Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory disease predominantly affecting intertriginous regions, with the axilla being one of the most commonly involved sites. Advanced-stage axillary HS often requires wide surgical excision, resulting in extensive defects that pose significant reconstructive challenges in terms of preserving shoulder mobility and achieving satisfactory aesthetic outcomes. We report a case of Hurley stage III axillary HS reconstructed using a thoracodorsal artery perforator (TDAP) flap, highlighting its functional and aesthetic benefits. A 42-year-old male patient with a long-standing history of left axillary HS refractory to conservative treatment underwent radical excision of the entire hair-bearing axillary skin. The resulting defect was reconstructed with a 5 x 17 cm TDAP flap.A single dominant perforator originating from the descending branch of the thoracodorsal artery was identified and dissected to obtain sufficient pedicle length. The flap was rotated into the axilla and inset in a tension-free manner, while the donor site was closed primarily. Postoperative recovery was uneventful, with no early or late complications. At 6 months of follow up, complete wound healing was achieved without recurrence. Shoulder range of motion was fully preserved, and no contracture formation was observed, resulting in high patient satisfaction regarding both function and aesthetics. This case demonstrates that the TDAP flap is a reliable and effective reconstructive option for extensive axillary HS defects, offering durable disease control, excellent functional preservation, and favorable aesthetic outcomes with minimal donor-site morbidity.
Aydin et al. (Sun,) studied this question.