Reconstruction in extensive axillary Hidradenitis suppurativa with local fasciocutaneous V-Y advancement flaps

Abstract

We present our experience with the use of local fasciocutaneous V-Y advancement flaps in the reconstruction of 10 axillae in 6 patients for large defects following wide excision of long-standing Hidradenitis suppurativa of the axilla. The defects were closed with local V-Y subcutaneous island flaps. A single flap from the chest wall was sufficient for moderate defects. However, for larger defects, an additional flap was taken from the medial side of the ipsilateral arm. The donor defects could be closed primarily in all the patients. The local areas of the lateral chest wall and the medial side of the arm have a plentiful supply of cutaneous perforators and the flaps can be designed in a V-Y fashion without resorting to preoperative marking of the perforator. The flaps were freed sufficiently to allow adequate movement for closure of the defects. Although no attempt was made to identify the perforators specifically, many perforators were seen entering the flap. Some perforators can be safely divided to increase reach of the flap. All the flaps survived completely. A follow up of 2.5 years is presented.

KEYWORDS

Hidradenitis suppurativa - axillary full thickness skin defects - fasciocutaneous v-y flap - lateral chest wall - medial arm

• 1 Parks RW, Parks TG. Pathogenesis, clinical features and management of Hidradenitis suppurativa. Ann R Coll Surg Engl 1997; 79: 83-9
• 2 Slade DE, Powell BW, Mortimer PS. Hidradenitis suppurativa : Pathogenesis and management. Br J Plast Surg 2003; 56: 451-61
• 3 Schwabeggar AS, Herczeg E, Piza H. The lateral thoracic fasciocutaneous island flap for treatment of recurrent hidradenitis axillary suppurativa and other axillary skin defects. 2000; 53: 676-8
• 4 Bhattacharya S, Bhagia SP, Bhatnagar SK, Chandra R. The lateral thoracic region flap. Br J Plast Surg 1990; 43: 162-8
• 5 Cormack GC, Lamberty BG. Thoracodorsal artery cutaneous branch. 1994; 478
• 6 Cormack GC, Lamberty BG. Lateral thoracic artery, superficial thoracic artery. 1994; 371
• 7 Cormack GC, Lamberty BG. 1986; 98
• 8 Watson JDD. Hidradenitis suppurativa - A clinical review. Br J Plast Surg 1985; 38: 567-9
• 9 Soldin MG, Tulley P, Kaplan H, Hudson DA, Grobbelaar AO. Chronic axillary hidradenitis - The efficacy of wide excision and flap coverage. Br J Plast Surg 2000; 53: 434-6
• 10 Niranjan NS, Geh JL. Perforator-based fasciocutaneous island flaps for the reconstruction of axillary defects following excision of Hidradenitis suppurativa. Br J Plast Surg 2002; 55: 124-8
• 11 Bohn J, Svensson H. Surgical treatment of Hidradenitis suppurativa. Scand J Plast Reconstr Hand Surg 2001; 35: 305-9
• 12 Hosnuter M, Tosun Z, Savaci N. Surgical therapy for uncontrolled Chronic Hidradenitis suppurativa. Eur J Plast Surg 2002; 25: 11
• 13 Rehman N, Kannan RY, Hassan S, Hart NB. Thoracodorsal artery perforator (TAP) type I V-Y advancement flap in axillary Hidradenitis suppurativa. Br J Plast Surg 2005; 58: 441-4