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Axillary Hidradenitis Suppurativa: A Further Option for Surgical Treatment

  • Basic/Clinical Science
  • Published:
Journal of Cutaneous Medicine and Surgery: Incorporating Medical and Surgical Dermatology

Abstract

Background: Hidradenitis suppurativa is a chronic inflammatory disease of the cutis with furuncles, fistulas, and abscesses. The disease is mostly located in groin and axilla. As conservative treatment can usually not prevent recurrence, surgical treatment is the method of choice. Methods: We report on 20 patients with axillary hidradenitis suppurativa. The inflammatory region was excised in a rhomboid shape and immediately covered with a transposition flap according to Limberg. Postoperatively, all patients received antibiotic treatment and immobilization of the arm. Physiotherapy started after 2 weeks. Results: No flap complications occurred. The functional and aesthetic results were very satisfactory. Movement of shoulder showed no restrictions. A recurrence with single fistulas was seen in 3 patients. Conclusions: Conservative treatment of hidradenitis suppurativa is followed by a high rate of recurrence. Only radical debridement offers a cure. The therapy of choice is the radical excision of the affected region and immediate coverage with a flap. Open granulation or split skin grafting often results in a prolonged hospitalization, higher morbidity, and functional problems. Thus, open granulation is inferior to primary closure by a transposition flap. Using the Limberg flap, the donor site is allowed to be closed primarily.

Antécédents: L’hidrosadénite est une maladie inflammatoire chronique de la peau qui se caractérise par l’apparition de furoncles, de fistules et d’abcès. Le siège de la maladie se trouve le plus souvent au niveau de l’aine et de l’aisselle. Comme un traitement traditionnel n’empêche pas la récidive de la maladie, le recours à la chirurgie est la méthode de choix. Méthodes: Nous rapportons le cas de 20 patients souffrant d’hidrosadénite dans la région axillaire. Une exérèse en forme de rhomboïde a été pratiquée dans la région de l’inflammation qui a été immédiatement couverte par un lambeau de transposition selon Limberg. Tous les patients ont subi une antibiothérapie et une immobilisation du bras après l’opération. Deux semaines plus tard, la physiothérapie a commencé. Résultats: Aucune complication n’est survenue à la suite de la chirurgie. Les résultats fonctionnels et esthétiques ont été très satisfaisants. Aucune restriction n’a été décelée dans le mouvement de l’épaule. Trois patients ont récidivé avec une seule fistule. Conclusions: Un traitement conservateur est suivi d’une récidive élevée. Seul un débridement radical permet la guérison. Le traitement de choix est une exérèse radicale de la région affectée, avec couverture d’un lambeau. La méthode à ciel ouvert ou la greffe de la peau sont associés à une hospitalisation prolongée, à une plus importante morbidité et à des problèmes fonctionnels. Par conséquent, la procédure à ciel ouvert est inférieure à la fermeture primaire qui utilise un lambeau de transposition. En effet, le lambeau rhomboïdal permet une fermeture primaire du site donneur

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Authors and Affiliations

  1. Department of Plastic, Reconstructive and Handsurgery, University of Magdeburg, Magdeburg, Germany

    S. Altmann, H. Fansa & W. Schneider

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  1. S. Altmann
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  2. H. Fansa
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  3. W. Schneider
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Correspondence to S. Altmann.

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Altmann, S., Fansa, H. & Schneider, W. Axillary Hidradenitis Suppurativa: A Further Option for Surgical Treatment . JCMS 8, 6–10 (2004). https://doi.org/10.1007/s10227-003-0162-5

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  • DOI: https://doi.org/10.1007/s10227-003-0162-5

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