Hidradenitis Suppurativa of the Underarm — Wide Excision and Flap Reconstruction

Patient identity withheld per confidentiality guidelines.

The Condition

Hidradenitis suppurativa is a chronic inflammatory skin condition that affects areas rich in sweat glands, most commonly the underarms, groin, and under the breasts. In this patient, the right armpit was affected by repeated crops of painful boils and abscesses that discharged pus, alongside fixed open sinus tracts and scarring built up over time. The disease in the affected skin was extensive rather than a single isolated spot, which is why piecemeal treatment of one boil at a time does not resolve it. Hidradenitis suppurativa is widely under-recognised, and many patients move between dermatology visits for years before the underlying need for surgery is identified.

Hidradenitis suppurativa is best understood as a disease of the skin itself in that region. Because the affected skin keeps generating new flares, the durable solution is to remove the entire involved area rather than drain individual lesions. Visit the hidradenitis suppurativa treatment service page for an overview of the surgical approach.

Emotional and Psychological Impact

Living with recurring underarm abscesses takes a heavy toll well beyond the physical pain. For a working mother, the constant discharge, dressing changes, and discomfort interfered with daily routine, work, and the ordinary movement of the arm. The patient had already undergone a smaller surgery elsewhere in the hope of a quick fix. When the stitches gave way within a week, that setback brought real distress, and she called in a state of panic. The cycle of flare, partial treatment, and recurrence is exactly what erodes confidence in patients with this condition and leaves them feeling that nothing will ever fully settle it.

What Was Assessed During the Consultation

• Full extent of the diseased skin across the right axilla, including active sinuses and scarred tissue
• Quality and laxity of the surrounding healthy skin available for reconstruction
• The failed previous limited excision and its broken-down wound
• The patient’s goal of a permanent, recurrence-free result with unrestricted arm movement
• General medical fitness for surgery under anaesthesia

Why This Approach Was Chosen

The patient had already experienced what a small, limited excision delivers: the wound came apart within a week and the disease remained. Dr. Leena Jain recommended the definitive plastic surgical approach for the following reasons.

• Complete removal of affected skin:Hidradenitis suppurativa recurs from any diseased skin left behind, so excising the entire involved area, rather than a part of it, is what changes the long-term outcome.
• Flap cover over the defect:Removing the full thickness of affected underarm skin leaves a sizable raw area. A flap brings in healthy, well-vascularised tissue to cover it, which heals far more reliably than leaving the wound to close under tension, the very thing that caused the earlier failure.
• Restoring movement:Covering the armpit with supple flap tissue preserves the range of motion at the shoulder, so the patient can return to normal work and daily activity without tightness or restriction.
• Curative intent:By changing the anatomy of the affected area through complete excision and healthy cover, the disease in that region is effectively cured rather than merely suppressed.

After being counselled again following her failed earlier surgery, the patient understood why the entire affected skin needed removal and consented to the flap procedure.

• Excision margins marked with the patient positioned to expose the full extent of diseased axillary skin
• General anaesthesia administered
• Complete wide excision of all affected skin, sinus tracts, and scar tissue from the right axilla
• Healthy tissue margins confirmed to ensure no diseased skin was left behind
• Flap raised from adjacent healthy tissue and transposed to cover the excision defect
• Flap inset with attention to preserving shoulder and arm movement
• Layered wound closure with the flap providing tension-free cover

Dr. Leena Jain recommended a wide local excision of the affected tissue in both armpits to remove the diseased skin completely. Following the excision, flap coverage was performed to cover the surgical sites with healthy tissue, promoting optimal healing and reducing the risk of recurrence. This two-step approach was designed to not only address the abscesses but also ensure long-term relief and restore full function to the arms.

The surgery delivered a complete and lasting result. With the entire affected area removed and covered by a healthy flap, the wound healed soundly and there was no recurrence. By three months after surgery the patient was fully comfortable, free of pain, and able to carry out all her work and daily activities without any restriction in arm movement.

Outcomes at a Glance

Recorded during clinical follow-up.

“After my first small surgery elsewhere failed and the stitches gave way, I was really scared. This time the whole affected area was treated properly. Three months on, there are no boils coming back, I have no pain, and I can move my arm and do all my work freely. I finally feel relieved.”

Profile: Female · 35 years · Working professional · Mumbai
Procedure: Wide excision with flap reconstruction · Plastikos Clinic, Mumbai
Surgeon: Dr. Leena Jain · Plastikos Clinic

Instructions Given to Patient

• Keep the operated area and flap clean and protected as advised
• Attend scheduled dressing changes and suture checks
• Take prescribed medication for the full duration
• Restrict heavy arm and shoulder movement initially, then gradually resume as advised
• Begin gentle mobilisation of the arm once healing allows, to preserve range of motion
• Attend all follow-up appointments to monitor healing and confirm no recurrence

Recovery Timeline

Related: Learn more about Dr. Leena Jain and her plastic and reconstructive surgery practice, or explore the full range of plastic surgery services in Mumbai.