Outcome comparison between thoracodorsal artery perforator flap and muscle‐sparing latissimus dorsi flap in axillary reconstruction after hidradenitis suppurativa excision

Abstract

Background Thoracodorsal artery perforator (TDAP) flap and muscle‐sparing latissimus dorsi (MSLD) flap have been frequently used for axillary coverage after hidradenitis suppurativa (HS) excision. However, none showed superiority to others. This study compared both flaps to define the ideal option, highlighting flap outcomes and functional and aesthetic results. Methods A retrospective study was conducted to compare both flaps that were used for axillary reconstruction in nine patients with bilateral HS Hurley stage III between 2017 and 2020. Eight TDAP and 10 MSLD flaps underwent functional evaluation using shoulder abduction angle (SA); the Disabilities of the Arm, Shoulder, and Hand (DASH) score; visual analog scale (VAS) for pain; and the Dermatology Life Quality Index (DLQI) questionnaires. Aesthetic assessment included the Scar Cosmesis Assessment and Rating (SCAR) scale and arm–chest interval. Results The mean operating time was 194.4 ± 51.58 and 128.5 ± 31.45 min for TDAP and MSLD (p = .009), respectively. Flap complications were significantly higher in the TDAP group (p = .034). There was no significant difference between both groups regarding SA; DASH, DLQI, VAS, and SCAR scale (p > .05). The mean arm–chest interval was significantly longer in the MSLD than in the TDAP group by 6.9 mm (p = .001). Conclusions TDAP and MSLD are comparable versatile flaps to eradicate axillary HS with higher TDAP flap complications. Although the TDAP flap is less bulky than the MSLD flap, the MSLD flap shortens the harvesting time without a significant difference in functional outcomes and scar results.

Pedicled circumflex scapular artery perforator flap with intra‐axillary tunneling for axillary defect coverage after surgical excision of hidradenitis suppurativa: A case report and literature review

“…The TDAP flap vascularization is based on the perforators originating from either the transverse or the descending branch of the thoracodorsal artery, which, like the circumflex scapular artery, originates from the subscapular artery (La Padula et al, 2023). These vessels are normally located 8 cm below the axillary fold, thus making this flap particularly suited for breast and axillary reconstructions, in particular for the treatment of HS (El‐Shebly et al, 2022; Horta et al, 2023). However, the main drawback of this procedure is related to the anatomy of its perforator vessels, which is much more variable compared to the CSAP flap.…”

Unusual Vascular Distribution in the Third Segment of the Axillary Artery

“…Similar to other systems, damage to the arterial system of the latissimus dorsi has a spectrum of presentations. For example, those at a proximal level present with severe bleeding and require emergency surgical intervention to control the resulting hemorrhage and revascularize the muscle [ 16 , 17 , 18 ]. With all flap transfers, if the vascular pedicle is not functional, there will be a greater risk of muscle necrosis.…”

Surgical management of axillary hidradenitis suppurativa with latissimus dorsi flap on a 24-year-old patient: A case report

“…When specifically comparing the flaps derived from the latissimus dorsi, both TDAP and muscle-sparing latissimus dorsi (MSLD) have advantages. While MSLD has a shorter procurement time, TDAP is less bulky [ 16 ], which may offer greater comfort for the patient in terms of functionality. Furthermore, as exhibited by Elgohary et al surgical management of stage III HS of axilla by TDAP flap showed good aesthetic and functional results with a 100 % success rate in eradicating and complete remission of the disease during the follow-up period [ 17 ].…”