The thoracodorsal artery perforator (TDAP) flap for the treatment of hidradenitis suppurativa of the axilla: A prospective comparative study

Abstract

Background: Hidradenitis suppurativa (HS) is a common chronic condition that is often resistant to conservative treatment and requires a wide and aggressive surgical approach to prevent recurrence. A prospective study was performed comparing the outcomes of thoracodorsal artery perforator (TDAP) flap-based reconstruction and secondary intention closure (SIC) after wide local excision (WLE) of axillary HS. Methods: A prospective study was conducted on 68 patients with stage 3 axillary HS. Thirty-three patients underwent a WLE procedure and were left to heal by secondary intention (SIC group), and 35 patients underwent immediate reconstruction with a homolateral TDAP flap (TDAP group). Inpatient stay, healing time, postoperative complications rate, and pain were analyzed in both groups, comparing preoperative shoulder function (using Constant-Murley shoulder outcome score) and quality of life (using a dermatology life quality index) with postoperative shoulder function and quality of life. Results: Patients receiving TDAP flaps had significantly faster recovery, fewer complications, and fewer overall number of procedures than those who underwent SIC. All patients reported an improved quality of life after their operation. The TDAP group showed significantly more improvement than the SIC group (P < 0.001). Patients receiving TDAP flaps reported a significant reduction in pain and discomfort and better shoulder function compared with patients in the SIC group (P < 0.001). Conclusions: WLE and TDAP flap-based reconstruction for axillary stage 3 HS provide optimal postprocedural functional results with a low complication rate. Complete remission of the disease was observed after the procedure. Despite the relatively slow learning curve of this procedure, the authors strongly recommend this technique as a very good option for the management of stage 3 axillary HS. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

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).…”

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

“…The TDAP group showed significantly more improvement than the SSG group [ 14 ]. Also, as demonstrated by La Padula et al in the study they conducted, TDAP patients had significantly faster recovery, fewer complications, and fewer overall number of procedures than those who underwent secondary intention closure (SIC), being, that the TDAP group showed a greater increase in quality of life than the SIC group [ 15 ]. Surgical management is decided upon the fact that HS Hurley stage III usually presents with extensive cases refractory to the noninvasive therapies, requiring large excisions of the entire affected area with surgical margins extending beyond the clinical borders of disease activity [ 13 ].…”

Simultaneous Free Fibula and Anterolateral Thigh Flap in Lower Extremity Reconstruction Following Osteomyelitis in a Trauma Patient: A Case Report

“…Designing the free tissue transfer as a flow-through flap preserves perfusion for either tissues distal to the defect, functioning as a bypass, or to supply a second free flap in more complex reconstructive procedures [ 14 , 15 ]. While local as well as free perforator flaps are an important tool in the hands of plastic surgeons, the ALT flap, described in 1984 by Song et al remains a workhorse flap for soft tissue reconstruction, despite anatomical variations in its vascular pedicle [ 16 , 17 , 18 , 19 , 20 , 21 ]. In our experience, the ALT flap provides ample soft tissue and skin coverage for even larger defects.…”