Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review
Introduction Hidradenitis suppurativa (HS) is a chronic, debilitating, recurrent, auto-inflammatory disease of the pilosebaceous units of the skin. The axillary region is the most affected anatomical site and its reconstructive options include skin grafts, local random plasties, regional axial flaps...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2023-02-01
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| Series: | Indian Journal of Plastic Surgery |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1758452 |
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| author | Francesco Amendola Giuseppe Cottone Mario Alessandri-Bonetti Francesco Borelli Simone Catapano Riccardo Carbonaro Francesca Riccardi Luca Vaienti |
| author_facet | Francesco Amendola Giuseppe Cottone Mario Alessandri-Bonetti Francesco Borelli Simone Catapano Riccardo Carbonaro Francesca Riccardi Luca Vaienti |
| author_sort | Francesco Amendola |
| collection | DOAJ |
| description | Introduction Hidradenitis suppurativa (HS) is a chronic, debilitating, recurrent, auto-inflammatory disease of the pilosebaceous units of the skin. The axillary region is the most affected anatomical site and its reconstructive options include skin grafts, local random plasties, regional axial flaps, and regional perforator flaps. The main aim of this systematic review is to identify the best surgical technique for axillary reconstruction in the context of HS, in terms of efficacy and safety.
Methods We adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) throughout the whole review protocol build-up. The literature search was performed using MEDLINE, Embase, and Cochrane library databases, updated to March 2021. Quality was assessed for each study, through the National Institutes of Health Quality Assessment Tool.
Results A total of 23 studies were included in the final analysis. We reviewed a total of 394 axillary reconstructions in 313 patients affected by HS Hurley Stage II or III. Skin grafts were associated with the highest overall complication rate (37%), and highest rate of reconstruction failure (22%). Between thoraco-dorsal artery perforator flap, posterior arm flap, and parascapular flap, the latter showed fewer total complications, recurrences, and failures.
Conclusion Regional axial flaps should be considered as the best surgical approach in the management of advanced HS. The parascapular flap emerges as the most effective and safest option for axillary reconstruction. Local random flaps might be considered only for selected minor excisions, due to the higher risk of recurrence. The use of skin grafts for axillary reconstruction is discouraged. |
| format | Article |
| id | doaj-art-c7e3e8a5e4c445e5bcf989190628fa4a |
| institution | Kabale University |
| issn | 0970-0358 1998-376X |
| language | English |
| publishDate | 2023-02-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Indian Journal of Plastic Surgery |
| spelling | doaj-art-c7e3e8a5e4c445e5bcf989190628fa4a2025-08-20T03:24:11ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Plastic Surgery0970-03581998-376X2023-02-01560100601210.1055/s-0042-1758452Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic ReviewFrancesco Amendola0Giuseppe Cottone1Mario Alessandri-Bonetti2Francesco Borelli3Simone Catapano4Riccardo Carbonaro5Francesca Riccardi6Luca Vaienti7Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, ItalyDepartment of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, ItalyDepartment of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, ItalyDepartment of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, ItalyDepartment of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, ItalyDepartment of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, ItalyDepartment of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, ItalyDepartment of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, ItalyIntroduction Hidradenitis suppurativa (HS) is a chronic, debilitating, recurrent, auto-inflammatory disease of the pilosebaceous units of the skin. The axillary region is the most affected anatomical site and its reconstructive options include skin grafts, local random plasties, regional axial flaps, and regional perforator flaps. The main aim of this systematic review is to identify the best surgical technique for axillary reconstruction in the context of HS, in terms of efficacy and safety. Methods We adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) throughout the whole review protocol build-up. The literature search was performed using MEDLINE, Embase, and Cochrane library databases, updated to March 2021. Quality was assessed for each study, through the National Institutes of Health Quality Assessment Tool. Results A total of 23 studies were included in the final analysis. We reviewed a total of 394 axillary reconstructions in 313 patients affected by HS Hurley Stage II or III. Skin grafts were associated with the highest overall complication rate (37%), and highest rate of reconstruction failure (22%). Between thoraco-dorsal artery perforator flap, posterior arm flap, and parascapular flap, the latter showed fewer total complications, recurrences, and failures. Conclusion Regional axial flaps should be considered as the best surgical approach in the management of advanced HS. The parascapular flap emerges as the most effective and safest option for axillary reconstruction. Local random flaps might be considered only for selected minor excisions, due to the higher risk of recurrence. The use of skin grafts for axillary reconstruction is discouraged.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1758452hidradenitis suppurativaaxillary hidradenitisaxillary reconstructionparascapular flap |
| spellingShingle | Francesco Amendola Giuseppe Cottone Mario Alessandri-Bonetti Francesco Borelli Simone Catapano Riccardo Carbonaro Francesca Riccardi Luca Vaienti Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review Indian Journal of Plastic Surgery hidradenitis suppurativa axillary hidradenitis axillary reconstruction parascapular flap |
| title | Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review |
| title_full | Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review |
| title_fullStr | Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review |
| title_full_unstemmed | Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review |
| title_short | Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review |
| title_sort | reconstruction of the axillary region after excision of hidradenitis suppurativa a systematic review |
| topic | hidradenitis suppurativa axillary hidradenitis axillary reconstruction parascapular flap |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1758452 |
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