Surgical management of axillary hidradenitis suppurativa with latissimus dorsi flap on a 24-year-old patient: A case report

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory disorder with distinct characteristics: chronic nature, morphology, and location. It originates from occluded and ruptured follicles, releasing keratin and bacteria into the nearby dermis. This causes an inflammatory reaction, leading to the formation of abscesses and the destruction of the pilosebaceous junction. CASE PRESENTATION: We present the case 24-year-old female with a severe, stage III case of HS who had a lesion (approx. 10 × 15 cm) on her right axilla spanning 4 years. Despite some response to medical treatment, she experienced recurrent symptoms, due to this, surgical intervention was decided, using a latissimus dorsi thoracodorsal artery perforator (TDAP) flap. The lesion was successfully removed, and the flap was placed, leading to proper postoperative healing, cicatrization, and sensitivity in the patient. DISCUSSION: HS poses a challenge due to its recurring course. Treatment involves pharmacological and surgical approaches, with the former suited for mild to moderate cases and the latter for severe instances. Surgical options, like TDAP flaps, show lower recurrence rates than skin grafts. TDAP flaps also offer advantages such as reduced bulkiness and favorable aesthetic and functional outcomes compared to other latissimus dorsi flaps. CONCLUSION: HS represents an obstacle in terms of systemic effects and aesthetic concerns. Lattisimus dorsi flaps have emerged as an effective treatment method due to the reliable vascular supply and adequate volume to the recipient site as demonstrated by our case, where the patient showed appropriate evolution with no morbidity associated with the procedure as well as adequate aesthetic results.