Reconstruction of Axillary Defects With Propeller Parascapular Flap After Resection in Patients With Advanced Hidradenitis Suppurativa

Mehmet Emin Cem Yildirim, MD; Mehmet Dadaci, MD Prof; Ilker Uyar, MD; Bilsev Ince, MD Prof; Orkun Uyanik, MD

Disclosures

Wounds. 2022;34(10):245-249. 

In This Article

Abstract and Introduction

Abstract

Introduction: Wide excision of affected skin tissue and the apocrine glandular region is the standard treatment for advanced HS. Various flap types have been used for coverage.

Objective: This study was conducted to assess the use and outcomes of propeller parascapular flaps for unilateral or bilateral axillary defects after excision in patients with advanced axillary HS.

Materials and Methods: This retrospective case series reports on 11 patients with unilateral (7 patients) or bilateral (4 patients) advanced HS treated with propeller parascapular flap surgery between July 1, 2016, and December 31, 2018. Flap dimensions were measured. Patients were evaluated in terms of 2 main postoperative complications: postoperative recurrence and flap viability. In addition, other complications such as bleeding, infection, dehiscence, contracture, and hypertrophic scarring were noted.

Results: The average flap area was 160 cm2. One flap dehisced; no infection, partial necrosis, or total flap loss occurred, and no recurrence was observed. The mean follow-up period was 18 months. At final follow-up, no patient had contractures that caused restricted movement of the shoulder joint.

Conclusion: Parascapular flaps should be the first choice in patients with advanced HS owing to low donor area morbidity, low recurrence rate, wide rotation arc, and sufficient flap size.

Introduction

First described by Velpeau in 1839, HS is a chronic disease characterized by inflammation and infection of the apocrine sweat glands or hair follicles, as well as recurrent abscess and nodule formation.[1] HS can occur anywhere on the body where apocrine sweat glands are present, although the infection generally occurs on the skin in the axillary, inguinal, perineal, and inframammary regions.[2] If painful and purulent lesions become recurrent, they can cause chronic sinus tracts, fistulas, scarring, and fibrosis.[3] Thus, HS can seriously affect patient quality of life and cause considerable mental and physical difficulties.

Although abscess drainage and local excision provide short-term relief, these techniques do not deliver long-term benefits and can lead to complications such as recurrence and chronic inflammation.[3] To prevent these complications, wide excision of the affected skin tissue and apocrine glandular region is considered the standard of care for advanced HS.[4–6] Published studies of advanced HS surgery mention secondary healing or repair with STSG after extensive excision.[7,8] However, considerable complications such as a long healing process, secondary contractions, and joint contractures may be associated with these treatment methods.[7,8]

Skin and subcutaneous tissues adjacent to the defect can be harvested and prepared as a fasciocutaneous flap by transposition or advancement without separating tissues from the vessels from which they originate. The addition of muscle to these tissues results in a musculocutaneous flap. The local flap is adjacent to the defect; a part of the skin is left intact on one side to ensure the blood supply to the flap is unaffected.

The propeller flap is an island fasciocutaneous flap that is based on a single dissected perforator. Propeller flaps have a wide rotation arc range of up to 180°. The parascapular propeller flap is prepared by complete harvesting with only a principal pedicle (Figure 1). Thus, there is no attachment to prevent wide rotation of the flap. The flap can then be placed in the defect.[9] The literature indicates that local and regional flaps such as the fasciocutaneous V-Y flap, Limberg flap, latissimus dorsi musculocutaneous flap, thoracodorsal artery perforator flap, and parascapular flap have been used in the management of HS.[10,11] However, to the knowledge of the authors of the current study, the literature on the use of parascapular flaps for this indication consists solely of limited case reports, and no studies involving large numbers of patients have been published.

Figure 1.

Steps in the surgical technique for harvest and placement of a parascapular propeller flap in a patient with hidradenitis suppurativa (A) of the right axilla. (B) Incision lines and design of the propeller parascapular flap. (C) Flap dissection and harvesting. (D) Mobilization of the flap. (E) Passing the flap through the tunnel. (F) Setting the flap.

The authors of the current study hypothesized that the propeller parascapular flap can be reliably used in unilateral or bilateral axillary defects after excision in patients with advanced axillary HS.

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