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DOI: 10.1055/s-0043-1776898
Comment: 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]).
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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.
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Conflict of Interest
None declared.
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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
Address for correspondence
Publikationsverlauf
Artikel online veröffentlicht:
24. November 2023
© 2023. Association of Plastic Surgeons of India. 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 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
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