Aksillar hidradenitin rekonstrüksiyonunda torakodorsal arter perforatör flep kullanımı; klinik deneyimimiz
Öz
Amaç: Hidradenitis suppurativa (HS), esas olarak apokrin bezlerin bulunduğu bölgeleri etkileyen kronik inflamatuar bir deri hastalığıdır. İlerlemiş vakalarda geniş lokal eksizyon gerekebilir ve bu durumda optimal fonksiyonel ve estetik sonuçlar için flep rekonstrüksiyonu tercih edilmektedir. Bu çalışmada, aksiller HS nedeniyle geniş eksizyon uygulanan hastalarda torakodorsal arter perforatör (TDAP) flebi ile yapılan rekonstrüksiyon sonuçları değerlendirilmiştir.
Gereç ve Yöntem: 2018–2023 yılları arasında kliniğimizde aksiller HS tanısıyla cerrahi tedavi uygulanan hastalar retrospektif olarak incelendi. Tıbbi ve lokal tedaviye yanıt vermeyen, primer kapatmaya uygun olmayan ve sadece aksilla bölgesi tutulumuna sahip hastalar çalışmaya dahil edildi. Demografik veriler, flep boyutları, defekt alanı, postoperatif komplikasyonlar ve fonksiyonel sonuçlar analiz edildi.
Bulgular: Çalışmaya, yaş ortalaması 32,3 olan toplam 12 erkek hasta dahil edildi. Defekt boyutları 25–170 cm² (ortalama: 64,9 cm²) arasında değişmekteydi. Ortalama takip süresi 330 gündü. Hiçbir hastada tam flep kaybı gözlenmedi. Bir hastada flebin proksimal kenarında marjinal nekroz gelişti ve primer kapama ile başarılı şekilde tedavi edildi. Tüm hastalar cerrahi sonuçlardan memnuniyet bildirdi ve omuz hareket açıklığı korundu.
Sonuç: TDAP flebi, özellikle orta ve büyük boyuttaki aksiller HS defektlerinde güvenilir ve fonksiyonel olarak üstün bir rekonstrüksiyon seçeneği sunmaktadır. Tutarlı vasküler anatomisi, minimal donör saha morbiditesi ve omuz fonksiyonunun korunması, bu flebi etkili bir yöntem haline getirmektedir. Bulguların doğrulanması için ileriye dönük karşılaştırmalı çalışmalara ihtiyaç vardır.
Anahtar Kelimeler
Kaynakça
- P. J. Hynes, M. J. Earley, and D. Lawlor, “Split-thickness skin grafts and negative-pressure dressings in the treatment of axillary hidradenitis suppurativa,” Br. J. Plast. Surg., vol. 55, no. 6, pp. 507–509, Sep. 2002, doi: 10.1054/bjps.2002.3899.
- E. Chen and H. I. Friedman, “Management of Regional Hidradenitis Suppurativa With Vacuum-Assisted Closure and Split Thickness Skin Grafts,” Ann. Plast. Surg., vol. 67, no. 4, pp. 397–401, Oct. 2011, doi: 10.1097/SAP.0b013e3181f77bd6.
- M. Soldin, H. Kaplan, D. Hudson, P. Tulley, and A. Grobbelaar, “Chronic axillary hidradenitis — the efficacy of wide excision and flap coverage,” Br. J. Plast. Surg., vol. 53, no. 5, pp. 434–436, Jul. 2000, doi: 10.1054/bjps.1999.3285.
- J. Y. Lee, S. C. Chai, M. A. Mat Zain, and N. Basiron, “A review of the reconstructive methods in the management of axillary hidradenitis suppurativa,” Eur. J. Plast. Surg., vol. 43, no. 3, pp. 295–302, Jun. 2020, doi: 10.1007/s00238-019-01608-9.
- E. M. Taylor, R. Hamaguchi, K. M. Kramer, A. B. Kimball, and D. P. Orgill, “Plastic Surgical Management of Hidradenitis Suppurativa,” Plast. Reconstr. Surg., vol. 147, no. 3, pp. 479–491, Mar. 2021, doi: 10.1097/PRS.0000000000007677.
- S. La Padula et al., “The thoracodorsal artery perforator (TDAP) flap for the treatment of hidradenitis suppurativa of the axilla: A prospective comparative study,” Plast. Reconstr. Surg., Mar. 2023, doi: 10.1097/PRS.0000000000010435.
- L. S. Humphries, E. Kueberuwa, M. Beederman, and L. J. Gottlieb, “Wide excision and healing by secondary intent for the surgical treatment of hidradenitis suppurativa: A single-center experience,” J. Plast. Reconstr. Aesthetic Surg., vol. 69, no. 4, pp. 554–566, Apr. 2016, doi: 10.1016/j.bjps.2015.12.004.
- M. Schmidt, K. M. Dunst-Huemer, D. Lazzeri, H. Schoeffl, and G. M. Huemer, “The versatility of the islanded posterior arm flap for regional reconstruction around the axilla,” J. Plast. Reconstr. Aesthetic Surg., vol. 68, no. 7, pp. 953–959, Jul. 2015, doi: 10.1016/j.bjps.2015.03.002.
- S. S. Sirvan et al., “Posterior Arm Perforator Flap for Axillary Reconstruction After Hidradenitis Suppurativa Excision,” Plast. Surg., vol. 27, no. 3, pp. 204–210, Aug. 2019, doi: 10.1177/2292550319826087.
- A. Datli and O. Demirel, “Application of the free‐style brachial artery perforator based propellar flap in the management of axillary hidradenitis suppurativa,” Int. Wound J., vol. 20, no. 5, pp. 1552–1557, May 2023, doi: 10.1111/iwj.14010.
- F. Amendola et al., “Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review,” Indian J. Plast. Surg., vol. 56, no. 01, pp. 006–012, Feb. 2023, doi: 10.1055/s-0042-1758452.
- M. Meroni and M. F. Scaglioni, “Pedicled circumflex scapular artery perforator flap with intra‐axillary tunneling for axillary defect coverage after surgical excision of hidradenitis suppurativa: A case report and literature review,” Microsurgery, vol. 44, no. 1, Jan. 2024, doi: 10.1002/micr.31102.
- G. Ibarra, A. Rivera, B. Fernandez-Ibarburu, I. Capdevila, C. Ciudad-Blanco, and A. Garcia-Ruano, “Inframammary extended circumflex scapular (IMECS) flap for axillary hidradenitis suppurativa: Advantages over conventional alternatives,” J. Plast. Reconstr. Aesthetic Surg., vol. 104, pp. 57–66, May 2025, doi: 10.1016/j.bjps.2025.02.019.
- H. Ergani, A. Bas, B. Yasar, and R. Unlu, “Reconstruction of axillary hidradenitis suppurativa defects with thoracodorsal artery perforator flaps: Our clinical experience,” Turkish J. Plast. Surg., vol. 28, no. 1, p. 38, 2020, doi: 10.4103/tjps.tjps_2_19.
- A. Marchesi, F. Amendola, P. Garieri, Z. Steinberger, and L. Vaienti, “Wide Local Excisions and Pedicled Perforator Flaps in Hidradenitis Suppurativa,” Ann. Plast. Surg., vol. 86, no. 2, pp. 201–205, Feb. 2021, doi: 10.1097/SAP.0000000000002482.
- H. Elgohary, A. M. Nawar, A. Zidan, A. A. Shoulah, M. T. Younes, and A. M. Hamed, “Outcome of Pedicled Thoracodorsal Artery Perforator Flap in the Surgical Treatment of Stage II and III Hidradenitis Suppurativa of Axilla,” Ann. Plast. Surg., vol. 81, no. 6, pp. 688–693, Dec. 2018, doi: 10.1097/SAP.0000000000001658.
Application of the thoracodorsal artery perforator flap in the reconstruction of axillary hidradenitis; our clinical experience
Öz
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.
Anahtar Kelimeler
Kaynakça
- P. J. Hynes, M. J. Earley, and D. Lawlor, “Split-thickness skin grafts and negative-pressure dressings in the treatment of axillary hidradenitis suppurativa,” Br. J. Plast. Surg., vol. 55, no. 6, pp. 507–509, Sep. 2002, doi: 10.1054/bjps.2002.3899.
- E. Chen and H. I. Friedman, “Management of Regional Hidradenitis Suppurativa With Vacuum-Assisted Closure and Split Thickness Skin Grafts,” Ann. Plast. Surg., vol. 67, no. 4, pp. 397–401, Oct. 2011, doi: 10.1097/SAP.0b013e3181f77bd6.
- M. Soldin, H. Kaplan, D. Hudson, P. Tulley, and A. Grobbelaar, “Chronic axillary hidradenitis — the efficacy of wide excision and flap coverage,” Br. J. Plast. Surg., vol. 53, no. 5, pp. 434–436, Jul. 2000, doi: 10.1054/bjps.1999.3285.
- J. Y. Lee, S. C. Chai, M. A. Mat Zain, and N. Basiron, “A review of the reconstructive methods in the management of axillary hidradenitis suppurativa,” Eur. J. Plast. Surg., vol. 43, no. 3, pp. 295–302, Jun. 2020, doi: 10.1007/s00238-019-01608-9.
- E. M. Taylor, R. Hamaguchi, K. M. Kramer, A. B. Kimball, and D. P. Orgill, “Plastic Surgical Management of Hidradenitis Suppurativa,” Plast. Reconstr. Surg., vol. 147, no. 3, pp. 479–491, Mar. 2021, doi: 10.1097/PRS.0000000000007677.
- S. La Padula et al., “The thoracodorsal artery perforator (TDAP) flap for the treatment of hidradenitis suppurativa of the axilla: A prospective comparative study,” Plast. Reconstr. Surg., Mar. 2023, doi: 10.1097/PRS.0000000000010435.
- L. S. Humphries, E. Kueberuwa, M. Beederman, and L. J. Gottlieb, “Wide excision and healing by secondary intent for the surgical treatment of hidradenitis suppurativa: A single-center experience,” J. Plast. Reconstr. Aesthetic Surg., vol. 69, no. 4, pp. 554–566, Apr. 2016, doi: 10.1016/j.bjps.2015.12.004.
- M. Schmidt, K. M. Dunst-Huemer, D. Lazzeri, H. Schoeffl, and G. M. Huemer, “The versatility of the islanded posterior arm flap for regional reconstruction around the axilla,” J. Plast. Reconstr. Aesthetic Surg., vol. 68, no. 7, pp. 953–959, Jul. 2015, doi: 10.1016/j.bjps.2015.03.002.
- S. S. Sirvan et al., “Posterior Arm Perforator Flap for Axillary Reconstruction After Hidradenitis Suppurativa Excision,” Plast. Surg., vol. 27, no. 3, pp. 204–210, Aug. 2019, doi: 10.1177/2292550319826087.
- A. Datli and O. Demirel, “Application of the free‐style brachial artery perforator based propellar flap in the management of axillary hidradenitis suppurativa,” Int. Wound J., vol. 20, no. 5, pp. 1552–1557, May 2023, doi: 10.1111/iwj.14010.
- F. Amendola et al., “Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review,” Indian J. Plast. Surg., vol. 56, no. 01, pp. 006–012, Feb. 2023, doi: 10.1055/s-0042-1758452.
- M. Meroni and M. F. Scaglioni, “Pedicled circumflex scapular artery perforator flap with intra‐axillary tunneling for axillary defect coverage after surgical excision of hidradenitis suppurativa: A case report and literature review,” Microsurgery, vol. 44, no. 1, Jan. 2024, doi: 10.1002/micr.31102.
- G. Ibarra, A. Rivera, B. Fernandez-Ibarburu, I. Capdevila, C. Ciudad-Blanco, and A. Garcia-Ruano, “Inframammary extended circumflex scapular (IMECS) flap for axillary hidradenitis suppurativa: Advantages over conventional alternatives,” J. Plast. Reconstr. Aesthetic Surg., vol. 104, pp. 57–66, May 2025, doi: 10.1016/j.bjps.2025.02.019.
- H. Ergani, A. Bas, B. Yasar, and R. Unlu, “Reconstruction of axillary hidradenitis suppurativa defects with thoracodorsal artery perforator flaps: Our clinical experience,” Turkish J. Plast. Surg., vol. 28, no. 1, p. 38, 2020, doi: 10.4103/tjps.tjps_2_19.
- A. Marchesi, F. Amendola, P. Garieri, Z. Steinberger, and L. Vaienti, “Wide Local Excisions and Pedicled Perforator Flaps in Hidradenitis Suppurativa,” Ann. Plast. Surg., vol. 86, no. 2, pp. 201–205, Feb. 2021, doi: 10.1097/SAP.0000000000002482.
- H. Elgohary, A. M. Nawar, A. Zidan, A. A. Shoulah, M. T. Younes, and A. M. Hamed, “Outcome of Pedicled Thoracodorsal Artery Perforator Flap in the Surgical Treatment of Stage II and III Hidradenitis Suppurativa of Axilla,” Ann. Plast. Surg., vol. 81, no. 6, pp. 688–693, Dec. 2018, doi: 10.1097/SAP.0000000000001658.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Plastik, Rekonstrüktif ve Estetik Cerrahi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 8 Aralık 2025 |
| Gönderilme Tarihi | 19 Nisan 2025 |
| Kabul Tarihi | 23 Ağustos 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 64 Sayı: 4 |
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