Videos of Surgical Procedures in Dermatology
Parascapular Perforating Flap to Treat Severe Axillary Hidradenitis Suppurativa
Colgajo paraescapular perforante para tratamiento de la hidradenitis axilar grave
a UGC Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen de las Nieves, Granada, Spain
b UGC Dermatología Médico-Quirúrgica y Venereología, Hospital General Universitario Morales Meseguer, Murcia, Spain
c UGC Cirugía Plástica y Reparadora, Hospital Virgen de la Arreixaca, Murcia, Spain
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B, Surgical wound after removal of the drain 4 days after the operation. C, Healthy axilla 2 years after the operation. D, Partial view of the donor site 2 years after the operation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Hidradenitis suppurativa (HS) is a chronic inflammatory disease that arises in hair follicles in areas with a predominance of apocrine glands. It can cause major physical and psychosocial sequelae and its treatment is a significant challenge.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Surgical elimination of the affected tissues is considered to be the treatment of choice.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Severe axillary HS requires wide excision of the affected area, but reconstruction is complex and is associated with a high risk of postoperative complications. We used a pedicled parascapular flap in a patient with Hurley stage <span class="elsevierStyleSmallCaps">III</span><span class="elsevierStyleHsp" style=""></span>HS.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Description of the Technique</span><p id="par0010" class="elsevierStylePara elsevierViewall">The thoracodorsal artery provides the main blood supply to latissimus dorsi. After giving off the branch to the serratus muscle, the artery bifurcates into a medial and a lateral branch. After an intramuscular path of 2<span class="elsevierStyleHsp" style=""></span>cm, the lateral branch divides into 2 or 3 perforating arteries, the most proximal of which reaches the subcutaneous tissue 2 to 3<span class="elsevierStyleHsp" style=""></span>cm posterior to the lateral margin of the latissimus dorsi muscle and 8<span class="elsevierStyleHsp" style=""></span>cm inferior to the posterior axillary fold (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The patient in placed in the lateral decubitus position with the arm abducted at 90° over the head. Ultrasound is used to locate and mark the thoracodorsal perforating artery in the superolateral region of the scapula, and the distance to the center of the homolateral axilla is measured; this will define the size of the flap. The flap is drawn and is carefully dissected until a pedicle is fashioned that includes the artery and permits sufficient mobility for the flap to be tunneled towards the axilla (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). All the affected area of the axilla is excised (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A) and the tunnel to the scapular area is created. The flap is passed through the tunnel and is sutured by tissue planes. The defect left by the flap is also sutured by tissue planes (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). The immediate postoperative period is relatively short compared with a graft, and the patient can lead a normal life after the drain has been removed at 4 days. Two years after the operation in our patient there has been no recurrence, which he considers more than satisfactory (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C and D). Furthermore, abduction has been fully preserved, as has also been reported by other authors.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Indications</span><p id="par0015" class="elsevierStylePara elsevierViewall">The pedicled parascapular flap has advantages over the use of grafts as recovery is much faster and the complication rate is much lower.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> However, operating time is longer (4<span class="elsevierStyleHsp" style=""></span>hours) than for a graft (between 50 and 120<span class="elsevierStyleHsp" style=""></span>minutes). Other surgical options to treat axillary hidradenitis include healing by second intention, which has the disadvantage of a long healing period and the tendency to provoke retractile scars in the area. Direct closure creates tension, which can lead to the progressive appearance of a dehiscent scar. Finally, a rotation flap from the adjacent skin can be a safe alternative, with a minimal risk of necrosis and little postoperative discomfort.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Complications</span><p id="par0020" class="elsevierStylePara elsevierViewall">Flap necrosis is very unlikely if mobilization is performed carefully, with adequate dissection to avoid tension at the donor site where the artery arises. Torsion and compression of the flap pedicle must be avoided. If the artery is sectioned during the operation, the flap can be used as a graft.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="par0025" class="elsevierStylePara elsevierViewall">We have presented a method to treat severe axillary HS. Recovery is rapid and the cosmetic and functional results are magnificent, with a marked improvement in quality of life.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xpalclavsec577803" "titulo" => "Palabras clave" ] 1 => array:2 [ "identificador" => "xpalclavsec577802" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Description of the Technique" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Indications" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Complications" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of Interest" ] 8 => array:2 [ "identificador" => "xack189159" "titulo" => "Acknowledgments" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec577802" "palabras" => array:3 [ 0 => "Hidradenitis suppurativa" 1 => "Surgical flap" 2 => "Perforator flap" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Tercedor-Sánchez J, Ródenas-López JM, Ramón-Faba P, Muñoz-Romero F. Colgajo paraescapular perforante para tratamiento de la hidradenitis axilar grave. Actas Dermosifiliogr. 2015;106:669–671.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0045" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0040" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2835 "Ancho" => 1635 "Tamanyo" => 307775 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Parascapular flap after dissection, attached only by its vascular pedicle. B, Diagram of the blood supply to the area.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1373 "Ancho" => 990 "Tamanyo" => 303170 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Appearance immediately after the en bloc excision of the affected axillary skin, with a surgical margin. B, Surgical wound after removal of the drain 4 days after the operation. C, Healthy axilla 2 years after the operation. D, Partial view of the donor site 2 years after the operation.</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 141868856 "Video" => array:2 [ "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Carrascosa JM, Bassas J, Puig L. Hidradenitis supurativa: nuevas oportunidades para una enfermedad dermatológica huérfana. Actas Dermosifiliogr. 2015. pii: S0001-7310(15)00070-8. doi: 10.1016/j.ad.2015.01.008. [in press]" ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical treatment of severe hidradenitis suppurativa of the axilla: Thoracodorsal artery perforator (TDAP) flap versus split skin graft" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.C. Wormald" 1 => "A. Balzano" 2 => "J.J. Clibbon" 3 => "A. Figus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bjps.2014.04.032" "Revista" => array:6 [ "tituloSerie" => "J Plast Reconstr Aesthet Surg" "fecha" => "2014" "volumen" => "67" "paginaInicial" => "1118" "paginaFinal" => "1124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24933237" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The thoracodorsal artery perforator flap in the treatment of axillary hidradenitis suppurativa: Effect on preservation of arm abduction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F.F. Busnardo" 1 => "P.S. Coltro" 2 => "M.V. Olivan" 3 => "A.P. Busnardo" 4 => "M.C. Ferreira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PRS.0b013e3182268c38" "Revista" => array:7 [ "tituloSerie" => "Plast Reconstr Surg" "fecha" => "2011" "volumen" => "128" "paginaInicial" => "949" "paginaFinal" => "953" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21921770" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022347612011432" "estado" => "S300" "issn" => "00223476" ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack189159" "titulo" => "Acknowledgments" "texto" => "<p id="par0035" class="elsevierStylePara elsevierViewall">We would like to thank Dr. Eliseo Martínez García for the drawing in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000008/v1_201510011018/S1578219015002152/v1_201510011018/en/main.assets" "Apartado" => array:4 [ "identificador" => "6209" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Videos of Surgical Procedures in Dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000008/v1_201510011018/S1578219015002152/v1_201510011018/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015002152?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 4 | 12 |
| 2024 October | 91 | 47 | 138 |
| 2024 September | 88 | 34 | 122 |
| 2024 August | 133 | 75 | 208 |
| 2024 July | 84 | 45 | 129 |
| 2024 June | 109 | 37 | 146 |
| 2024 May | 73 | 39 | 112 |
| 2024 April | 84 | 22 | 106 |
| 2024 March | 67 | 37 | 104 |
| 2024 February | 70 | 34 | 104 |
| 2024 January | 65 | 32 | 97 |
| 2023 December | 73 | 18 | 91 |
| 2023 November | 94 | 36 | 130 |
| 2023 October | 96 | 20 | 116 |
| 2023 September | 103 | 37 | 140 |
| 2023 August | 82 | 25 | 107 |
| 2023 July | 85 | 34 | 119 |
| 2023 June | 93 | 22 | 115 |
| 2023 May | 76 | 27 | 103 |
| 2023 April | 58 | 15 | 73 |
| 2023 March | 58 | 27 | 85 |
| 2023 February | 52 | 25 | 77 |
| 2023 January | 48 | 19 | 67 |
| 2022 December | 55 | 37 | 92 |
| 2022 November | 35 | 28 | 63 |
| 2022 October | 37 | 15 | 52 |
| 2022 September | 51 | 46 | 97 |
| 2022 August | 47 | 25 | 72 |
| 2022 July | 40 | 27 | 67 |
| 2022 June | 51 | 23 | 74 |
| 2022 May | 88 | 44 | 132 |
| 2022 April | 74 | 30 | 104 |
| 2022 March | 74 | 46 | 120 |
| 2022 February | 57 | 23 | 80 |
| 2022 January | 62 | 35 | 97 |
| 2021 December | 55 | 37 | 92 |
| 2021 November | 62 | 45 | 107 |
| 2021 October | 51 | 66 | 117 |
| 2021 September | 64 | 47 | 111 |
| 2021 August | 51 | 40 | 91 |
| 2021 July | 55 | 42 | 97 |
| 2021 June | 49 | 34 | 83 |
| 2021 May | 52 | 26 | 78 |
| 2021 April | 94 | 72 | 166 |
| 2021 March | 68 | 43 | 111 |
| 2021 February | 67 | 42 | 109 |
| 2021 January | 65 | 23 | 88 |
| 2020 December | 44 | 26 | 70 |
| 2020 November | 32 | 26 | 58 |
| 2020 October | 20 | 19 | 39 |
| 2020 September | 27 | 24 | 51 |
| 2020 August | 24 | 33 | 57 |
| 2020 July | 24 | 26 | 50 |
| 2020 June | 39 | 34 | 73 |
| 2020 May | 37 | 29 | 66 |
| 2020 April | 34 | 24 | 58 |
| 2020 March | 28 | 23 | 51 |
| 2020 February | 4 | 12 | 16 |
| 2020 January | 0 | 9 | 9 |
| 2019 December | 4 | 5 | 9 |
| 2019 November | 0 | 3 | 3 |
| 2019 October | 0 | 8 | 8 |
| 2019 September | 4 | 7 | 11 |
| 2019 August | 0 | 11 | 11 |
| 2019 July | 0 | 19 | 19 |
| 2019 June | 2 | 44 | 46 |
| 2019 May | 0 | 89 | 89 |
| 2019 April | 0 | 40 | 40 |
| 2019 March | 2 | 11 | 13 |
| 2019 February | 3 | 7 | 10 |
| 2019 January | 5 | 7 | 12 |
| 2018 December | 4 | 18 | 22 |
| 2018 November | 16 | 8 | 24 |
| 2018 October | 21 | 0 | 21 |
| 2018 September | 8 | 1 | 9 |
| 2018 August | 0 | 2 | 2 |
| 2018 July | 0 | 9 | 9 |
| 2018 June | 0 | 5 | 5 |
| 2018 May | 0 | 1 | 1 |
| 2018 April | 0 | 4 | 4 |
| 2018 March | 1 | 2 | 3 |
| 2018 February | 36 | 12 | 48 |
| 2018 January | 37 | 5 | 42 |
| 2017 December | 38 | 12 | 50 |
| 2017 November | 30 | 11 | 41 |
| 2017 October | 27 | 10 | 37 |
| 2017 September | 31 | 17 | 48 |
| 2017 August | 61 | 12 | 73 |
| 2017 July | 22 | 12 | 34 |
| 2017 June | 37 | 25 | 62 |
| 2017 May | 25 | 8 | 33 |
| 2017 April | 29 | 11 | 40 |
| 2017 March | 19 | 14 | 33 |
| 2017 February | 16 | 18 | 34 |
| 2017 January | 19 | 9 | 28 |
| 2016 December | 24 | 19 | 43 |
| 2016 November | 25 | 22 | 47 |
| 2016 October | 16 | 25 | 41 |
| 2016 September | 0 | 7 | 7 |
| 2016 August | 0 | 7 | 7 |
| 2016 July | 1 | 3 | 4 |
| 2016 June | 3 | 2 | 5 |
| 2016 May | 7 | 8 | 15 |
| 2016 April | 3 | 1 | 4 |
| 2016 March | 1 | 6 | 7 |
| 2016 February | 0 | 1 | 1 |
| 2016 January | 0 | 1 | 1 |
| 2015 November | 0 | 3 | 3 |
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