Thoracodorsal Artery Perforator Flaps and Muscle-Sparing Latissimus Dorsi Myocutaneous Flaps for the Treatment of Axillary Hidradenitis

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Abstract

Purpose

The purpose of this study was to review a single surgeon’s experience with using the thoracodorsal artery perforator (TAP) flap for coverage of axillary defects.

Methods

This is a retrospective review of all flaps performed by the senior author (D.W.L.) after excision of axillary hidradenitis between 2004 and 2010.

Results

Nine TAP flaps were successfully performed, whereas 5 muscle-sparing latissimus dorsi (MSLD) myocutaneous flaps were necessary because of the inability to harvest a perforator flap. Overall, this equates to a 64% success rate in harvesting a perforator flap. The mean sizes of the TAP and MSLD flaps were 75 cm2 (range, 32–120 cm2) and 83 cm2 (range, 48–160 cm2), respectively. There were 2 (14%) flaps with wound complications. One patient had recurrent disease requiring debridement. Another patient who underwent the largest of all flaps (MSLD) had donor site and recipient bed dehiscence requiring debridement and skin grafting. This patient also later required flap debulking and Z-plasty for scar contracture.

Discussion

Overall, TAP and MSLD flaps can be performed reliably for coverage of axillary defects after excision of hidradenitis. Although not free of complications, they do offer improved results compared to historic attempts at primary closure or skin grafting.

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