The Thoracodorsal Artery Perforator (TDAP) Flap in the Management of Axillary Hidradenitis Suppurativa

Abstract: Background: Hidradenitis suppurativa is a chronic inflammatory disorder of the folliculopilosebaceous units that primarily affects intertriginous regions. In severe cases, wide surgical excision is often required. The thoracodorsal artery perforator (TDAP) flap represents an optimal reconstructive option for covering post-excisional axillary defects, providing a pliable, well-vascularized, and functional coverage with minimal donor-site morbidity. This study evaluates the efficacy, safety, and both aesthetic and functional outcomes of TDAP flap reconstruction in this setting. Methods: A retrospective study was conducted including patients who underwent surgical treatment for stage III axillary hidradenitis suppurativa (Hurley classification) between May 2023 and May 2025 at the Department of Plastic and Reconstructive Surgery, Ibn Sina University Hospital, Rabat. Demographic data, comorbidities, and perioperative variables were analyzed. All procedures were performed during the remission phase of the disease, and postoperative outcomes were assessed clinically and functionally. Results: Ten adult patients (6 males, 4 females; mean age: 31 years, range: 17–45) were included. The mean follow-up period was 12 months. Wide local excision followed by TDAP flap reconstruction resulted in a significantly shorter hospital stay (4 ± 1 days) and faster wound healing (average 3 weeks). Full functional recovery was achieved after an average of 5 weeks. Only one case of partial flap dehiscence was recorded and successfully managed by secondary closure. All patients showed significant improvement in shoulder function and overall quality of life, with no recurrence observed during follow-up. Conclusion: The thoracodorsal artery perforator (TDAP) flap is an excellent option for the reconstruction of extensive axillary defects following wide excision of hidradenitis suppurativa. It provides durable coverage, rapid recovery, low complication rates, and improved functional and aesthetic outcomes.