Radical Surgical Excision and Use of Lateral Thoracic Flap for Intractable Axillary Hidradenitis Suppurativa

Current treatments for hidradenitis suppurativa (HS) include prolonged courses of antibiotics, retinoids, immunosuppressants, and biologics. Severe cases that are resistant to prolonged medical treatment pose a therapeutic challenge. We propose radical excision and lateral thoracic flap reconstruction as a treatment option for such cases. In our experience with two patients, good aesthetic and functional outcomes were achieved, with a high level of patient satisfaction. The availability of suitable flap coverage allows for wide resection of all of the hair-bearing skin, leading to a low incidence of residual disease and subsequent recurrence. Following excision of the affected tissue, the ideal reconstructive method in the axilla provides suitable coverage without unacceptable donor site morbidity and also avoids axillary contractures. A long lateral thoracic flap with delay has excellent coverage with minimal donor tissue sacrifice. With a suitable flap coverage option, the management paradigm of intractable HS should shift from prolonged medical treatment to allow decisive radical excision, which will improve the quality of life for patients.

Keywords

Hidradenitis - Surgical flaps - Axilla

This paper was presented as an oral presentation at the Joint 15th Association of Southeast Asian Nations (ASEAN) Congress of Plastic Surgery and the 8th Asian Pacific Craniofacial Conference on July 15-17, 2010 in Kuching, Sarawak, Malaysia.

Publication History

Received: 20 May 2012

Accepted: 17 October 2012

Article published online:
01 May 2022

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