Aesthetic Plastic Surgery

, Volume 34, Issue 6, pp 785–792 | Cite as

Experience Using the Thoracodorsal Artery Perforator Flap in Axillary Hidradentitis Suppurativa Cases

  • Carlos Laredo Ortiz
  • Virginia López Castillo
  • Francisco Solesio Pilarte
  • Elena Lorda Barraguer
Case Reports

Abstract

Hidradenitis suppurativa is a chronic and recurrent inflammatory disease of the apocrine glands characterized by recurrent abscesses, draining sinus tracts, and scarring that can be located in the groin, axilla, perineal, and perianal areas and less frequently in the scalp area. The chronic and relapsing nature of hidradenitis suppurativa leads to physical and psychological damage because it frequently causes disabling pain, diminished range of motion, and social isolation. Surgical removal of all apocrine glands in the affected region is the definitive treatment because conservative treatment usually does not prevent recurrence of hidradenitis suppurativa. The resultant defect can be either left to heal secondarily or closed primarily. Secondary healing in the axilla may cause contractures and stiffening of the shoulder. Primary healing requires direct closure, split-skin grafting, or locoregional flap transposition. The majority of the listed surgical procedures cause long hospital stays and leave contour defects in both the axilla and the arm. This report presents a series of 16 cases managed between March 2006 and June 2008. All the patients had endured a long period of medical treatment and subsequently required surgery for long-term relief of symptoms. The functional and aesthetic outcomes were very satisfactory in all cases despite the final scar. The initial reconstructive aims were achieved for these patients. The authors consider the thoracodorsal artery perforator flap a useful option for the surgical treatment of axillary hidradenitis suppurativa.

Keywords

Axillary hidradenitis suppurativa Perforator flap TDAP flap Verneuil’s disease 

References

  1. 1.
    Jemec GB, Heidenheim M, Nielsen NH (1996) The prevalence of hidradenitis suppurativa and its potential precursor lesions. J Am Acad Dermatol 35:191–194CrossRefPubMedGoogle Scholar
  2. 2.
    Slade DE, Powell BW, Mortimer PS (2003) Hidradenitis suppurativa: pathogenesis and management. Br J Plast Surg 56:451–461CrossRefPubMedGoogle Scholar
  3. 3.
    Solding MG, Tulley P, Kaplan H, Hudson DA, Grobbealaar AO (2000) Chronic axillary hidradenitis: The efficacy of wide excision and flap coverage. Br J Plast Surg 53:434–436CrossRefGoogle Scholar
  4. 4.
    Kagan RJ, Yakuboff KP, Warner P, Warden GD (2005) Surgical treatment of hidradenitis suppurativa: a 10-year experience. Surgery 138:734–740CrossRefPubMedGoogle Scholar
  5. 5.
    Altmann S, Fansa H, Schneider W (2004) Axillary hidradenitis suppurativa: a further option for surgical treatment. J Cutan Med Surg 8:6–10CrossRefPubMedGoogle Scholar
  6. 6.
    Rompel R, Petres J (2000) Long-term results of wide surgical excision in 106 patients with hidradenitis suppurativa. Dermatol Surg 26:638–643CrossRefPubMedGoogle Scholar
  7. 7.
    Tanaka A, Hatoko M, Tada H, Kuwahara M, Mashiba K, Yurugi S (2001) Experience with surgical treatment of hidradenitis suppurativa. Ann Plast Surg 47:634–636CrossRefGoogle Scholar
  8. 8.
    Laredo C, Márquez M, Navarro L, Salvador J, Novo A, Lorda E (2007) Versatility of the pedicled thoracodorsal artery perforator (TDAP) flap in soft tissue reconstruction. Ann Plast Surg 58:315–320CrossRefGoogle Scholar
  9. 9.
    Hamdi M, Van Landuyt K, Hijjawi JB, Roche N, Blondeel P, Monstrey S (2008) Surgical technique in pedicled thoracodorsal artery perforator flaps: a clinical experience with 99 patients. Plast Reconstr Surg 121:1632–1641CrossRefPubMedGoogle Scholar
  10. 10.
    Ayhan S, Tuncer S, Demir Y, Kandal S (2008) Thoracodorsal artery perforator flap: a versatile alternative for various soft tissue defects. J Reconstr Microsurg 24:285–293CrossRefPubMedGoogle Scholar
  11. 11.
    Dabernig J, Sorensen K, Shawdunn J, Hart AM (2007) The thin circumflex scapular artery perforator flap. J Plast Reconstr Aesthet Surg 60:1082–1096CrossRefPubMedGoogle Scholar
  12. 12.
    Geh JL, Niranjan NS (2002) Perforator-based fasciocutaneous island flaps for the reconstruction of axillary defects following excision of hidradenitis suppurativa. Br J Plast Surg 55:124–128CrossRefPubMedGoogle Scholar
  13. 13.
    Rehman N, Kannan RY, Hassan S, Hart NB (2005) Thoracodorsal artery perforator (TAP) type I V-Y advancement flap in axillary hidradenitis suppurativa. Br J Plast Surg 58:441–444CrossRefPubMedGoogle Scholar
  14. 14.
    Heitmann C, Guerra A, Metzinger SW, Levin LS, Allen RJ (2003) The thoracodorsal artery perforator flap: anatomic basis and clinical application. Ann Plast Surg 51:23–29CrossRefPubMedGoogle Scholar
  15. 15.
    Thomas BP, Geddes GR, Tang M, Williams J, Morris SF (2005) The vascular basis of the thoracodorsal artery perforator flap. Plast Reconstr Surg 116:818–822CrossRefPubMedGoogle Scholar
  16. 16.
    Hynes PJ, Earley MJ, Lawlor D (2002) Split-thickness skin grafts and negative-pressure dressings in the treatment of axilary hidradenitis suppurativa. Br J Plast Surg 55:507–509CrossRefPubMedGoogle Scholar
  17. 17.
    Blondeel PN, Beyens G, Verhaeghe R, Van Landuyt K, Tonnard P, Monstrey SJ, Matton G (1998) Doppler flowmetry in the planning of perforator flaps. Br J Plast Surg 51:202–209CrossRefPubMedGoogle Scholar
  18. 18.
    Alonso Burgos A, García Tutor E, Bastarrika E, Tutor G, Cano D, Martínez Cuesta A, GPina LJ (2006) Preoperaive planning of deep inferior epigastric artery perforator flan reconstruction with multislice-CT angiography: imaging findings and initial experience. J Plast Reconstr Aesthet Surg 59:585–593CrossRefPubMedGoogle Scholar
  19. 19.
    Angrigiani C, Grillo D, Siebert J (1995) Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg 96:1608–1614CrossRefPubMedGoogle Scholar
  20. 20.
    Spinelli HM, Fink JA, Muzaffar AR (1996) The latissimus dorsi perforator based fasciocutaneous flap. Ann Plast Surg 37:500–506CrossRefPubMedGoogle Scholar
  21. 21.
    Hamdi M, Van Landuyt K, Monstrey S, Blondeel P (2004) Pedicled perforator flaps in breast reconstruction: a new concept. Br J Plast Surg 57:531–539CrossRefPubMedGoogle Scholar
  22. 22.
    Amarante J, Reis J, Santa Comba A, Malheiro E (1996) A new approach in axillary hidradenitis treatment: the scapular island flap. Aesthetic Plast Surg 20:443–446CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2010

Authors and Affiliations

  • Carlos Laredo Ortiz
    • 1
  • Virginia López Castillo
    • 1
  • Francisco Solesio Pilarte
    • 1
  • Elena Lorda Barraguer
    • 2
  1. 1.Méd. Adjunto Sección de Cirugía Plástica y ReconstructivaHospital General Universitario de AlicanteAlicanteSpain
  2. 2.Jefe de Sección de Cirugía Plástica y ReconstructivaHospital General Universitario de AlicanteAlicanteSpain

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