Axillary Hidradenitis Reconstruction Using a Dermal Regeneration Template

1. WHAT IS YOUR DIAGNOSIS?

2. AXILLARY Hidradenitis suppurativa

3. Axillary Hidradenitis Reconstruction Using a
Dermal Regeneration Template
Casey Kraft, MD1 and Gregory Pearson, MD1,2
1Ohio State University Wexner Medical Center, Columbus, OH;
2Nationwide Children's Hospital, Columbus, OH
Correspondence
Gregory Pearson, MD, Nationwide Children's Hospital, 700 Children's Dr,
Columbus, OH 43205; gregory.pearson@nationwidechildrens.org
February 2022
ISSN 1044-7946
Index Wounds 2022;34(2):43–46
PRESENTER: Gerelmaa J, MD
AGAPE CHRISTIAN HOSPITAL, JOURNAL CLUB
2022.04.29

4. Introduction
Hidradenitis suppurativa can be a debilitating
condition, particularly in the pediatric population.
Axillary hidradenitis can be particularly
challenging because of the risk of scar
contracture and limited range of motion after
definitive resection and reconstruction.

5. TREATMENT OPTION
• A dermal regeneration template (DRT)
• Skin grafting

6. Dermal Regeneration Template (DRT)

7. This case series retrospectively
reviewed and evaluated
outcomes using DRT and skin
grafting for axillary hidradenitis
reconstruction.

8. Materials and Methods
• Patient selection
Single surgeon, patients between 2015 -2018
Inclusion criteria: DRT was used for the reconstruction.
Exclusion criteria:
- reconstruction using any other method
- absence of plastic surgery involvement in reconstruction
- hidradenitis location other than the axilla.

9. Materials and Methods
Treatment data:
- several negative pressure wound therapy (NPWT) changes
- time to skin grafting
- age at treatment
- pain medication consumption
- axillary range of motion.
Surgical complications:
- infection
- DRT loss
- graft loss
- hidradenitis recurrence

10. Surgical technique
Representative
example of hidradenitis
suppurativa
preoperatively with
areas of drainage and
induration.

11. Surgical technique
• Complete axillary excision was performed
to encompass all hair follicles of the axilla.
• Excision:
- dermis to the subcutaneous tissue
- all affected dermis

12. Surgical technique
- The DRT was then
trimmed to the
shape of the excised
area and stapled
into place.

13. Surgical technique
- The NPWT device
- Airplane splint that had
been customized
preoperatively by an
occupational therapist

14. Surgical technique
- This splint remained
- The patient was then admitted to the hospital
- Weekly or biweekly NPWT changes
- Complete take of the DRT - in the OR

15. Surgical technique
- The NPWT device
- Gentle use of the
arm as tolerated was
allowed, and
standard wound
care for skin
grafting

16. Results

17. Discussion
- Axillary reconstruction- NPWT, skin grafting, local flaps,
extended latissimus dorsi flaps, and thoracodorsal artery
perforator flaps.[9–12]
- bilayer DRT - good results.[13,14]
- These studies are limited, with Ribeiro and Guerra[13] describing a single case report and Gonzaga et al[14]
reporting a cohort of 4 patients with a 25% skin substitute loss rate
and 50% reoperation rate.

18. Discussion
- there were no unplanned operations
- there was no DRT loss or recurrence of hidradenitis.
- Cost concerns have been raised in the literature.
- Reduced risk of axillary contracture from using DRT
and the elimination of additional donor sites is worth
consideration until higher-level studies are performed.

19. Limitations
- This study is a limited case series of a single
surgeon's experience at 1 academic center
- Additional prospective, large-scale, multi-
surgeon studies are warranted for further analysis

20. Conclusions
1. Management of axillary hidradenitis with complete
excision and reconstruction using a
DRT with skin grafting appears to be safe and
effective in the pediatric population.

21. Conclusions
2. Patients in the current cohort tolerated
the procedure well and had no complications,
including loss of DRT or skin graft, infection, loss of axillary
range of motion, or recurrence of hidradenitis.

22. Conclusions
3. Surgeons should consider using
this method of reconstruction for
axillary hidradenitis, although more extensive
studies are needed to confirm its safety and efficacy.

23. 1.ACH case
2.Recommendation for other doctors

24. DIAGNOSIS

25. TREATMENT RECOMMENDATIONS
The Hurley staging system:
• mild and moderate cases (stages I and II) - topical
antibiotics, oral antibiotics, biologics, laser therapy,
and botulinum toxin.[2–5]
• severe cases (stage III)- wide excision and
reconstruction.[6,7]

26. THANK YOU
FOR YOUR
ATTENTION
AND
NO
QUESTION,
OKAY?!