Reconstruction after Excision of Hidradenitis Suppurativa: Are Skin Grafts Better than Flaps?

Abstract

Summary:After surgical excision of hidradenitis suppurativa, reconstruction with a skin graft or a flap is performed when primary closure is not possible. However, the recurrence rate is reportedly high even after wide surgical excision. It is still unclear which reconstruction method provides the lowest recurrence rate. In this report, we present a case of intractable hidradenitis suppurativa in the bilateral perineal region. After wide excision and repair with bilateral groin flaps, a unilateral groin flap was replaced with a split-thickness skin graft because of flap necrosis. Although the skin graft repair region has been recurrence free for 4 years postoperatively, other regions with flap repair showed recurrence 1 year postoperatively, leading to reexcision and repair with a split-thickness skin graft. The current case provides an opportunity to reconsider the optimal surgical strategy for hidradenitis suppurativa. Taking into consideration the fact that hair follicles and sweat glands are involved in the etiology of hidradenitis suppurativa, split-thickness skin grafting, which lack cutaneous appendages, may be superior to flap repair or primary closure in terms of recurrence.

Colgajo dorsal ancho para reconstrucción axilar secundario a hidradenitis supurativa severa

“…[4][5][6] Medhizaded y colaboradores observaron en una revisión sistemática que entre las opciones quirúrgicas con menos tasas de recurrencia se encuentran los injertos de espesor parcial y los colgajos, con cifras de hasta 6 y 8% respectivamente, tal vez porque los injertos cutáneos parciales carecen de anexos cutáneos, problema principal de la hidradenitis supurativa. 2,3 Para casos como el presentado en este trabajo, que llegan a ser extensos, reconstrucciones con colgajos como el de dorsal ancho para la zona axilar, siempre será una buena opción…”

“…Es necesario resaltar que en muchas ocasiones este tratamiento se realiza de manera multidisciplinaria, incluyendo desde el médico general en atención primaria hasta dermatólogos, endocrinólogos y en casos más severos al cirujano plástico, ya que el tratamiento quirúrgico, reservado para casos más severos, tiene un espectro amplio de opciones, desde destechamiento, marsupialización, escisión parcial, completa y cobertura por cierre primario, injertos y/o el uso de colgajos mixtos. 3 Presentamos el caso de una paciente con hidradenitis supurativa axilar unilateral a quien se le realizó escisión completa y cobertura, usando el colgajo de Latissimus dorsi.…”

Reconstruction of bilateral inferomedial gluteal defects after resection of hidradenitis suppurativa with symmetrical keystone flaps designed parallel to relaxed skin-tension lines

“…After surgical resection of gluteal HS, skin grafting has commonly been used to achieve a simple coverage of the defect. [6,8] However, skin grafting for gluteal defects may often lead to contracture, stiffness, and contour deformity. [2,6] Furthermore, skin grafting cannot provide enough cushions in these areas, and return to normal daily life is delayed due to a long healing time.…”

“…[2] There have been various reconstructive options for HS lesions, such as skin grafting, conventional fasciocutaneous (FC) flaps, and pedicled perforator flaps (PPFs). [1,2,[6][7][8] Among these, there is no universally accepted reconstructive method for gluteal defect coverage; therefore, reconstructive surgeons choose the proper method on a case-bycase basis. Herein, we present our experience of bilateral inferomedial gluteal defects reconstruction after resection of gluteal HS with symmetrical keystone flaps (KFs) designed parallel to relaxed skin-tension lines (RSTLs).…”

Reconstruction after Excision of Hidradenitis Suppurativa: Are Skin Grafts Better than Flaps?

“…Sugio et al 1 have recently published in Plastic and Reconstructive Surgery Global Open a very interesting case report entitled “Reconstruction after Excision of Hidradenitis Suppurativa: Are Skin Grafts Better than Flaps?” They present a case of bilateral inguinal hidradenitis suppurativa (HS) that was first treated with excision and bilateral inguinal flaps. Due to flap loss in the right side, a mesh skin grafting was performed.…”