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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2021; 06(02): e63-e69
DOI: 10.1055/s-0041-1736422
Case Report

Reconstruction of Axillary Defect due to Necrotizing Fasciitis and Debridement Using a Free-Flap Transfer: A Report of Three Cases

Haruo Ogawa 
1   Department of Plastic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan
,
Haruki Nakayama
2   Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
,
Shinichi Nakayama
2   Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
,
Shinya Tahara
3   Department of Plastic Surgery, Meiwa Hospital, Nishinomiya, Japan
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Abstract

Background Necrotizing fasciitis is a well-known disease that causes extensive tissue infection and requires radical debridement of the infected tissue. It can occur in all parts of the body, but there are few reports of necrotizing fasciitis in the axilla. We treated three patients with axillary necrotizing fasciitis.

Methods In all cases, patients were referred to us after radical debridement of the infected soft tissue in the emergency department. At the first visit to our department, there were fist-sized soft tissue defects in the axilla. Moreover, the ipsilateral pectoralis major and latissimus dorsi muscles were partially resected because of the debridement of necrotizing fasciitis. In all cases, the ipsilateral thoracodorsal vessels were severely damaged and free-flap transfer was performed to close the axillary wound.

Results All free flaps survived without complications. The patient's range of motion for shoulder abduction on the affected side was maintained postoperatively.

Conclusion If necrotizing fasciitis occurs in the axilla, tissue infection can spread beyond it. In such a case, free-flap transfer can be an optimal treatment. Radical resection of the infected tissue results in the absence of recipient vessels in the axilla. Surgeons should bear in mind that, because of radical resection of the infected tissue, they may need to seek recipient vessels for free-flap transfer far from the axilla.

Keywords

axilla - necrotizing fasciitis - free flaps

Financial Disclosure

The authors have nothing to disclose.




Publication History

Received: 24 May 2021

Accepted: 02 August 2021

Article published online:
18 October 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Grishkevich VM. Shoulder adduction contracture after burn: anatomy and treatment with quadrangular local scar subcutaneous pedicled flap, a new approach. Burns 2013; 39 (07) 1423-1429
    CrossrefPubMedSearch in Google Scholar
  • 2 Chen HC, Wu KP, Yen CI. et al. Anterolateral thigh flap for reconstruction in postburn axillary contractures. Ann Plast Surg 2017; 79 (02) 139-144
    CrossrefPubMedSearch in Google Scholar
  • 3 Ogawa R, Hyakusoku H, Murakami M, Koike S. Reconstruction of axillary scar contractures–retrospective study of 124 cases over 25 years. Br J Plast Surg 2003; 56 (02) 100-105
    CrossrefPubMedSearch in Google Scholar
  • 4 Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol 2009; 60 (04) 539-561 , quiz 562–563
    CrossrefPubMedSearch in Google Scholar
  • 5 Visconti G, Eltahir Y, Van Ginkel RJ, Werker PM. Reconstruction of an extended defect in the axilla using a thoracodorsal fasciocutaneous perforator flap. Aesthetic Plast Surg 2008; 32 (05) 813-816
    CrossrefPubMedSearch in Google Scholar
  • 6 Yii NW, Niranjan NS. Metastatic basal cell carcinoma of the axilla: report of a case and reconstruction with an island lateral pectoral flap. Ann Plast Surg 2000; 45 (01) 78-82
    CrossrefPubMedSearch in Google Scholar
  • 7 Baghaki S, Cevirme M, Diyarbakirli M, Tatar C, Aydin Y. Locoregional use of lateral thoracic artery perforator flap as a propeller flap. Ann Plast Surg 2015; 74 (05) 532-535
    CrossrefPubMedSearch in Google Scholar
  • 8 Guha G, Agarwal AKR, Gupta S. et al. Posterior arm flap in management of axillary contracture. Burns 2013; 39 (05) 972-977
    CrossrefPubMedSearch in Google Scholar
  • 9 Alharbi M, Perignon D, Assaf N, Qassemyar Q, Elsamad Y, Sinna R. Application of the inner arm perforator flap in the management of axillary hidradenitis suppurativa. Ann Chir Plast Esthet 2014; 59 (01) 29-34
    CrossrefPubMedSearch in Google Scholar
  • 10 Hodgins N, Bhat W, Pape SA. The posterior arm flap in reconstruction of axillary defects: a lifeboat when soft tissue cover is limited. J Plast Reconstr Aesthet Surg 2015; 68 (11) 1629-1631
    CrossrefPubMedSearch in Google Scholar
  • 11 Schmidt M, Dunst-Huemer KM, Lazzeri D, Schoeffl H, Huemer GM. The versatility of the islanded posterior arm flap for regional reconstruction around the axilla. J Plast Reconstr Aesthet Surg 2015; 68 (07) 953-959
    CrossrefPubMedSearch in Google Scholar
  • 12 Ching DL, Mughal M, Papas A, Soldin M. Axillary reconstruction for hidradenitis suppurativa with an inner-arm transposition flap creating a brachioplasty effect. Arch Plast Surg 2017; 44 (03) 228-233
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Knowlton EW. Release of axillary scar contracture with a latissimus dorsi flap. Plast Reconstr Surg 1984; 74 (01) 124-126
    CrossrefPubMedSearch in Google Scholar
  • 14 Chen B, Xu M, Chai J, Song H, Gao Q. Surgical treatment of severe or moderate axillary burn scar contracture with transverse island scapular flap and expanded transverse island scapular flap in adult and pediatric patients–a clinical experience of 15 cases. Burns 2015; 41 (04) 872-880
    CrossrefPubMedSearch in Google Scholar
  • 15 Freedlander E, Lee K, Vandervord JG. Reconstruction of the axilla with a pectoralis major myocutaneous island flap. Br J Plast Surg 1982; 35 (02) 144-146
    CrossrefPubMedSearch in Google Scholar
  • 16 Geh JLC, Niranjan NS. Perforator-based fasciocutaneous island flaps for the reconstruction of axillary defects following excision of hidradenitis suppurativa. Br J Plast Surg 2002; 55 (02) 124-128
    CrossrefPubMedSearch in Google Scholar
  • 17 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 (04) 441-444
    CrossrefPubMedSearch in Google Scholar
  • 18 Kosutic D, Potter S, Gulic R. Circumflex scapular perforator propeller flap for axillary reconstruction. Microsurgery 2012; 32 (03) 251-252
    CrossrefPubMedSearch in Google Scholar
  • 19 Elboraey MA, Alali AB, Alkandari QA. Immediate and delayed reconstruction after excision of axillary hidradenitis suppurutiva using a propeller flap. Plast Reconstr Surg Glob Open 2019; 7 (08) e2387
    CrossrefPubMedSearch in Google Scholar
  • 20 Marchesi A, Marcelli S, Zingaretti N, Parodi PC, Vaienti L. Pedicled thoracodorsal artery perforator and muscle-sparing latissimus dorsi flaps in the axillary reconstruction after hidradenitis suppurativa excision. Ann Plast Surg 2018; 81 (06) 694-701
    CrossrefPubMedSearch in Google Scholar
  • 21 Cunningham JD, Silver L, Rudikoff D. Necrotizing fasciitis: a plea for early diagnosis and treatment. Mt Sinai J Med 2001; 68 (4–5): 253-261
    PubMedSearch in Google Scholar
  • 22 Yamasaki O, Nagao Y, Sugiyama N, Otsuka M, Iwatsuki K. Surgical management of axillary necrotizing fasciitis: a case report. J Dermatol 2012; 39 (03) 309-311
    CrossrefPubMedSearch in Google Scholar
  • 23 Adachi K, Tsutsumi R, Yoshida Y, Watanabe T, Nakayama B, Yamamoto O. Necrotizing fasciitis of the breast and axillary regions. Eur J Dermatol 2012; 22 (06) 817-818
    CrossrefPubMedSearch in Google Scholar
  • 24 Edlich RF, Cross CL, Dahlstrom JJ, Long III WB. Modern concepts of the diagnosis and treatment of necrotizing fasciitis. J Emerg Med 2010; 39 (02) 261-265
    CrossrefPubMedSearch in Google Scholar
  • 25 Bonne SL, Kadri SS. Evaluation and management of necrotizing soft tissue infections. Infect Dis Clin North Am 2017; 31 (03) 497-511
    CrossrefPubMedSearch in Google Scholar
  • 26 Tanaka A, Hatoko M, Tada H, Kuwahara M. An evaluation of functional improvement following surgical corrections of severe burn scar contracture in the axilla. Burns 2003; 29 (02) 153-157
    CrossrefPubMedSearch in Google Scholar