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European Journal of Plastic Surgery
Published in: European Journal of Plastic Surgery 1/2023

23-06-2022 | Acne Inversa | Review

Axillary reconstruction: proposal of a therapeutic algorithm based on systematic review of the literature

Authors: Ester Sanz Aranda, Valentin Yuste Bevanvente, Enara Reola Ramírez, Alba Perales Enguita, Josep María Martí Ayats, Alba Sobrino Casorrán

Published in: European Journal of Plastic Surgery | Issue 1/2023

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Abstract

Background

The use of therapeutic algorithms for the reconstruction of defects in different anatomical locations is common in plastic surgery. Nevertheless, axillary reconstruction has been unnoticed in this regard. The aim of this article is to review the surgical techniques employed in the reconstruction of axillary defects focusing on the indication for each one, with the aim of creating a therapeutic algorithm that serves as a guide for decision-making in axillary defect reconstruction.

Methods

A systematic review was performed using the MEDLINE, EMBASE and Cochrane library databases and including articles published between 2000 and 2020.

Results

After excluding case reports, duplicates and non-relevant articles, we selected a total of 11 relevant articles. Relevant information was extracted and employed to create a therapeutic algorithm. We suggest a reconstructive algorithm that classifies the defects according to their size in three categories.

Conclusions

We propose the use of local flaps for smaller defects (less than 30 cm2), regional flaps for medium-sized defects (30 to 200 cm2) and microsurgical fasciocutaneous flaps for large defects (more than 200 cm2). Regarding regional flaps, we consider the TDAP flap as the first choice for axillary reconstruction.
Level of evidence: Not ratable
Literature
1.
Ching DL, Mughal M, Papas A, Soldin M (2017) Axillary reconstruction for hidradenitis suppurativa with an inner-arm transposition flap creating a brachioplasty effect. Arch Plast Surg 44(3):228–33CrossRefPubMedPubMedCentral
2.
Schmidt M, Dunst-huemer KM, Lazzeri D, Schoeffl H, Huemer GM (2015) The versatility of the islanded posterior arm flap for regional reconstruction around the. Br J Plast Surg 68(7):953–959
3.
Marchesi A, Marcelli S, Zingaretti N, Parodi PC, Vaienti L (2018) Pedicled thoracodorsal artery perforator and muscle-sparing latissimus dorsi flaps in the axillary reconstruction after hidradenitis suppurativa excision: functional and aesthetic issues. Ann Plast Surg 81(6):694–701
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Melkun ET, Few JW (2004) The use of biosynthetic skin substitute (Biobrane ) for axillary reconstruction after surgical excision for hidradenitis suppurativa. Plast Reconstr Surg 115(5):1385–1388CrossRef
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Busnardo FF, Coltro PS, Olivan MV, Busnardo APV, Ferreira MC (2011) The thoracodorsal artery perforator flap in the treatment of axillary hidradenitis suppurativa: effect on preservation of arm abduction. Plast Reconstr Surg 128(4):949–953CrossRefPubMed
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D’Arpa S, Pignatti M, Vieni S, Muradov M, Blondeel P, Cordova A (2019) The thin bilateral and bipedicled DIEAP flap for axillary reconstruction in hidradenitis suppurativa. Handchir Mikrochir Plast Chir 51(6):469–76CrossRefPubMed
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Ogawa R, Hyakusoku H, Murakami M, Koike S (2003) Reconstruction of axillary scar contractures — retrospective study of 124 cases over 25 years. Br J Plast Surg 56:100–105CrossRefPubMed
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Miyamoto S, Fujiki M, Kawai A, Chuman H (2016) Anterolateral thigh flap for axillary reconstruction after sarcoma resection. Microsurgery 36(5):378–83CrossRefPubMed
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Sever C, Uygur F, Kulahci Y, Karagoz H, Sahin C (2012) Thoracodorsal artery perforator fasciocutaneous flap: A versatile alternative for coverage of various soft tissue defects. Indian J Plast Surg 45(3):478–484
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Laredo Ortiz C, Márquez Mendoza M, Navarro Sampere L, Salvador Sanz J, Novo Torres A, Lorda BE (2007) Versatility of the pedicled thoracodorsal artery perforator ( TDAP ) flap in soft tissue reconstruction. Ann Plast Surg 58(3):315–320CrossRefPubMed
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Sirvan SS, Demir IA, Irmak F, Sevim KZ, Dagdelen D, Yazar SK, Karsidag S (2019) Posterior arm perforator flap for axillary reconstruction after hidradenitis suppurativa excision. Plast Surg 27(3):204–10CrossRef
Metadata
Title
Axillary reconstruction: proposal of a therapeutic algorithm based on systematic review of the literature
Authors
Ester Sanz Aranda
Valentin Yuste Bevanvente
Enara Reola Ramírez
Alba Perales Enguita
Josep María Martí Ayats
Alba Sobrino Casorrán
Publication date
23-06-2022
Publisher
Springer Berlin Heidelberg
Keyword
Acne Inversa
Published in
European Journal of Plastic Surgery / Issue 1/2023
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-022-01977-8

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