Purpose: Hidradenitis suppurativa (HS) is a cutaneous disease affecting apocrine-gland-bearing skin. It is a distressing skin condition with a point prevalence estimated at 4,1% of the adult population most frequently in the axillary region. Chronicity, recurrent abscesses, sinus formation and scarring are hallmarks of axillary hidradenitis. The principle of surgical treatment is radical excision of all apocrine-bearing tissue. This study represents our experience utilizing thinned thoracodorsal perforator-based cutaneous flap for axillary reconstruction after radical excision of hidradenitis.

Methods: Six axillary reconstructions in three male adult patients with bilateral severe hidradenitis were done. The cutaneous perforators of the thoracodorsal artery were marked using a Doppler flowmeter. The flap was designed to fit the axillary skin defect. The flaps were thinned after harvesting to a similar thickness of the reminiscent axillary skin. The thinned tissue was transposed as an island flap.

Results: One flap presented minor skin edge necrosis. The wound was left to heal secondarily, without compromising the outcome. The other flaps healed uneventfully. In all patients the donor sites closed primarily. The results were considered satisfactory by the authors , with total shoulder range of motion and without axillary soft tissue bulging.

Conclusion: The principle of surgical treatment for HS is that it should be less debilitating than the condition itself. The recurrence rate is proportional to the radicality of surgery. After radical excision of axillary skin, many methods can be used to close the resulting defect. However, poor cosmetic and functional results are observed after skin grafting. Cutaneous flaps from the back are thicker than the axillary skin, with the need for secondary debulking. In our series, the thinned flap produced good aesthetic and functional results.