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

Abstract

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.

Surgical management of axillary hidradenitis suppurativa with latissimus dorsi flap on a 24-year-old patient: A case report

“…However, in cases of severe conditions where patients do not respond to the aforementioned options or have irreversible lesions, surgical treatment should be considered [ 1 ]. Surgical options include skin grafts, local random flaps, regional axial flaps, regional perforator flaps, and secondary intention healing [ 13 ]. A review conducted by Amendola et al highlighted the positive outcomes of Thoracodorsal artery perforator (TDAP) flaps compared to skin grafts, showing lower recurrence rates [ 13 ].…”

“…Surgical options include skin grafts, local random flaps, regional axial flaps, regional perforator flaps, and secondary intention healing [ 13 ]. A review conducted by Amendola et al highlighted the positive outcomes of Thoracodorsal artery perforator (TDAP) flaps compared to skin grafts, showing lower recurrence rates [ 13 ]. This is supported by the findings of Wormald et al who demonstrated in their study that patients who underwent TDAP flap reconstruction had significantly faster recovery, fewer complications, and fewer overall number of procedures than those who underwent split skin grafts (SSG) reconstruction.…”

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

“…We have read the review article titled “Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review” by Amendola et al 1 While congratulating the authors on this insightful review article, we would like to contribute some insights.…”

Axillary Hidradenitis Suppurativa: A Comparison between Two Perforator Flap Reconstructive Approaches after Radical Surgical Management

“…33 Among the options for pedicled fasciocutaneous flaps, various alternatives exist, including the thoracodorsal artery perforator (TDAP), circumflex scapular artery perforator, serratus anterior thoracic artery, lateral thoracic artery perforator, lateral intercostal artery perforator, inner arm artery perforator (IAAP), and posterior arm artery perforator flaps. [34][35][36][37][38][39][40] In severe cases with extensive defects, some authors have reported the utilization of free flaps, such as the deep inferior epigastric artery perforator flap. 41 However, the outcomes of these various techniques are not yet well-established, and no technique has emerged as the optimal solution.…”