Experience With Surgical Treatment of Hidradenitis Suppurativa

Abstract

The authors report their experience with 23 sites of hidradenitis suppurativa, including cases with musculocutaneous flap repair, and discuss the surgical methods applied. Twenty-three sites in 19 patients with chronic inflammatory skin lesions were reviewed. The lesions were divided into two groups: The limited group was comprised of mild lesions, which appear isolated and have limited abscesses without sinus tract formations. The severe group was compromised of severe lesions, which included diffuse, multiple abscesses with severe sinus tract formation and fibrosis. Nine sites were limited and 14 sites were severe. After resecting the lesion, the defect was covered with a split-thickness skin graft (four sites were limited, nine sites severe), a musculocutaneous flap (five sites severe), primary closure (four sites limited), and a local skin flap (one site limited). In six sites in 6 severe-group patients, local recurrence occurred. The local recurrence rate differed significantly between the limited and the severe groups. The reason for this may be because the lesions in the limited group could be resected completely, whereas the lesions in the severe group were diffuse and total resection was sometimes difficult for various reasons. The method of surgical repair did not affect the local recurrence rate. In recurrent cases, four sites treated with skin grafting required further surgical treatment, and two sites treated with musculocutaneous flaps were controlled with oral antibiotics. In conclusion, sufficient resection of the lesion is the most important issue in treating follicular occlusion triad disease. In lesions that can be resected completely, the surgical procedure to cover the lesions should be selected to suit the size and site of the defect. However, in cases that cannot be resected completely, a musculocutaneous flap is recommended instead of a skin graft for enhanced postoperative management of the recurring wound, and its contribution to aesthetic and functional improvement.

Retalho fasciocutâneo toracodorsal no tratamento cirúrgico da hidradenite supurativa: relato de caso e revisão de literatura

“…The pathophysiology of Verneuil's disease involves the obstruction of the apocrine glands, resulting in glandular dilatation, bacterial infection with abscess formation and con sequent rupture, tissue injury, fistula formation, fibrosis, and retractable scars 5 . Conservative and surgical treatments can be used to resol ve hidradenitis suppurativa.…”

Reconstructive options in severe cases of Hidradenitis suppurativa

“…There is a need for a radical debridement that plays a major role in avoiding recurrence and chronicity of the disease [3,[19][20][21][22][23]. Therefore, a radical excision of the affected areas should be the primary concern.…”

“…Firstly, incision and drainage should be avoided because it is of limited value [34][35]. As the treatment of choice, surgical removal of the involved tissue is strongly advised [3,[36][37].…”

“…Another study showed 70% recurrence following primary closure and excision [37]. It is speculated that musculocutaneous flaps are more resistant to recurrence than a skin graft [3]. However, it is reported that there may be no difference between a muscuocutaneous flap and a fasciocutaneous flap in this regard [38].…”

“…Hidradenitis suppurativa is a chronic, debilitating inflammatory disease of apocrine glands characterized with abscesses and nodulstar lesions [1][2][3][4][5][6]. The affected areas are mainly the axillae, groin, buttocks, perianal and infra-mammary regions where a high density of apocrine glands exists.…”