Axillary hidradenitis suppurativa: a further option for surgical treatment.

BACKGROUND: Hidradenitis suppurativa is a chronic inflammatory disease of the cutis with furuncles, fistulas, and abscesses. The disease is mostly located in groin and axilla. As conservative treatment can usually not prevent recurrence, surgical treatment is the method of choice.

METHODS: We report on 20 patients with axillary hidradenitis suppurativa. The inflammatory region was excised in a rhomboid shape and immediately covered with a transposition flap according to Limberg. Postoperatively, all patients received antibiotic treatment and immobilization of the arm. Physiotherapy started after 2 weeks.

RESULTS: No flap complications occurred. The functional and aesthetic results were very satisfactory. Movement of shoulder showed no restrictions. A recurrence with single fistulas was seen in 3 patients.

CONCLUSIONS: Conservative treatment of hidradenitis suppurativa is followed by a high rate of recurrence. Only radical debridement offers a cure. The therapy of choice is the radical excision of the affected region and immediate coverage with a flap. Open granulation or split skin grafting often results in a prolonged hospitalization, higher morbidity, and functional problems. Thus, open granulation is inferior to primary closure by a transposition flap. Using the Limberg flap, the donor site is allowed to be closed primarily.