Wide excision and latissimus dorsi flap reconstruction for advanced axillary hidradenitis suppurativa: a case series

Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the pilosebaceous unit characterized by recurrent nodules, tunnels, scarring, and functional impairment, most commonly affecting intertriginous regions. Surgical excision addresses irreversible tissue damage, while medical therapy controls the underlying inflammatory process; both strategies should be considered complementary. Following wide excision, secondary intention healing remains a valid option for axillary defects; however, flap reconstruction may be electively chosen in selected patients to shorten healing time and reduce wound care burden based on patient preference and surgeon experience. This article presents a case series of three patients with Hurley stage III axillary HS who underwent wide excision followed by reconstruction with latissimus dorsi musculocutaneous flaps. Operative details, perioperative management, postoperative outcomes, and follow-up are reported. All patients achieved durable coverage, preserved shoulder range of motion, high aesthetic satisfaction, and no clinical recurrences during follow-up.