Island Thoracodorsal Artery Perforator–Based V-Y Advancement Flap After Radical Excision of Axillary Hidradenitis

Hallock, Geoffrey G.

doi:10.1097/sap.0b013e31824b3e42

Cited by 11 publications

(5 citation statements)

References 18 publications

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“…Anatomical location-specific flap reconstruction alternatives have also been described and may offer fewer complications in addition to a superior aesthetic and functional result compared to skin grafting. [23][24][25] Our institutional data align with previously reported high recurrence rates following excision and reconstruction, with our population having a recurrence rate of 20.2 percent within 1 year and a rate of 11.5 percent after 1 year at the same operative site. The specific cause of this is unclear, but underrecognition of the extent of diseased tissue with inadequate resection at the time of surgery is possible, and these rates argue for more aggressive initial excisions.…”

Section: Discussionsupporting

confidence: 85%

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Hidradenitis Suppurativa: A Comparison of Institutional Experience and the Tracking Operations and Outcomes for Plastic Surgeons Registry

Steele

Miller

Wallace

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Hidradenitis suppurativa is a chronic inflammatory dermatologic condition occurring most commonly in areas with large numbers of apocrine sweat glands. Surgical excision and wound reconstruction are indicated for severe or refractory disease. This study aims to explore institutional reconstructive outcomes following hidradenitis suppurativa excision and compare these to the nationally recognized Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database to determine best-practice guidelines. Methods: A retrospective chart review of all patients with surgically treated hidradenitis suppurativa from January of 2004 to January of 2016 was performed. Data on patient characteristics, reconstructive methods, and outcomes were collected. Outcomes for each reconstructive method were analyzed and associations between reconstruction and complications were determined. These results were compared to TOPS data. Results: A total of 382 operative sites for 101 individual patients were reviewed. Overall complication rates were 80, 68.3, and 59.6 percent for simple, intermediate, and complex closure, respectively; 68.3 percent for adjacent soft-tissue rearrangement; and 100 percent for split-thickness skin grafts and perforator flaps. Statistical significance was identified between superficial wound dehiscence and adjacent tissue rearrangement compared to intermediate and complex closure (p = 0.0132). TOPS data revealed similar wound breakdown rates for primary closure methods but much lower rates with negative-pressure wound therapy, split-thickness skin grafts, and muscle flaps. Conclusions: Primary closure techniques for hidradenitis suppurativa wound reconstruction possess high complication rates, whereas improved outcomes are observed with negative-pressure wound therapy, split-thickness skin grafts, and muscle flaps. The correlation in outcomes between our experience and that reported in the TOPS database provides a level of validation to this national database.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Hidradenitis Suppurativa: A Comparison of Institutional Experience and the Tracking Operations and Outcomes for Plastic Surgeons Registry

Steele

Miller

Wallace

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Among 52 identified, 36 [ 28 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ] studies were included, as shown in the corresponding flowchart ( Figure 1 ). We included 286 patients with 380 defects and 387 flaps, some defects being reconstructed by two flaps.…”

Section: Resultsmentioning

confidence: 99%

Outcomes and Reliability of Perforator Flaps in the Reconstruction of Hidradenitis Suppurativa Defects: A Systemic Review and Meta-Analysis

Vaillant

Berkane

Lupon

et al. 2022

JCM

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Introduction: Hidradenitis suppurativa (HS) is a common and debilitating disease, in which the only effective treatment involves a wide excision of the affected skin. Secondary wound healing and skin grafting are two well-known options for managing these defects, but perforator flaps provide a new therapeutic alternative by ensuring reconstructions of large defects, reducing donor site morbidity, and enhancing functional recovery. The aim of this study was to achieve a systematic review of perforator flaps use in HS. Patients and Methods: PubMed and Cochrane databases were searched from 1989 to 2021. The PRISMA statement was used in the study selection process and the review was registered on PROSPERO. Furthermore, patient characteristics, operative technique, complications, and recurrences were searched. Results: Thirty-six articles were selected including 286 patients and 387 flaps. Axillary localization was mostly represented (83.2%). Direct donor site closure was achieved in 99.1% of cases. In total, 15.1% of the flaps presented at least one of the following complications: wound dehiscence (5.5%), partial necrosis (2.9%), hematoma or seroma (2.1%), infection (2.1%), venous congestion (1.8%), and nerve injury (0.3%). Two cases of total necrosis were recorded. Recurrence of the disease was observed in 2.7% of the defects. Conclusions: Pedicled perforator flaps are a reliable and reproducible technique in the reconstruction of HS defects. They are associated with a low recurrence rate while ensuring an effective reconstruction with reduced morbidity and faster recovery compared to the techniques classically used in this indication.

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“…Only 57 articles were assessed for full-text eligibility, and among those, 22 studies were eventually included by criteria defined in the protocol ( Table 1 ). 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Of the 35 articles excluded after full text screening, the majority was rejected due to follow-up length not clearly stated or patient characteristics not well described. Mean quality score was 6.4, ranging from 2 to 9, according to NIH Quality Assessment Tool.…”

Section: Resultsmentioning

confidence: 99%

Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review

Amendola

Cottone

Alessandri‐Bonetti

et al. 2022

Indian J Plast Surg

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Introduction Hidradenitis suppurativa (HS) is a chronic, debilitating, recurrent, auto-inflammatory disease of the pilosebaceous units of the skin. The axillary region is the most affected anatomical site and its reconstructive options include skin grafts, local random plasties, regional axial flaps, and regional perforator flaps. The main aim of this systematic review is to identify the best surgical technique for axillary reconstruction in the context of HS, in terms of efficacy and safety. Methods We adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) throughout the whole review protocol build-up. The literature search was performed using MEDLINE, Embase, and Cochrane library databases, updated to March 2021. Quality was assessed for each study, through the National Institutes of Health Quality Assessment Tool. Results A total of 23 studies were included in the final analysis. We reviewed a total of 394 axillary reconstructions in 313 patients affected by HS Hurley Stage II or III. Skin grafts were associated with the highest overall complication rate (37%), and highest rate of reconstruction failure (22%). Between thoraco-dorsal artery perforator flap, posterior arm flap, and parascapular flap, the latter showed fewer total complications, recurrences, and failures. Conclusion Regional axial flaps should be considered as the best surgical approach in the management of advanced HS. The parascapular flap emerges as the most effective and safest option for axillary reconstruction. Local random flaps might be considered only for selected minor excisions, due to the higher risk of recurrence. The use of skin grafts for axillary reconstruction is discouraged.

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Island Thoracodorsal Artery Perforator–Based V-Y Advancement Flap After Radical Excision of Axillary Hidradenitis

Cited by 11 publications

References 18 publications

Hidradenitis Suppurativa: A Comparison of Institutional Experience and the Tracking Operations and Outcomes for Plastic Surgeons Registry

Hidradenitis Suppurativa: A Comparison of Institutional Experience and the Tracking Operations and Outcomes for Plastic Surgeons Registry

Outcomes and Reliability of Perforator Flaps in the Reconstruction of Hidradenitis Suppurativa Defects: A Systemic Review and Meta-Analysis

Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review

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