Use of a versatile transpositional flap in the surgical treatment of axillary hidradenitis suppurativa

Axillary hidradenitis suppurativa is a chronic recurrent disorder characterized by abscessing inflammation, fistulating sinus tracts, and scarring. This is not only a medical disease, but, also a complicated problem necessitating surgical intervention. While various management strategies have been reported, the results are frequently unsatisfactory. Primary closure of the defect after radical excision is often impossible and results in poor wound healing. Skin graft on the soft tissue defect often results in obvious scar contracture and limitation of movement. Local muscle flap can fill in the defect but the range of adduction of the arm will be limited by its muscle bulk. Free flap transfer is a choice of management but this technique calls for a trained team, laborious execution, expensive instruments and plenty of time. We describe the rise of transpositional fasciocutaneous flap, which can provide a reliable flap of variable size of skin and soft tissue coverage with good elastic properties. The technique is easily adapted to the reconstruction of resultant defects. This technique was used to transfer 8 transpositional fasciocutaneous flaps in 7 patients for the closure of axillary defects resulting from radical excision of chronic hidradenitis suppurativa. No flap complication or disease recurrence was observed during 2 years of follow-up. The technique had satisfactory esthetic and functional results as well as low donor site morbidity.