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Thoracodorsal Artery Perforator Flaps and Muscle-Sparing Latissimus Dorsi Myocutaneous Flaps for the Treatment of Axillary Hidradenitis
Joshua Fosnot, MD, Shareef Jandali, MD, Michael N. Mirzabeigi, BS, David W. Low, MD.
The University of Pennsylvania Health System, Philadelphia, PA, USA.
BACKGROUND: Hidradenitis suppurativa (HS) is chronic disease of apocrine sweat glands characterized by recurrent axillary and perineal abscesses requiring extensive surgical debridement. The purpose of this study was to review a single surgeon’s experience with using the thoracodorsal artery perforator (TAP) flap for coverage of axillary defects.
METHODS: This is a retrospective review of all flaps performed by the senior author (DWL) following excision of axillary hidradenitis between 2004 and 2010. Medical records were scrutinized for patient characteristics, treatment and complications.
RESULTS: During this time period, 14 flaps were performed in 9 patients (all female). Nine TAP flaps were successfully performed while 5 muscle sparing latissimus dorsi (MSLD) myocutaneous flaps were necessary due to the inability to harvest a perforator flap. Overall, this equates to a 64% success rate in harvesting a perforator flap. The mean sizes of the TAP and MSLD flaps were 75 cm2 (range 32-120 cm2) and 83 cm2 (range 48-160 cm2) respectively. All flaps survived transposition. There were 2 flaps with wound complications (14%). One patient had recurrent disease requiring debridement. Another patient who underwent the largest of all flaps (MSLD) had donor site and recipient bed dehiscence requiring debridement and skin grafting. This patient also later required flap debulking and Z-plasty for scar contracture.
CONCLUSIONS: Overall, TAP and MSLD flaps can be performed reliably for coverage of axillary defects following excision of hidradenitis. While not free of complications, they do offer improved results compared to historic attempts at primary closure or skin grafting.
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