Aim: To pioneer the use of the type 1 V-Y thoracodorsal artery perforator (TAP) flap in closing axillary defects.

Methods: In five consecutive patients with hidradenitis suppurutiva, the diseased glands were excised down to deep fascia leaving a large defect. A single large V-Y (type 1) flap, measuring an average 15 by 10 cms was raised based on two to three perforators of the ipsilateral thoracodorsal artery and advanced superiorly to close the defect. These perforators were found 2 to 3 cms posterior to the anterior border of the latissimus dorsi muscle pre-operatively using a Doppler probe. Post-operatively, drains were left in-situ for 24 hours.

Results: 20% of cases had recurrent infection. Post-operative shoulder movements were not impaired and all wounds healed in two weeks.

Discussion: We found that a single large V-Y TAP flap is of sufficient size and thickness to close deep axillary defects cosmetically whilst preserving contour. It is robust and user-friendly. Unlike the Austrian group, we found it unnecessary to isolate the perforators down to the main thoraco-dorsal artery. Moreover, this endangers flap survival.