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DOI: 10.1055/s-0043-1764312
Comments on “Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review”
The circumflex scapular artery is a branch of the subscapular artery originating from the axillary artery. It gives two different branches, transverse and vertical, on the posterior aspect of the trunk. A parascapular flap can be designed over the branches given by the circumflex scapular artery. The pedicle length of this flap is approximately 3 to 7 cm. The flap can be designed as a pedicled flap or it can be used as a free flap.[1]
Parascapular flap has many advantages; its vascular anatomy is stable, it can be used for large defects, it does not cause significant donor site morbidity, it is possible to repair the donor area primarily, and it can be used as a pedicled or free flap.[1] [2] [3] This flap is used in many body regions such as lower extremity, upper extremity, shoulder, neck, axilla, breast, and chest.[4] [5]
The use of the parascapular flap in axillary defects such as hidradenitis suppurative excision is quite practical. The wide design of the flap allows wide removal of the lesion, thus minimizing the possibility of recurrence.[1] However, weight is very important in patients who are planned for repair with a parascapular flap. In overweight patients, the subcutaneous tissue is quite thick, so the planned parascapular flap in these patients will also be thick. In overweight patients, the transposed parascapular flap may create a bulky appearance in the axillary area, making it difficult for the arm to adhere to the trunk.
Although the parascapular flap designed as a propeller is a very good option for the repair of axillary defects, the bulky appearance that may occur in patients with a high body mass index (BMI) can be considered as a disadvantage of this flap.
In conclusion, this letter has been prepared as a contribution to the manuscript titled “Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review” published in the last issue. If parascapular flap is to be preferred in patients with high BMI, patients should be informed that there may be bulky tissue in the axillary region after the operation and adduction cannot be fully performed in the upper extremity ([Fig. 1]).
Informed Consent
Informed consent was obtained.
Publication History
Article published online:
13 March 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 Yildirim MEC, Dadaci M, Uyar I, Ince B, Uyanik O. Reconstruction of axillary defects with propeller parascapular flap after resection in patients with advanced hidradenitis suppurativa. Wounds 2022; 34 (10) 245-249
- 2 Nassif TM, Vidal L, Bovet JL, Baudet J. The parascapular flap: a new cutaneous microsurgical free flap. Plast Reconstr Surg 1982; 69 (04) 591-600
- 3 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; . Epub ahead of print. DOI: 10.1055/s-0042-1758452.
- 4 Burns JT, Schlafly B. Use of the parascapular flap in hand reconstruction. J Hand Surg Am 1986; 11 (06) 872-875
- 5 Kim PS, Gottlieb JR, Harris GD, Nagle DJ, Lewis VL. The dorsal thoracic fascia: anatomic significance with clinical applications in reconstructive microsurgery. Plast Reconstr Surg 1987; 79 (01) 72-80