Immediate and Delayed Reconstruction after Excision of Axillary Hidradenitis Suppurativa Using a Propeller Flap

Abstract

The chronic inflammatory skin condition hidradenitis suppurativa (acne inversa), characterized by hair follicle or apocrine gland infection, causes recurrent superficial nodules and abscesses in axillary, mammary, and perianal regions. Chronic reoccurrence results in fistula formation, causing scarring and fibrosis. Surgical excision of affected skin tissue with adequate free margins is the gold standard treatment to prevent recurrence. This case series describes 6 cases of radical excision of localized axillary hidradenitis suppurativa, with immediate or delayed perforator-based propeller flap defect closure.

Methods: All patients presenting for surgical treatment of hidradenitis suppurativa between 2016 and 2018 were identified from the hospital database. Only patients with hidradenitis suppurativa confined to the axilla were included. Patients with simple abscess incisions, recurrence after previous grafting/flap surgery, and extension of the disease outside the axilla region were excluded. Patient demographics, size of defect, complications, time of follow-up, recurrences, and level of patient satisfaction were documented.

Results: Six patients with localized axillary hidradenitis suppurativa were identified, with 8 propeller flap surgeries performed. Defect size was assessed by pathologic examination of excised specimens, ranging from 11-18 cm × 6-14 cm × 0.5-2 cm (length × width × depth). Seven of the eight wounds healed primarily. Functional and aesthetic results were satisfactory and there were no recurrences. The only observed complication was venous congestion following 1 flap procedure.

Conclusion: These findings confirm that the propeller flap procedure can be effective for immediate or delayed defect closure after radical excision of localized axillary hidradenitis suppurativa, providing that no perifocal signs of infection are present after debridement.

Fig. 1.

Grade 111 hidradenitis suppurativa in the right axilla region, graded according to the Hurley classification criteria.

Fig. 2.

Axilla region after excision of the lesion.

Fig. 3.

Marking for flap formation and identification of the perforator.

Fig. 4.

Cutting the flap and dissection of the donor site.

Fig. 5.

Flap placement and direct closure of the donor site.