Mohos Balázs, Sándor Gábor, Bognár Gábor, Csucska Máté, Lóderer Zoltán
Általános, Ér- és Plasztikai Sebészet, Markusovszky Egyetemi Oktatókórház 9700 Szombathely, Markusovszky L. u. 5.
Általános és Érsebészeti Osztály, Veszprém Megyei Csolnoky Ferenc Kórház Veszprém.
Magy Seb. 2017 Dec;70(4):303-306. doi: 10.1556/1046.70.2017.4.2.
The only definitive treatment of chronic axillar hidradenitis suppurativa (HS) that prevents relapses is 'in toto' excision of the infected glandular tissue. This way a deficiency emerges, which needs to be restored. Reconstruction with split skin graft (SSG) is a most common way of recovery, but thoracodorsal artery perforator (TDAP) fasciocutneous flap delivers better functional and aesthetic results.
Between May 2014 and July 2016, 14 patients underwent reconstructive surgery after excision of axillary HS, 2 of them had bilateral lesion. In 15 cases TDAP was used, in 1 case we used thoracodorsal artery capillar perforator flap (TAPcp).
In all but 2 cases 1 dominant perforator was found. 1 flap had 2 dominant perforators and 1 flap was supplied by capillary perforators. Size of the flaps spread between 6 × 8 and 10 × 15 cm. 15 reconstructions were successful, 1 flap necrotised because of the lack of compliance of the patient.
As a result of the glandular tissue excision carried out because of a chronic HS, a deficiency emerges. TDAP flap is an ideal solution for surgical reconstruction of axillar deficiencies, and a great alternative to SSG.
慢性腋窝化脓性汗腺炎(HS)唯一能预防复发的确定性治疗方法是对感染的腺组织进行“完全”切除。这样会出现一种缺损,需要进行修复。采用中厚皮片移植(SSG)进行重建是最常见的修复方法,但胸背动脉穿支(TDAP)筋膜皮瓣能带来更好的功能和美学效果。
2014年5月至2016年7月期间,14例患者在腋窝HS切除术后接受了重建手术,其中2例为双侧病变。15例使用了TDAP,1例使用了胸背动脉毛细血管穿支皮瓣(TAPcp)。
除2例病例外,其余所有病例均发现1支优势穿支。1例皮瓣有2支优势穿支,1例皮瓣由毛细血管穿支供血。皮瓣大小在6×8至10×15厘米之间。15例重建成功,1例皮瓣因患者依从性差而坏死。
由于慢性HS而进行腺组织切除会导致缺损。TDAP皮瓣是腋窝缺损手术重建的理想解决方案,也是SSG的一个很好的替代方案。