Anzeige
Erschienen in:
01.06.2020 | Original Paper
A review of the reconstructive methods in the management of axillary hidradenitis suppurativa
Erschienen in: European Journal of Plastic Surgery | Ausgabe 3/2020
Einloggen, um Zugang zu erhaltenAbstract
Background
Hidradenitis suppurativa (HS) is a chronic debilitating inflammatory disease of the apocrine gland-bearing body areas, characterized by painful recurrent abscess, sinus tract formation, and scarring. The treatment for HS consists of medical and surgical treatments in a multidisciplinary approach. Wide excision and reconstruction over the axillary hidradenitis suppurativa can be challenging due to possible morbidities; for example, scarring can lead to contracture over the axilla.
Methods
In this report, we present 10 patients who underwent wide excision and reconstruction for the axilla hidradenitis suppurativa in our center from the year 2007 until the year 2017 with a mean follow-up of 3.17 years. All relevant operative information and data were collected from past medical records.
Results
Seventeen sites of affected axilla were reconstructed post-wide excision using various methods; from primary closure (n = 5), split thickness skin grafting (n = 5), and local fasciocutaneous flap (n = 2) to pedicle partial latissimus dorsi myocutaneous flap (n = 5). Primary closure is only achievable in smaller axillary defects with mean size of 65.2 cm2. Larger defects with averages 2 to 3 times the size are not amenable for primary closure and require skin grafting or flap coverage. Complications include wound dehiscence (n = 1), poor graft take (n = 3), and marginal flap edge necrosis (n = 1). Local fasciocutaneous flap is versatile and easily designed with the shortest mean operative time of 95 min. Hospital stay is shorter for primary closure and local fasciocutaneous flap with an average of 6 days for each as compared to using skin grafting (20 days) and pedicle partial latissimus dorsi myocutaneous flap (9 days). Only one recurrence (5.8%) was noted in a patient with primary closure post excision. All patients are satisfied with the surgical outcome and have no restriction of movement over their shoulders. Esthetically, reconstruction using primary closure and flap coverage methods is superior to skin grafting.
Conclusions
Axillary HS requires complete excision to prevent future recurrence. Reconstructive method with soft tissue coverage presented a better outcome compared to split thickness skin grafting in terms of surgical time, recovery rate, morbidity, as well as functional and esthetic outcomes.
Level of evidence: Level IV, therapeutic study.