Aesth Plast Surg
DOI 10.1007/s00266-014-0335-1
CASE REPORT
Reconstruction for Extensive Groin Hidradenitis Suppurativa
Using a Combination of Inferior Abdominal Flap and Medial
Thigh-Lift: A Case Report
Takahide Mizukami • Masao Fujiwara •
Kayoko Ishikawa • Shohei Aoyama •
Hidekazu Fukamizu
Received: 12 January 2014 / Accepted: 18 April 2014
Ó Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2014
Abstract Various methods for reconstructing hidradeni-
tis suppurativa of the groin have been reported. However, it
is difficult to attain favorable results both aesthetically and
functionally. This report describes a case in which a defect
was reconstructed using a combination of inferior abdom-
inal flap and medial thigh-lift after radical excision of
extensive groin hidradenitis suppurativa. A 37-year-old
woman patient underwent radical excision of bilateral
groin hidradenitis suppurativa. After the excision, an
inferior abdominal flap and bilateral medial thigh flaps
were created and advanced to close the defect. The oper-
ative procedure was simple and did not require a donor site.
The postoperative scar coincided with the inguinal folds
and was concealed by undergarments. No functional dis-
order remained. Reconstruction for extensive groin
hidradenitis suppurativa using this method can attain good
aesthetic and functional results. The combination of infe-
rior abdominal flap and medial thigh-lift is potentially a
useful option for reconstruction of extensive groin
hidradenitis suppurativa.
Level of Evidence IV This journal requires that authors
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description of these Evidence-Based Medicine ratings,
please refer to the Table of Contents or the online
Instructions to Authors www.springer.com/00266.
T. Mizukami (&)
M. Fujiwara
S. Aoyama
H. Fukamizu
Department of Plastic and Reconstructive Surgery, Hamamatsu
University School of Medicine, Handayama 1-20-1, Higashi-ku,
Hamamatsu, Shizuoka 431-3192, Japan
e-mail: takahide1210@gmail.com
K. Ishikawa
Department of Plastic and Reconstructive Surgery, Numazu City
Hospital, Shizuoka, Japan
GENERAL RECONSTRUCTION
Keywords Inferior abdominal flap
Abdominoplasty

Medial thigh-lift
Hidradenitis suppurativa
Groin
Vulva
Introduction
Hidradenitis suppurativa is a chronic relapsing inflamma-
tory disease originating from occlusion of the apocrine
gland follicles with subsequent abscess and sinus formation
[1]. Extensive hidradenitis suppurativa often is refractory
to conservative treatments such as antibiotic administra-
tion, hormonal therapy, and incision and drainage [2].
Thus, radical excision of the affected tissue is the only
curative treatment [3].
Various reconstruction methods after radical excision of
groin hidradenitis suppurativa have been described
including secondary healing, split-thickness skin grafting,
creation of a local fasciocutaneous flap, abdominoplasty,
and medial thigh-lift [2–8]. However, it is difficult to attain
favorable results both aesthetically and functionally.
We report a case in which a groin defect was recon-
structed by the combination of inferior abdominal flap and
medial thigh-lift after radical excision of extensive
hidradenitis suppurativa.
Materials and Methods
Case Report
A 37-year-old woman presented with a subcutaneous
abscess of the right groin. She had a 20-year history of
repeated hidradenitis suppurativa of the bilateral groin and
vulva. Although she had undergone repeated conservative
treatments including antibiotic administration and incision
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Fig. 1 Top left hidradenitis

suppurativa of the bilateral
groin and vulva is excised en
bloc. Top right the size of the
defect is 32 9 27 cm. Bottom
left the inferior abdominal flap
and bilateral medial thigh flaps
are undermined to the dotted
lines. Bottom right the flaps are
advanced and sutured. The
crosses are the point at which
the subdermal layer and dermis
of the bilateral medial thigh
flaps are sutured to Colles’
fascia

Fig. 2 Appearance 9 months

after surgery. Left the
postoperative scar coincides
with the inguinal fold. Right
deformity of the labia majora or
minor is not observed

and drainage, the lesion had gradually progressed to
involve the entire surface of the bilateral groin and vulva.
Physical examination showed acute inflammation and
abscess formation of the right groin. Indurations indicating
a dense network of sinus tracts were palpated in the lower
abdomen, bilateral groin, vulva, and medial thigh.
Incision and drainage was performed to control the acute
inflammation of the groin. After the infection had settled,
radical surgery was performed to treat the hidradenitis
suppurativa of the groin and vulva. The entire lesion was
excised en bloc. The medial labia majora were preserved
bilaterally. The size of the defect was 32 9 27 cm. The
defect was reconstructed with an inferior abdominal flap
and bilateral medial thigh-lifts (Fig. 1).
Minor wound dehiscence and temporary lymphedema
occurred postoperatively but healed with conservative
treatment. At 9 months postoperatively, the patient
remained free of the disease. A good aesthetic result was
obtained (Fig. 2). Neither deformity of the labia majora nor
dysuria occurred. The patient was able to abduct her hips
through a full normal range.
Surgical Technique
Under general anesthesia, the patient was placed in the
lithotomy position with an interthigh angle of 120°. After
sterilization of the skin, the lesion was removed completely
just above the level of the superficial fascia. The resulting
defect was reconstructed using an inferior abdominal flap
and medial thigh-lifts (Fig. 3).
In the abdomen, the flap was raised superficial to the
rectus sheath. The lateral neurovascular bundles of the flap

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Aesth Plast Surg
Fig. 3 Schematic drawing showing the combination of inferior
abdominal flap and medial thigh-lift. Top the inferior abdominal flap
and the bilateral medial thigh flaps are undermined to the dotted lines.
Bottom the flaps are advanced to close the defect
and the perforators of the bilateral deep inferior epigastric
vessels around the umbilicus were preserved. Undermining
was performed cranial to the level of the umbilicus, with
care taken not to sacrifice the perforators.
In the medial thigh region, the flap was raised superficial
to the fascia lata. The perforators of the bilateral medial
circumflex femoral vessels were preserved. This perforator
usually exists around the point at which the medial cir-
cumflex femoral vessels enter the gracilis muscle, 6–10 cm
below the pubic tubercle [9]. The inferior abdominal flap
and bilateral medial thigh flaps then were advanced to close
the defect. The subdermal layer and dermis of the medial
thigh flap were sutured to Colles’ fascia to suspend the
medial thigh. Suction drains were placed in the subcutis of
the abdomen and bilateral thighs.
Closure of the defect was performed in two layers. The
patient was kept in bed in a slight lithotomy position for
72 h, and thromboembolic prophylaxis with low-molecu-
lar-weight heparin was administered for 14 days. The
suction drains were removed when the drainage volume
was less than 20 ml.
Discussion
The conventional techniques used to repair groin and vul-
val defects, such as secondary healing, skin grafting, and
local fasciocutaneous flaps, have some disadvantages. The
postoperative scar in patients who undergo reconstruction
with secondary healing is unsightly. In addition, scar
contracture often causes dysfunction of the hip joint.
Complicated dressings (e.g., tie-over dressing) and long-
term bed rest are necessary for patients who undergo
reconstruction with skin grafting [4]. Defecation manage-
ment, including dietary restriction, also is required to keep
the dressing clean for about 1 week postoperatively. The
postoperative scar is unsightly, and skin graft shrinkage
often results in dysfunction such as labia majora dehis-
cence, which causes vulval pruritus [8, 10].
In patients who undergo reconstruction with local flaps,
the scar protrudes outside the bikini line, and the flap often
is bulky because of the complicated three-dimensional
anatomy of the groin and vulva [5, 11]. Most local flap
surgeries result in additional scarring at the donor site and
are associated with donor-site morbidity [8].
Reconstruction of groin and vulval defects using a
combination of inferior abdominal flap and medial thigh-
lift has the following advantages. First, the operative pro-
cedure is simple. Second, this method does not require a
donor site, so problems associated with donor-site mor-
bidity and scarring do not occur. Third, neither complicated
dressings nor long-term bed rest is required postopera-
tively. The patient can resume oral intake in the early
postoperative period. Fourth, large defects can be covered
by this procedure because the flaps are advanced from both
the abdomen and bilateral thighs.
Finally, excellent aesthetic and functional results can be
obtained. The postoperative scar coincides with the ingui-
nal fold and can be concealed by undergarments. An
improved, slimmed contour of the body can be expected
through the inherent effect of the abdominal flap
advancement resembling an abdominoplasty [12] and
medial thigh-lift.
Anchoring of the medial thigh flap to the tough, inelastic
deep layer of the superficial perineal fascia or Colles’
fascia prevents dehiscence of the labia majora [8, 10, 13]. It
also prevents ptosis of the thigh. This procedure does not
prevent full-range abduction of the hips.
Good candidates for this combination of inferior
abdominal flap and medial thigh-lift are those who are not
thin and have some laxity of skin. Patients with hidrade-
nitis suppurativa often are obese, especially women [3].
This method therefore can be a useful option for these
patients. However, it may be difficult to perform in thin
patients.
The possible complications specific to this combination
method are marginal necrosis of the flaps and wound
dehiscence. The lateral neurovascular bundles of the
abdominal flap [14] and the perforators of the bilateral deep
inferior epigastric vessels around the umbilicus should be
preserved to prevent marginal necrosis of the abdominal
flap. Additionally, the perforators of the bilateral medial
circumflex femoral vessels should be preserved in the
medial thigh-lifts.
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In the reported case, minor wound dehiscence occurred
but healed with conservative treatment. To prevent severe
wound dehiscence, it is important to fix the medial thigh
flap to Colles’ fascia. The patient is advised to start
walking slowly in a hunched position to avoid stretching of
the abdomen [14].
Conclusion
Reconstruction for extensive groin hidradenitis suppurativa
using a combination of inferior abdominal flap and medial
thigh-lift can attain a good aesthetic and functional out-
come. This method may be a useful option for treatment of
extensive groin hidradenitis suppurativa.
Conflict of interest The authors declare that they have no conflicts
of interest.
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