Secondary intention healing in skin surgery: our own experience and expanded indications in hidradenitis suppurativa, rhinophyma and non‐melanoma skin cancers

Bieniek, Andrzej; Matusiak, Łukasz; Chlebicka, Iwona; Szepietowski, Jacek C.

doi:10.1111/j.1468-3083.2012.04646.x

Cited by 35 publications

(22 citation statements)

References 13 publications

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“…Previously, Bieniek et al 15 demonstrated favourable cosmetic results of secondary intention healing after HS surgery. We argue that secondary intention healing prevents recurrences because there will be no entrapment of epithelial strands or debris, as can occur after primary closure.…”

Section: Discussionmentioning

confidence: 97%

Hidradenitis suppurativa treated with wide excision and second intention healing: a meaningful local cure rate after 253 procedures

Deckers

Dahi

Zee

et al. 2018

Acad Dermatol Venereol

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Section: Discussionmentioning

confidence: 97%

Hidradenitis suppurativa treated with wide excision and second intention healing: a meaningful local cure rate after 253 procedures

Deckers

Dahi

Zee

et al. 2018

Acad Dermatol Venereol

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“…The width of the excision and not the wound closure technique influenced the therapeutic outcome [25, 27, 29], whereas vacuum-assisted closure may accelerate the time-point of a delayed primary closure as shown by a retrospective study [30]. On the other hand, secondary intention healing revealed “good’ or “excellent” results in 27.3 % and 39.4 %, respectively, of 97 cases studied after 12 months of follow-up [31]. Buimer et al [24] observed 41 % recurrences in 200 patients treated with radical surgery and closed by primary closure or skin graft.…”

Section: Methodsmentioning

confidence: 99%

Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

Gulliver

Zouboulis

Prens

et al. 2016

Rev Endocr Metab Disord

196

288

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Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses that rupture and lead to sinus tracts and scarring. To date, an evidence-based therapeutic approach has not been the standard of care and this is likely due to the lack of evidence based treatment guidelines. The purpose of this study was to promote a holistic evidence-based approach which implemented Level of Evidence and Strength of Recommendation for the treatment of HS. Based upon the European Dermatology Forumguidelines for the management of HS, evidence-based approach was explored for the treatment of HS. The diagnosis of HS should be made by a dermatologist or other healthcare professional with expert knowledge in HS. All patients should be offered adjuvant therapy as needed (pain management, weight loss, tobacco cessation, treatment of super infections, and application of appropriate dressings). The treating physician should be familiar with disease severity scores, especially Hurley staging, physician global assessment and others. The routine use of patient’reported outcomesincluding DLQI, itch and pain assessment (Visual Analogue Scale) is strongly recommended. The need for surgical intervention should be assessed in all patients depending upon type and extent of scarring, and an evidence-based surgical approach should be implemented. Evidence-based medical treatment of mild disease consists of topical Clindamycin 1 % solution/gel b.i.d. for 12 weeks or Tetracycline 500 p.o. b.i.d. for 4 months (LOE IIb, SOR B), for more widespread disease. If patient fails to exhibit response to treatment or for a PGA of moderate-to-severe disease, Clindamycin 300 p.o. b.i.d. with Rifampicin 600 p.o. o.d. for 10 weeks (LOE III, SOR C) should be considered. If patient is not improved, then Adalimumab 160 mg at week 0, 80 mg at week 2; then 40 mg subcutaneously weekly should be administered (LOE Ib, SOR A). If improvement occurs then therapy should be maintained as long as HS lesions are present. If the patient fails to exhibit response, then consideration of second or third line therapy is required. A growing body of evidence is being published to guide the treatment of HS. HS therapy should be based upon the evaluation of the inflammatory components as well as the scarring and should be directed by evidence-based guidelines. Treatment should include surgery as well as medical treatment. Future studies should include benefit risk ratio analysis and long term assessment of efficacy and safety, in order to facilitate long term evidence based treatment and rational pharmacotherapy.

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“…Patients with extensive disease at multiple locations are usually operated in several sessions. The wounds are allowed to heal by secondary intention as in our experience, and that of others, it is time‐efficient and leads to good cosmetic and functional results . Furthermore, it allows prolonged wound drainage, diminishing the risk of wound infection …”

Section: Discussionmentioning

confidence: 80%

Skin‐Tissue‐sparing Excision with Electrosurgical Peeling (STEEP): a surgical treatment option for severe hidradenitis suppurativa Hurley stage II/III

Blok

Spoo

Leeman

et al. 2014

Acad Dermatol Venereol

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In contrast to wide excisions that generally reach into the deep subcutaneous fat, the fat is maximally spared with the STEEP procedure by performing successive tangential excisions of lesional tissue until the epithelialized bottom of the sinus tracts has been reached. From here, secondary intention healing can occur. In addition, fibrotic tissue is completely removed in the same manner as this also serves as a source of recurrence. This tissue-sparing technique results in low recurrence rates, high patient satisfaction with relatively short healing times and favourable cosmetic outcomes without contractures.

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Secondary intention healing in skin surgery: our own experience and expanded indications in hidradenitis suppurativa, rhinophyma and non‐melanoma skin cancers

Abstract: SIH is a safe and efficient form of treatment for various post-operative skin defects. In certain areas of the body, SIH shows favourable cosmetic and functional effects. In these cases, it may even be regarded as the method of choice.

Cited by 35 publications

References 13 publications

Hidradenitis suppurativa treated with wide excision and second intention healing: a meaningful local cure rate after 253 procedures

Hidradenitis suppurativa treated with wide excision and second intention healing: a meaningful local cure rate after 253 procedures

Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

Skin‐Tissue‐sparing Excision with Electrosurgical Peeling (STEEP): a surgical treatment option for severe hidradenitis suppurativa Hurley stage II/III

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