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
J. Tercedor-Sáncheza,
, J.M. Ródenas-Lópezb, P. Ramón-Fabac, F. Muñoz-Romeroc
Autor para correspondencia
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" ]
| año/Mes | Html | Total | |
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