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Wide surgical excision reduced postsurgical risks in patients with hidradenitis suppurativa

Wide surgical excision decreased the risk for recurrence and postsurgical complications in patients with hidradenitis suppurativa, according to recent study results.

In a retrospective analysis conducted in Aachen, Germany, researchers reviewed 50 surgical procedures performed on 32 patients (12 male, 20 female) with chronic inflammatory, moderate-to-severe (Hurley stage II and III) hidradenitis suppurativa between 2003 and 2009. The patients, aged 17 to 51 years at presentation, underwent surgeries at the following anatomical sites: 23 involving the axilla, 17 in the inguinal region, eight in the perianal/perineal area, one in the gluteal region and one in the trunk region. Twenty-two patients were considered obese; 10 were smokers.

Patients’ conditions were classified for severity using the Hurley’s Staging System presurgery, and they were assessed for efficacy by the Sartorius Staging System postsurgery. Before excision, patients were treated with antibiotics for inflammation and underwent minor surgeries for abscess drainage with irrigation.

Using wide (1 cm) and deep margins including skin and subcutaneous tissue to the fascia, all the patients underwent wide surgical excisions. Based on location, reconstructions included primary closure, skin grafting, local flaps, regional flaps and free tissue transfer.

Researchers reported 28 patients displayed no postsurgical complications, and the average hospital stay was 5 days. At follow-up (mean, 24 months), 26 patients showed no recurrence of hidradenitis suppurativa, while the six patients with recurrence, including five smokers, had been classified with Hurley stage III.

“Treatment of hidradenitis suppurativa has wide modalities,” the researchers concluded. “However … after eliminating the acute inflammatory phase, wide surgical excision is recommended and [the] planning of reconstruction should be initiated to achieve the best outcome and consequently decrease the risk of recurrence and complications after surgery. Our concept of treatment … is cost effective and prevented skin contractures as well as excessive scarring and showed good functional and aesthetic results.”