Axillary reconstruction: proposal of a therapeutic algorithm based on systematic review of the literature

Background The use of therapeutic algorithms for the reconstruction of defects in different anatomical locations is common in plastic surgery. Nevertheless, axillary reconstruction has been unnoticed in this regard. The aim of this article is to review the surgical techniques employed in the reconstruction of axillary defects focusing on the indication for each one, with the aim of creating a therapeutic algorithm that serves as a guide for decision-making in axillary defect reconstruction. Methods A systematic review was performed using the MEDLINE, EMBASE and Cochrane library databases and including articles published between 2000 and 2020. Results After excluding case reports, duplicates and non-relevant articles, we selected a total of 11 relevant articles. Relevant information was extracted and employed to create a therapeutic algorithm. We suggest a reconstructive algorithm that classifies the defects according to their size in three categories. Conclusions We propose the use of local flaps for smaller defects (less than 30 cm(2)), regional flaps for medium-sized defects (30 to 200 cm(2)) and microsurgical fasciocutaneous flaps for large defects (more than 200 cm(2)). Regarding regional flaps, we consider the TDAP flap as the first choice for axillary reconstruction.