TIDAP Perforator Flap vs Skin Grafting for Axillary Tissue Defects Following Verneuil’s Disease Excision: A Case Series of 8 Patients

Introduction: Hidradenitis suppurativa (HS), also known as Verneuil’s disease, is a chronic, suppurative, inflammatory, and scarring disorder of the pilosebaceous follicles, primarily affecting apocrine gland-rich regions such as the axillae. In advanced stages, treatment relies on wide surgical excision of the affected area. Post-excisional reconstruction remains challenging, with options including split-thickness skin grafting (STSG) and perforator flaps, particularly the thoracodorsal artery perforator (TIDAP) flap, which offers functional and aesthetic advantages. Materials and Methods: This retrospective study was conducted over a 3-year period and included 8 patients (5 men and 3 women) with severe axillary hidradenitis suppurativa. All patients underwent wide surgical excision, followed either by reconstruction with a split-thickness skin graft (n=4) or a TIDAP perforator flap (n=4). Intraoperative data, healing time, postoperative complications, and patient satisfaction were compared between the two groups. Results: Patients reconstructed with the TIDAP flap experienced significantly faster recovery, single-stage healing, lower rates of infectious complications, and reduced postoperative care needs. In contrast, the skin graft group required longer immobilization, experienced slower directed healing, and had more frequent complications, including dehiscence and superinfection. Functional and aesthetic satisfaction was also higher in the TIDAP group. Conclusion: Reconstruction of axillary defects following Verneuil’s disease excision can be achieved using several techniques. While split-thickness skin grafting remains a simple option, it carries increased risks of complications and prolonged healing time. Although technically demanding, the TIDAP perforator flap offers a reliable, rapid, and durable alternative, providing better postoperative comfort and functional recovery.