Surgical approach to extensive hidradenitis suppurativa

Dermatol Surg. 2011 Jun;37(6):835-42. doi: 10.1111/j.1524-4725.2011.01961..x.

Abstract

Background: Hidradenitis suppurativa (HS) is a chronic suppurative disease of skin with high recurrence.

Objective: To determine factors affecting complications and recurrence of HS in patients who underwent surgery.

Materials and methods: We operated on 15 patients with HS at 36 sites between 1999 and 2009. The affected areas were classified as groin, axilla, buttocks, nuchae, perianal, and perineal. All patients were treated using wide surgical excision under general anesthesia. The methods of reconstruction varied depending on the size and location of the defect.

Results: The female:male ratio of patients was 4:11. Mean age was 41.8 ± 10.6. Twenty-eight (77%) of the lesions were Stage III according to Hurley's staging system. Mean follow-up was 42 months. Radical excision was performed on all lesions; 20 were reconstructed with primary closure, nine with fasciocutaneous flaps, and five with split-thickness skin grafts. The overall complication rate was 25% (9/36) and complications occurred mostly in perineal, perianal, and buttocks sites. Two (5.5%) recurrences were seen only in buttocks site.

Conclusion: To prevent complication, avoid recurrence of HS, and improve patients' quality of life, early and wide surgical excision is important and effective. The recurrence and complications are mostly related to the location of the disease. The authors have indicated no significant interest with commercial supporters.

MeSH terms

  • Adult
  • Anal Canal / surgery
  • Axilla / surgery
  • Buttocks / surgery
  • Escherichia coli Infections / microbiology
  • Female
  • Groin / surgery
  • Hidradenitis Suppurativa / microbiology
  • Hidradenitis Suppurativa / surgery*
  • Humans
  • Klebsiella Infections / microbiology
  • Male
  • Middle Aged
  • Perineum / surgery
  • Proteus Infections / microbiology
  • Recurrence
  • Skin Transplantation
  • Staphylococcal Infections / microbiology
  • Surgical Wound Infection
  • Treatment Outcome