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CC BY 4.0 · Arch Plast Surg 2025; 52(04): 211-216
DOI: 10.1055/a-2575-1211
Breast/Trunk
Idea and Innovation

Keystone Perforator Island Advancement Flap as Another Option for Closure after Radical Excision of Axillary Hidradenitis Suppurativa

Timea H. Virag 
1   Clinic of Plastic, Aesthetic Surgery and Reconstructive Microsurgery, University of Medicine Iuliu Hatieganu, Clinical Hospital of Rehabilitation, Cluj Napoca, Cluj, Romania
,
Geoffrey G. Hallock 
2   Division of Plastic Surgery, Sacred Heart Campus, St. Luke's Hospital, Allentown, Pennsylvania
,
Ileana R. Matei 
1   Clinic of Plastic, Aesthetic Surgery and Reconstructive Microsurgery, University of Medicine Iuliu Hatieganu, Clinical Hospital of Rehabilitation, Cluj Napoca, Cluj, Romania
,
Alexandru V. Georgescu 
1   Clinic of Plastic, Aesthetic Surgery and Reconstructive Microsurgery, University of Medicine Iuliu Hatieganu, Clinical Hospital of Rehabilitation, Cluj Napoca, Cluj, Romania
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Abstract

Surgical treatment of axillary hidradenitis suppurativa (HS) requires wide excision followed by definitive wound closure to not limit shoulder function. An international prospective study was undertaken to compare how a keystone perforator island advancement flap can be a reliable solution. Independently, two Transatlantic institutions, from 2019 to 2024, surgically resected axillary HS followed by a keystone perforator flap for defect management. A total of 23 patients were treated, including 4 with bilateral disease, employing 27 total flaps that permitted the comparison of demographic data, Hurley disease stage, flap viability and complications, need for secondary surgeries, duration of treatment, and functional outcome. Demographic data in both countries was similar with regard to mean age, female preponderance, presence of obesity, and prior means of treatment. Surgical treatment was not limited in either country only to Hurley stage III individuals. In Romania, 6/11 (54.5%) compared to 3/12 (25.0%) of U.S. patients were classified as Hurley stage II. No flap necrosis was observed, allowing unrestricted shoulder mobility within 3.5 (2–4) months in Romania, but more slowly by 4.4 (3–9) months in the United States. All complications were minor, occurring in 11 (43.5%) patients, albeit three times more frequently in the United States. Overall, the most common problem was lesser curvature dehiscence (63.6%). No disease recurrences were noted. The keystone perforator island advancement flap is a safe, rapid, and simple local flap option for the closure of the axillary defect after the excision of HS. The learning curve was straightforward, so reconstructive surgeons can readily adapt to utilize this approach.

Keywords

hidradenitis suppurativa - axilla - keystone perforator island flap

Authors' Contributions

Conceptualization, actual surgery for those patients included in their country, and writing, including original draft, review, and editing, was done by all authors. The video itself was re-edited by G.G.H.


Ethical Approval

Not applicable.


Patient Consent

Informed consent was obtained from all patients to appropriately allow the use of their clinical photographs or other data for this research, educational, and publication purposes.




Publication History

Received: 25 March 2024

Accepted: 31 March 2025

Article published online:
23 July 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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