Axillary hidradenitis suppurativa: wide excision and flap coverage is best

Abstract

Eur J Plast Surg (1993) Summary. The extent of axillary excision and method of closure in 17 patients (29 axillae) with symptomatic chronic axillary hidradenitis suppurativa was analyzed. Limited excision of only the diseased skin led to recurrence in 2 of 3 patients, and excision of the hair-bearing skin alone, in 2 of 5 patients. There was no recurrence in 11 patients after wide excision. Some patients had more than one procedure. Three of four patients who had skin grafts used for closure, developed axillary contractures. Primary closure was achieved successfully in 7 patients (14 axillae). Flap coverage was used to close 12 axillae in 9 patients (3 patients had both axillae treated). These flaps included Limberg 4; random fasciocutaneous 3; parascapular fasciocutaneous: 5. Our experience suggests that wound closure after wide excision in the axilla is best achieved by means of a flap. While smaller defects can be closed with random fasciocutaneous flaps, wide axillary excision often leads to a large defect. The fasciocutaneous parascapular flap should be considered where a large defect exists.

Chronic axillary hidradenitis — the efficacy of wide excision and flap coverage

“…15 In an attempt to reduce the incidence of recurrent disease further, wide local excision (2 cm beyond the hair bearing skin) was performed. This was suggested to be the best form of treatment in an initial study of nine patients 11 and in this series where this was effected, there was no disease recurrence. However, this method of treatment did not reach statistical significance when compared to excision of all the hair bearing skin (P = 0.18, Fischer's exact test).…”

“…A number of studies have shown that inadequate excision is the major cause of recurrence. 4,11,14 Excision of all the hair bearing skin is a more extensive resection. Most of the apocrine glands are excised with this type of procedure.…”

“…[3][4][5][6] In established HS, surgery is the best method of treatment. 3 However, a number of different modalities of surgical [5][6][7][8][9][10][11][12] treatment have been advocated, with variable results. In fact, two recent reviews 3,4 do not give directions as to a preferable form of surgical treatment and few studies have compared different forms of treatment.…”