Wormald Justin C R, Balzano Antonella, Clibbon Jonothan J, Figus Andrea
Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK; Faculty of Medicine and Health Science, Norwich Medical School, University of East Anglia, Norwich, UK.
J Plast Reconstr Aesthet Surg. 2014 Aug;67(8):1118-24. doi: 10.1016/j.bjps.2014.04.032. Epub 2014 May 15.
Hidradenitis suppurativa (HS) is a chronic, inflammatory disease affecting the apocrine glands of the axillary, groin and mammary regions with significant physical and psychosocial sequelae. Surgical excision of the affected tissue is the gold standard treatment. Severe axillary HS is associated with high rates of recurrence and requires extensive surgical resection with challenging reconstruction associated with risk of post-operative complications. The most effective method for reconstruction of the axilla after excision of HS is yet to be identified. We present a prospective observational study comparing thoraco-dorsal artery perforator (TDAP) flap and split-skin graft (SSG).
Over 4 years, we enrolled 27 consecutive patients with Hurley's Stage III HS of the axilla who underwent surgical excision with reconstruction using either SSG (n=12) or TDAP flap reconstruction (n=15). We evaluated and compared intraoperative and post-operative data, quality of life (dermatology life quality index questionnaire) and pain/discomfort (visual analogue scale) before and after surgery.
Patients who underwent TDAP flap reconstruction had significantly faster recovery, fewer complications and fewer overall number of procedures than those who underwent SSG reconstruction. All patients reported an improved quality of life (QOL) after their operation and the TDAP group showed significantly more improvement than the SSG group. All patients reported a reduction in pain/discomfort but there was no significant difference between groups.
TDAP flap and SSG both improve QOL for patients with severe axillary HS. The TDAP flap showed greater benefits in terms of QOL, recovery, rate of complications and number of overall procedures.
化脓性汗腺炎（HS）是一种慢性炎症性疾病，累及腋窝、腹股沟和乳腺区域的顶泌汗腺，会产生严重的身体和心理社会后遗症。手术切除受影响组织是金标准治疗方法。严重的腋窝HS复发率高，需要广泛的手术切除以及具有挑战性的重建，且伴有术后并发症风险。HS切除术后腋窝重建的最有效方法尚未确定。我们开展了一项前瞻性观察性研究，比较胸背动脉穿支（TDAP）皮瓣和分层皮片移植（SSG）。
在4年时间里，我们连续纳入了27例腋窝Hurley III期HS患者，他们接受了使用SSG（n = 12）或TDAP皮瓣重建（n = 15）的手术切除。我们评估并比较了手术前后的术中及术后数据、生活质量（皮肤病生活质量指数问卷）和疼痛/不适（视觉模拟量表）。
接受TDAP皮瓣重建的患者比接受SSG重建的患者恢复明显更快，并发症更少，总体手术次数更少。所有患者术后生活质量（QOL）均有所改善，且TDAP组的改善明显大于SSG组。所有患者均报告疼痛/不适有所减轻，但两组之间无显著差异。
TDAP皮瓣和SSG均能改善严重腋窝HS患者的QOL。TDAP皮瓣在QOL、恢复、并发症发生率和总体手术次数方面显示出更大的优势。
