Treatment of severe hidradenitis suppurativa of the axilla: Thoracodorsal artery perforator (TDAP) flap versus split skin graft

Wormald, Justin C.R.; Balzano, Antonella; Clibbon, John; Figus, Andrea

doi:10.1016/j.ijsu.2014.08.087

Cited by 3 publications

(5 citation statements)

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“…TDAP flaps have also been shown to be superior in postoperative arm abduction compared to other reconstructive procedures [ 22 ]. A study with direct comparison of STSG and TDAP flap demonstrated that TDAP flap is superior with reduced recovery time, has less postoperative complications and better quality of life [ 23 ]. The posterior-arm flap demonstrated its capabilities of using a similar pedicle for reconstructing axillary as well as thoracic wall defects, but has the downside of leaving a highly visible horizontal scar on the posterolateral aspect of the arm which may not be suitable to certain population groups [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Axillary Reconstruction for Hidradenitis Suppurativa with an Inner-Arm Transposition Flap Creating a Brachioplasty Effect

et al. 2017

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BackgroundHidradenitis suppurativa (HS) is a chronic skin condition that can affect any area with apocrine sweat glands and has the potential to involve multiple sites concurrently. Commonly affected sites include the axilla, groin, perineum and perianal areas. In this study we performed a literature review on the surgical methods for HS and describe an innovative technique for reconstructing axilla HS using an inner-arm transposition flap.MethodsWe reviewed all cases (5 cases from 4 patients) of transposition flap reconstruction performed by the senior author at a single London tertiary hospital from 2008–2013. Patient related outcome measures were collected using the Derriford appearance scale (DAS 24) and a study specific questionnaire.ResultsAll patients were satisfied with their final result. One out of five cases had a complication but did not result in flap failure. There is no disease recurrence to date. DAS 24 scores collected demonstrated acceptable postoperative distress that did not deviate far from the norm tables while study specific questionnaire reveal desirable outcomes.ConclusionsWe have managed to achieve our aim through the use of the innovative inner-arm transposition flap. Our study hopes to provide an additional technique for axillary reconstruction. This technique offers the effective concealment of scars with the benefit of tightening of the arm tissue producing ‘brachioplasty like’ effects. All things considered it would be reasonable to conclude the innovative flap technique is a reliable, effective, and simple method that results in multiple benefits.

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Section: Discussionmentioning

confidence: 99%

Axillary Reconstruction for Hidradenitis Suppurativa with an Inner-Arm Transposition Flap Creating a Brachioplasty Effect

et al. 2017

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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%

“…11 The TDAP flap also requires a meticulous preoperative planning, with the mapping of the perforators, and a consistent operative time. 11 13 26 Wormald et al compared the use of TDAP with the skin graft for axillary reconstruction in patients affected by HS, and showed a significantly improved quality of life in the TDAP group. 26 Similarly, Busnardo et al demonstrated a significant increase in arm abduction and mobility of the arm and shoulder at 6 months follow-up using the TDAP flap after excision of severe axillary HS.…”

Section: Discussionmentioning

confidence: 99%

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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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“…Flaps have a definite advantage over skin grafts, avoiding complications like poor graft take, poor color match, and possible secondary contracture, limiting the range of motion. The flaps described include local transposition flaps such as Limberg flap 3 or the V-Y advancement flap, 4 thoracodorsal artery perforator flap, 5 lateral thoracic flap, 6 and posterior arm flap. 7 8 9…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Bilateral Reconstruction of the Axilla with Posterior Arm Flap in Recurrent Hidradenitis Suppurativa

Ete

et al. 2022

Indian J Plast Surg

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Introduction Hidradenitis suppurativa (HS) is a chronic inflammatory disease, with the axilla being the most commonly affected site. Radical excision of the involved tissue is a definitive treatment. There are numerous techniques described for the reconstruction of the axilla. Patients and methods Patients with axillary HS who underwent wide excision and posterior arm flap cover between August 2017 and December 2020 were reviewed. Results A total of 15 flaps were done in eight patients in the study period. Bilateral radical excision of the disease was done simultaneously in all eight patients with the help of a two-team approach. Reconstruction of the axilla was done with a posterior arm flap bilaterally, except one side in a single patient, wherein the split-thickness skin graft was performed. All flaps settled well without significant complications. On follow-up ranging from 12 to 42 months, one patient complained of disease recurrence on one side. The flap and the donor site had settled well in all patients, causing no significant morbidity. Conclusion Radical excision of axillary hidradenitis must be considered early on presentation. After wide excision, simultaneous bilateral reconstruction with posterior arm flap is a simple and reliable technique with an excellent patient-reported outcome.

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Treatment of severe hidradenitis suppurativa of the axilla: Thoracodorsal artery perforator (TDAP) flap versus split skin graft

Cited by 3 publications

References 0 publications

Axillary Reconstruction for Hidradenitis Suppurativa with an Inner-Arm Transposition Flap Creating a Brachioplasty Effect

Axillary Reconstruction for Hidradenitis Suppurativa with an Inner-Arm Transposition Flap Creating a Brachioplasty Effect

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

Simultaneous Bilateral Reconstruction of the Axilla with Posterior Arm Flap in Recurrent Hidradenitis Suppurativa

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