Axillary Hidradenitis Reconstruction Using a Dermal Regeneration Template

Casey Kraft, MD; Gregory Pearson, MD

Disclosures

Wounds. 2022;34(2):43-46. 

In This Article

Materials and Methods

Patient Selection

After institutional review board approval was obtained, all patients undergoing axillary hidradenitis reconstruction by a single surgeon were retrospectively reviewed from 2015 through 2018. All patients were included if the DRT was used for the reconstruction. Exclusion criteria included reconstruction using any other method, absence of plastic surgery involvement in reconstruction, or hidradenitis location other than the axilla. Demographic data and medical comorbidities, including body mass index, history of diabetes, and immunosuppression, comprised the inclusion criteria. Treatment data were recorded, including several negative pressure wound therapy (NPWT) changes, time to skin grafting, age at treatment, pain medication consumption, and axillary range of motion. Surgical complications including infection, DRT loss, graft loss, and hidradenitis recurrence were also recorded.

Surgical Technique

After a patient had been deemed appropriate for treatment of their hidradenitis, complete axillary excision was performed to encompass all hair follicles of the axilla (Figure 1). Excision was carried through the dermis to the subcutaneous tissue, and all affected dermis was excised entirely. The DRT was then trimmed to the shape of the excised area and stapled into place (Figure 2). The DRT was used because of its well-known ability to reduce scar contracture of a wound bed, theoretically reducing the risk of axillary contracture compared with skin grafting alone.[8] The NPWT device was applied over the DRT and set to −125 mm Hg of continuous suction. The patient's arm was placed in an airplane splint that had been customized preoperatively by an occupational therapist (Figure 3). This splint remained in place at all times to prevent shear forces and disruption of the reconstruction. The patient was then admitted to the hospital for observation and pain control. Weekly or biweekly NPWT changes were done under light sedation, depending on the family's ability to transport the patient to the clinic. When complete take of the DRT was deemed to have occurred, the patient was returned to the operating room based on clinical evaluation of tissue ingrowth to the entirety of the matrix and the ability to easily peel off the superficial silicone layer for split-thickness skin grafting. The NPWT was again applied over the skin graft, and the patient maintained use of the airplane splint until the NPWT device was removed at follow-up, at which time skin graft take was determined (Figure 4). Gentle use of the arm as tolerated was allowed, and standard wound care for skin grafting—specifically, a daily dressing of a petrolatum-based fine mesh gauze and antibiotic ointment for several weeks, followed by daily moisturizing lotion application—was continued until complete healing was confirmed.

Figure 1.

Representative example of hidradenitis suppurativa preoperatively with areas of drainage and induration.

Figure 2.

Example of dermal regeneration template placement after wide excision of the affected axilla.

Figure 3.

Representative example of the airplane splint used after surgical treatment. Of note, the patient in this figure was not included in the study.

Figure 4.

Split-thickness skin graft placement to the axilla after use of a negative pressure wound therapy dressing for 1 week.

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