Axillary Hidradenitis Suppurativa Reconstruction with Thoracodorsal Artery Perforator Flap: A Case Report

Abstract

Introduction: Hidradenitis suppurativa (HS) is a chronic condition affecting the pilosebaceous unit, characterized by nodules, abscesses, sinus tracts, and scarring, most commonly in axillary, inguinal, and inframammary regions. Medical treatments are first-line management; however, surgical interventions are necessary for resistant cases. Case: A 52-year-old male presented with bilateral axillary swelling and discharge for four years. Classified as Hurley Stage II, his condition included nodules, sinus tracts, and purulent discharge. Conservative treatments failed to resolve symptoms. Surgical excision of right axillary lesions and reconstruction using a thoracodorsal artery perforator flap was performed. Postoperatively, the flap remained viable with rapid capillary refill and normalized without complications. The patient experienced complete symptom resolution, with no contractures or movement restrictions. Discussion: HS presents significant diagnostic and therapeutic challenges, particularly in advanced cases. Surgical excision and flap reconstruction provide excellent functional and aesthetic outcomes in localized disease. The thoracodorsal artery perforator flap minimizes contracture risks, ensuring durable reconstruction. This case emphasizes the importance of early diagnosis and surgical intervention in resistant HS cases to prevent complications and improve outcomes. Further research is necessary to assess long-term effectiveness of flap-based methods.

Keywords

• Hidradenitis Suppurativa
• Thoracodorsal artery perforator flap
• axillar reconstruction

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