draining sinus tracts, and scarring that can be located in the groin, axilla, perineal, and perianal areas and less frequently in the scalp area. The chronic and relapsing nature of hidradenitis suppurativa leads to physical and psychological damage because it frequently causes disabling pain, diminished range of motion, and social isolation. Surgical removal of all apocrine glands in the affected region is the definitive treatment because conservative treatment usually does not prevent recurrence of hidradenitis suppurativa. The resultant defect can be either left to heal secondarily or closed primarily. Secondary healing in the axilla may cause contractures and stiffening of the shoulder. Primary healing requires direct closure, split-skin grafting, or locoregional flap transposition. The majority of the listed surgical procedures cause long hospital stays and leave contour defects in both the axilla and the arm. This report presents a series of 16 cases managed between March 2006 and June 2008. All the patients had endured a long period of medical treatment and subsequently required surgery for long-term relief of symptoms. The functional and aesthetic outcomes were very satisfactory in all cases despite the final scar. The initial reconstructive aims were achieved for these patients. The authors consider the thoracodorsal artery perforator flap a useful option for the surgical treatment of axillary hidradenitis suppurativa.

No abstract

Una de las herramientas más útiles con las que cuenta el cirujano plástico y estético de hoy en día es la fotografía. Cirugía Estética y fotografía son inseparables. El registro fotográfico de pacientes para crear un archivo permanente es esencial para especialidades como la nuestra por varios motivos: ayudar al diagnóstico, facilitar la relación médico-paciente, dejar constancia documental, para protección legal y como herramienta de marketing, entre otros. Por consiguiente son importantes la estandarización y las recomendaciones referentes a fotografía clínica, que deben ser bien conocidas por los profesionales. A pesar de que son numerosos los artículos referentes a esta materia, todavía es frecuente encontrar en publicaciones y presentaciones en congresos imágenes que no satisfacen unos estándares mínimos de calidad fotográfica. Es importante que nuestro archivo fotográfico sea consistente, comparable y esté bien organizado para que pueda ser usado fácilmente y con eficacia.