Perforator-based fasciocutaneous island flaps for the reconstruction of axillary defects following excision of hidradenitis suppurativa.
Hidradenitis suppurativa is a chronic socially debilitating disorder of unknown aetiology. Treatments include simple incision and drainage, excision and healing by secondary intention, spilt-skin grafting, and local-flap reconstructions. All of these methods can leave unsightly scars. Recurrence of the disease can be significantly reduced only by wide local excision of all the hair-bearing skin. Most methods involve repeated hospital admission, and leave contour defects in the upper arm and axilla. We describe a new method using double opposing V-Y perforator-based flaps to recreate the axillary contour after wide excision of the hair-bearing skin of the axilla. This method allows both axillae to be treated in a single stage, and represents a new alternative in the treatment of axillary hidradenitis suppurativa. Four patients are described: three underwent bilateral excision and reconstruction, while the fourth had a unilateral procedure. All patients had a single surgical procedure with no flap loss. The result following known reconstructive procedures is far from satisfactory: skin grafting leaves a divot deformity, and when a local flap, such as the posterior arm or thoracodorsal flap, is used it leaves a large bulky flap in the axilla. In our technique the flaps maintain the diamond shape of the axilla.
Geh
J L C
JL
St Andrew's Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, UK.
Niranjan
N S
NS
D000328:Adult; D001365:Axilla / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017497:Hidradenitis Suppurativa / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps