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

Year 2025, Volume: 7 Issue: 1, 31 - 34, 04.05.2025

Ensari Yavuz , İhtişam Zafer Cengiz , Rana Kapukaya , Fatma Çakmak

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

References

• 1. Ingram JR. The epidemiology of hidradenitis suppurativa. Br J Dermatol. 2020;183(6):990-998. doi:10.1111/bjd.19435
• 2. Mohammadi S, Gholami A, Hejrati L, Rohani M, Rafiei-Sefiddashti R, Hejrati A. Hidradenitis suppurativa; classification, remedies, etiology, and comorbidities; a narrative review. J Fam Med Prim care. 2021;10(11):4009-4016. doi:10.4103/jfmpc.jfmpc_795_21
• 3. Riis PT, Ring HC, Themstrup L, Jemec GB. The Role of Androgens and Estrogens in Hidradenitis Suppurativa - A Systematic Review. Acta Dermatovenerol Croat. 2016;24(4):239-249.
• 4. Sabat R, Jemec GBE, Matusiak Ł, Kimball AB, Prens E, Wolk K. Hidradenitis suppurativa. Nat Rev Dis Prim. 2020;6(1):18. doi:10.1038/s41572-020-0149-1
• 5. Sivanand A, Gulliver WP, Josan CK, Alhusayen R, Fleming PJ. Weight Loss and Dietary Interventions for Hidradenitis Suppurativa: A Systematic Review. J Cutan Med Surg. 2020;24(1):64-72. doi:10.1177/1203475419874412
• 6. Nguyen T V, Damiani G, Orenstein LA V, Hamzavi I, Jemec GB. Hidradenitis suppurativa: an update on epidemiology, phenotypes, diagnosis, pathogenesis, comorbidities and quality of life. J Eur Acad Dermatology Venereol. Published online 2020. doi:10.1111/jdv.16677
• 7. Saginc H. Treatment of a patient with hidradenitis suppurativa. Pamukkale Med J. Published online 2021.
• 8. Hurley H. Hidradenitis suppurativa. In: Roenigk RK, Jr HHR, eds. Dermatologic Surgery: Principles and Practice. CRC Press; 1989:729-739.
• 9. Szulczyńska-Gabor J, Fuksiewicz W, Emerele A, Głośnicka M, Bowszyc-Dmochowska M, Żaba R. Hidradenitis suppurativa – the therapeutic possibilities – case report. Adv Dermatology Allergol. 2008;25(3):142.
• 10. Saunte DML, Jemec GBE. Hidradenitis Suppurativa: Advances in Diagnosis and Treatment. JAMA. 20