Reconstruction for axillary hidradenitis suppurativa using one stage local tissue rearrangement - a retrospective analysis of fifty-three cases
Yinglun Wu, BS, Ledibabari M. Ngaage, MA Cantab MB BChir, Shealinna Ge, MD, Erin M. Rada, MD, Yvonne M. Rasko, MD.
University of Maryland School of Medicine, Baltimore, MD, USA.
Background: Hidradenitis suppurativa (HS) is a chronic, debilitating disease that commonly affects the intertriginous skin of the axilla. To date, wide excision is the only known curative therapy for severe axillary HS. However, aggressive resection may result in postoperative scar contracture and affect shoulder mobility and function. Although a variety of techniques have previously been used, the gold standard management has yet to be defined. We describe our novel local tissue rearrangement technique for one stage closure of large axillary HS defects.
Methods: We performed a retrospective review of all patients who underwent one-stage surgical management for axillary HS at a single center tertiary care hospital from 2009 - 2018. All consecutive patients with moderate to severe axillary HS (Hurley II or III). Data were collected on patient characteristics, operative details, complications and readmissions within 90 days, and long-term recurrence. The operative technique involves extending an incision medially and laterally, elevating the skin and subcutaneous flaps, and rotating and advancing the lateral inferior and medial superior skin flaps into the defect.
Results: We identified 34 patients. The majority were female (85%) with a mean age of 31 ± 9 years and BMI 34.7 ± 8.6. This yielded a total of 53 operative sites. The average defect size was 109 ± 92 cm2 and the majority were treated using the local tissue rearrangement technique (72%). Other techniques used included: tissue advancement (15%), primary sutured closure (8%), Z-plasty (2%), or a combination (4%). The mean operative time was 46 ± 16 minutes. Nearly one fifth of operative sites experienced complications but these were minor in nature with only one complication requiring reoperation. Local cure rate was high and the majority of operative sites did not experience a recurrence (89%, n=47). Two thirds of recurrences were managed surgically, and the rest conservatively. At a median follow-up of 31 months, two sites (4%) showed decreased
range of motion. However, all patients had achieved remission without any further recurrence of disease.
Conclusions: HS presents a surgical challenge due to its recurrent nature. We describe a novel one-stage local tissue rearrangement technique for management of moderate to severe HS that achieves a high local cure rate with minimal functional morbidity and acceptable wound complication rates.
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