title: Surgical treatment of severe hidradenitis suppurativa of the axilla: thoracodorsal artery perforator (TDAP) flap versus split skin graft.
abstract: BACKGROUND
  Hidradenitis suppurativa (HS) is a chronic, inflammatory disease affecting the apocrine glands of the axillary, groin and mammary regions with significant physical and psychosocial sequelae. Surgical excision of the affected tissue is the gold standard treatment. Severe axillary HS is associated with high rates of recurrence and requires extensive surgical resection with challenging reconstruction associated with risk of post-operative complications. The most effective method for reconstruction of the axilla after excision of HS is yet to be identified. We present a prospective observational study comparing thoraco-dorsal artery perforator (TDAP) flap and split-skin graft (SSG).
  
  
  METHODS
  Over 4 years, we enrolled 27 consecutive patients with Hurley's Stage III HS of the axilla who underwent surgical excision with reconstruction using either SSG (n=12) or TDAP flap reconstruction (n=15). We evaluated and compared intraoperative and post-operative data, quality of life (dermatology life quality index questionnaire) and pain/discomfort (visual analogue scale) before and after surgery.
  
  
  RESULTS
  Patients who underwent TDAP flap reconstruction had significantly faster recovery, fewer complications and fewer overall number of procedures than those who underwent SSG reconstruction. All patients reported an improved quality of life (QOL) after their operation and the TDAP group showed significantly more improvement than the SSG group. All patients reported a reduction in pain/discomfort but there was no significant difference between groups.
  
  
  CONCLUSIONS
  TDAP flap and SSG both improve QOL for patients with severe axillary HS. The TDAP flap showed greater benefits in terms of QOL, recovery, rate of complications and number of overall procedures.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
authors.forename: Justin C R
authors.initials: JC
authors.lastname: Wormald
authors.affiliation: Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
authors.forename: Antonella
authors.initials: A
authors.lastname: Balzano
authors.affiliation: Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
authors.forename: Jonothan J
authors.initials: JJ
authors.lastname: Clibbon
authors.affiliation: Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK; Faculty of Medicine and Health Science, Norwich Medical School, University of East Anglia, Norwich, UK. Electronic address: andrea.figus@nnuh.nhs.uk.
authors.forename: Andrea
authors.initials: A
authors.lastname: Figus
mesh_terms: D000328:Adult; D001365:Axilla; D005260:Female; D017497:Hidradenitis Suppurativa / Q000145:classification / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D061646:Operative Time; D061525:Perforator Flap / Q000098:blood supply; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D016038:Skin Transplantation; D064232:Visual Analog Scale; D014945:Wound Healing
keywords: Hidradenitis suppurativa; Quality of life; Reconstruction of the axilla; SSG; Skin graft; TDAP flap