Our Experience in Using Lateral Chest Flap to Treat Axillary Hidradenitis Suppurativa

Abstract

Background: Hidradenitis suppurativa is a chronic inflammatory condition that affects apocrine gland-bearing areas‚ causing abscesses and sinuses. Multimodality treatment is suggested for management. The surgical option is becoming more widely used, especially in drug-resistant cases. In this article, we describe a series of bilateral axillary hidradenitis cases which we treated with wide local excision and immediate reconstruction with lateral chest flap. Methods: Fourteen patients presented to our clinic with bilateral hidradenitis suppurativa of the axilla. The cases were all resistant to medical treatment. They were managed by excision and simultaneous reconstruction with lateral chest flaps. Results: At 3 months postoperatively, all patients had full shoulder range of motion and were completely satisfied with the aesthetic outcome, except for one patient who complained of the bulky look of his axilla. Liposuction was performed for him‚ with a pleasant resultant outcome. Conclusions: Our patients underwent wide local excision of bilateral disease plus reconstruction with lateral chest flaps in the same session. Our aim was to introduce a treatment option for moderate to severe axillary hidradenitis suppurativa that offers good aesthetic and functional outcomes.

Use of multiple fasciocutaneous flaps for the management of extensive hidradenitis suppurativa

“…Additionally, split-thickness grafts have been associated with a lower recurrence rate because they do not contain cutaneous appendages, which are involved in the aetiology of the disease18; however, in this case study, a skin graft was not considered a closure method because flaps are more reliable in mobility areas, like the axilla and groin. Moreover, skin grafts require a prolonged period of immobilisation postoperatively, which may result in contractures and decreased range of motion 19 20…”

“…Moreover, skin grafts require a prolonged period of immobilisation postoperatively, which may result in contractures and decreased range of motion. 19 20 …”

The Pathogenesis and Treatment of Hidradenitis Suppurativa

“…This treatment is reserved as a last resort for disease that is refractory to pharmacologic treatments and with irreversible tissue damage such as scarring and sinus tract formation [ 23 ]. There are variable rates of recurrence with surgical excision, but closure technique can minimize recurrence [ 22 , 23 , 30 , 31 ].…”