Comment: Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review

Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review

We have read the review article titled “Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review” by Amendola et al.[1] While congratulating the authors on this insightful review article, we would like to contribute some insights.

In the review article, it has been suggested that the parascapular flap is the preferred option for axillary reconstructions in patients affected by hidradenitis suppurativa due to its lower complication rate compared to other reconstructive techniques, including the thoracodorsal artery perforator (TDAP) flap. However, based on our experience, axillary reconstruction with the TDAP flap results in scars that are easily concealed under the posterior bra line. This is a significant consideration given the psychological impact on female patients, especially when contrasted with the vertical and less concealable scar resulting from parascapular flap reconstruction.[2] [3] [4]

In our experience, considering the challenging nature of axillary reconstruction, the thoracodorsal system is a valuable option. To emphasize the importance of a discreet scar at the donor site, we recommend commencing the reconstruction surgery with a TDAP flap. In case of an unfavorable anatomy of the perforator arteries, this approach allows for an easy transition to a muscle-sparing reconstruction, utilizing the underlying muscular component beneath the skin paddle to achieve a half-latissimus dorsi flap. Such a technique effectively keeps the scar concealed beneath the bra line[5] ([Figs. 1] [2] [3]).

Fig. 1 Lateral view wearing the bra.

Fig. 2 Lateral view.

Fig. 3 Posterior view wearing the bra.

Regarding the recurrence rate, in our opinion, it does not depend so much on the reconstructive technique as it does on the radicality of the excision. This is demonstrated by the fact that both TDAP and parascapular flap present overlapping skin and appendages.

While your study highlights the parascapular flap's lower overall complication rate compared to the TDAP flap, it is worth noting that the TDAP flap does have a steeper learning curve. This aspect might introduce a bias in the analyzed studies.

Although the parascapular flap emerges as the most effective and secure choice for axillary reconstruction in your study, we concur that further research involving a larger number of patients is warranted.

Conflict of Interest

None declared.

• References

• 1 Amendola F, Cottone G, Alessandri-Bonetti M. et al. Reconstruction of the axillary region after excision of hidradenitis suppurativa: a systematic review. Indian J Plast Surg 2022; 56 (01) 6-12
• 2 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: functional and aesthetic issues. Ann Plast Surg 2018; 81 (06) 694-701
• 3 Marchesi A, Amendola F, Garieri P, Steinberger Z, Vaienti L. Wide local excisions and pedicled perforator flaps in hidradenitis suppurativa: a study of quality of life. Ann Plast Surg 2021; 86 (02) 201-205
• 4 Brambilla L, Parisi P, Gatto A. et al. A retrospective comparative analysis of latissimus dorsi (LD) flap versus thoracodorsal artery perforator (TDAP) flap in total breast reconstruction with implants: a pilot study. J Reconstr Microsurg 2022; 38 (06) 451-459
• 5 Gatto A, Parisi P, Brambilla L. et al. Thoracodorsal artery perforator flap, muscle-sparing latissimus dorsi, and descending branch latissimus dorsi: a multicenter retrospective study on early complications and meta-analysis of the literature. J Plast Reconstr Aesthet Surg 2022; 75 (11) 3979-3996

Publication History

Article published online:
24 November 2023