Outcomes and Reliability of Perforator Flaps in the Reconstruction of Hidradenitis Suppurativa Defects: A Systemic Review and Meta-Analysis

Abstract

Introduction: Hidradenitis suppurativa (HS) is a common and debilitating disease, in which the only effective treatment involves a wide excision of the affected skin. Secondary wound healing and skin grafting are two well-known options for managing these defects, but perforator flaps provide a new therapeutic alternative by ensuring reconstructions of large defects, reducing donor site morbidity, and enhancing functional recovery. The aim of this study was to achieve a systematic review of perforator flaps use in HS. Patients and Methods: PubMed and Cochrane databases were searched from 1989 to 2021. The PRISMA statement was used in the study selection process and the review was registered on PROSPERO. Furthermore, patient characteristics, operative technique, complications, and recurrences were searched. Results: Thirty-six articles were selected including 286 patients and 387 flaps. Axillary localization was mostly represented (83.2%). Direct donor site closure was achieved in 99.1% of cases. In total, 15.1% of the flaps presented at least one of the following complications: wound dehiscence (5.5%), partial necrosis (2.9%), hematoma or seroma (2.1%), infection (2.1%), venous congestion (1.8%), and nerve injury (0.3%). Two cases of total necrosis were recorded. Recurrence of the disease was observed in 2.7% of the defects. Conclusions: Pedicled perforator flaps are a reliable and reproducible technique in the reconstruction of HS defects. They are associated with a low recurrence rate while ensuring an effective reconstruction with reduced morbidity and faster recovery compared to the techniques classically used in this indication.

Axillary Hidradenitis Suppurativa: A Comparison between Two Perforator Flap Reconstructive Approaches after Radical Surgical Management

“…Specifically, they reported complication rates of 17.1% for TDAP flaps and 16.7% for IAAP flaps. 33 All studies above confirm our team's findings: surgical management for Hurley grade 3 axillary HS by radical excision offers excellent results with a low recurrence rate (a single patient in our series). A plethora of solutions exists for managing the resulting defect.…”

“…Although they require longer operative times and greater surgical skills, they offer shorter postoperative healing periods and deliver excellent functional and aesthetic outcomes for the upper limb. 33,37,49 To our knowledge, our study is the first to directly compare the islanded TDAP flap and propeller IAAP flap for axillary reconstruction after wide local excision in patients with stage 3 HS. All the flaps in our study were performed by a single academic surgeon (N.…”

“…Flap reconstruction, in particular, has gained recognition as an appealing, effective, and minimally morbid alternative. 33 Among the options for pedicled fasciocutaneous flaps, various alternatives exist, including the thoracodorsal artery perforator (TDAP), circumflex scapular artery perforator, serratus anterior thoracic artery, lateral thoracic artery perforator, lateral intercostal artery perforator, inner arm artery perforator (IAAP), and posterior arm artery perforator flaps. [34][35][36][37][38][39][40] In severe cases with extensive defects, some authors have reported the utilization of free flaps, such as the deep inferior epigastric artery perforator flap.…”

Soft tissue reconstruction of the trunk with pedicled perforator and musculocutaneous flaps: A single‐center comparative retrospective study

“…For what concerns postoperative complications after reconstruction with perforator flaps, Vaillant et al (2022), published a systematic review reporting an overall complication rate as high as 15.1%. Moreover, in their study, Lafaye et al (2022) found a partial flap necrosis rate of 28.4%.…”

Current Medical and Surgical Treatment of Hidradenitis Suppurativa—A Comprehensive Review

“…As local flaps bear the risk of containing HS affected skin, reconstruction with skin flaps should only be performed after wide surgical excisions [ 228 ]. Currently, there is a large number of different skin flaps that have been described for HS reconstruction and frequently used flaps are lateral thoracic island fasciocutaneous flaps [ 229 ], Limberg transposition flaps [ 230 ], fasciocutaneous perforator-based flaps [ 231 ], myocutaneous flaps [ 232 , 233 ] and thoracodorsal artery perforator flaps [ 234 , 235 ].…”