The thoracodorsal artery perforator (TDAP) flap for the treatment of hidradenitis suppurativa of the axilla: A prospective comparative study.

INTRODUCTION: Hidradenitis suppurativa (HS) is a common chronical condition. It is often resistant to conservative treatment and requires a wide and aggressive surgical approach to avoid recurrence. A prospective study was compared comparing the outcomes of thoracodorsal artery perforator (TDAP) flap-based reconstruction and secondary intention closure (SIC) following wide local excision (WLE) of axillary HS.

MATERIAL AND METHODS: A prospective study was conducted on sixty-eight patients suffering from stage III axillary HS. Thirty-three patients underwent a WLE procedure and were left to heal by secondary intention (SIC group), whereas 35 patients underwent immediate reconstruction with a homolateral TDAP flap (TDAP group). The inpatient stay, the healing time, the post-operative complications rate and pain were analysed in both groups, comparing preoperative shoulder function (using Constant-Murley shoulder outcome score), and quality of life (using a dermatology life quality index) with post-operative shoulder function and quality of life.

RESULTS: TDAP patients had significantly faster recovery, fewer complications, and fewer overall number of procedures than those who underwent SIC. All patients reported an improved quality of life after their operation and the TDAP group showed significantly more improvement than the SIC group (P<0.001). TDAP patients reported a significant reduction in pain/discomfort and a better shoulder function compared to SIC patients (P<0.001).

CONCLUSIONS: WLE and TDAP flap-based reconstruction for axillary stage III HS provide optimal post-procedural functional results with a low complication rate. The complete remission of the disease was observed after the procedure. Despite the relatively slow learning curve of this procedure, we strongly recommend this technique as a very good option for the management of stage III axillary HS.