Inframammary extended circumflex scapular (IMECS) flap for axillary hidradenitis suppurativa: Advantages over conventional alternatives

Abstract

Background

We presented our experience with the use of the inframammary extended circumflex scapular (IMECS) flap in the reconstruction of axillary hidradenitis suppurativa (HS). Although this flap has been described as a free flap, its use for the reconstruction of the axilla has not been documented yet.

Methods

The study included patients with HS in the axillary region, Hurley stage III, operated between 2016 and 2020 with wide local excision and coverage with the inframammary extended circumflex scapular flap. We recorded patients’ demographic details (sex, age, comorbidities, smoking habit), affected area characteristics (stage, extension, side), operative technique (simple or tunneled flap, surgical timing, hospitalization days), and postoperative outcome (time to healing, complications, recurrences, additional surgeries, and follow-up).

Results

A total of 7 flaps were successfully performed in 6 patients. The mean size of the flaps was 160 cm² (range 115–225), and the mean surgical time was 82 min (range 65–90). The flap success rate was 100%, without any partial or complete flap necrosis. There was 1 flap dehiscence and 1 additional surgery to correct a dog-ear deformity. No local recurrence was documented during follow-up. There were no complications in the donor site and no limitation to arm abduction.

Conclusions

The IMECS flap is an easy and reliable option for the reconstruction of axillary defects after excision of HS stage III hidradenitis, with low morbidity and good functional and aesthetic results.