Application of the thoracodorsal artery perforator flap in the reconstruction of axillary hidradenitis; our clinical experience

Aim: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition primarily affecting apocrine gland-bearing areas such as the axilla. Advanced stages often necessitate wide local excision, with flap-based reconstruction emerging as a preferred technique for optimal functional and aesthetic outcomes. This study evaluates the clinical outcomes of thoracodorsal artery perforator (TDAP) flap reconstruction following wide excision for axillary HS Materials and Methods: A retrospective review was conducted on patients who underwent surgical treatment for axillary HS between 2018 and 2023 at our institution. Inclusion criteria comprised patients with Hurley stage III HS unresponsive to medical therapy and unsuitable for primary closure. Demographic data, flap dimensions, defect size, postoperative complications, and functional outcomes were analyzed. Results: Twelve male patients (mean age: 32.3 years) were included. Defect sizes ranged from 25 to 170 cm² (mean: 64.9 cm²), with an average follow-up period of 330 days. No complete flap loss occurred. One patient experienced marginal necrosis at the flap edge, managed conservatively. All patients reported high satisfaction, with preserved shoulder mobility and no significant recurrence. Conclusion: The TDAP flap offers a reliable and functionally superior reconstructive option for axillary HS, particularly in moderate-to-large defects. Its favorable vascular anatomy, minimal donor site morbidity, and preservation of shoulder function make it an effective solution. Further comparative studies are warranted to establish long-term outcomes and validate these findings.