Axillary hidradenitis suppurativa: wide excision and flap coverage is best

Summary The extent of axillary excision and method of closure in 17 patients (29 axillae) with symptomatic chronic axillary hidradenitis suppurativa was analyzed. Limited excision of only the diseased skin led to recurrence in 2 of 3 patients, and excision of the hair-bearing skin alone, in 2 of 5 patients. There was no recurrence in 11 patients after wide excision. Some patients had more than one procedure. Three of four patients who had skin grafts used for closure, developed axillary contractures. Primary closure was achieved successfully in 7 patients (14 axillae). Flap coverage was used to close 12 axillae in 9 patients (3 patients had both axillae treated). These flaps included Limberg 4; random fasciocutaneous 3; parascapular fasciocutaneous: 5. Our experience suggests that wound closure after wide excision in the axilla is best achieved by means of a flap. While smaller defects can be closed with random fasciocutaneous flaps, wide axillary excision often leads to a large defect. The fasciocutaneous parascapular flap should be considered where a large defect exists.