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Excision, unroofing procedures effective surgical treatment of hidradenitis suppurativa

Excision and unroofing were effective surgical procedures for patients with hidradenitis suppurativa, with a low complication rate and moderate rate of postoperative recurrence, according to recently published study results.

Researchers conducted a retrospective review of 590 consecutive patients with hidradenitis suppurativa (57.4% men; mean age at time of surgery, 41 years) who underwent surgical treatment between 1976 and 2012.  The majority of patients were white (91%), smokers (57.7%) and had Hurley Stage III disease (80.7%).

Types of procedures included excision of varying extent (68.6%); unroofing, exteriorization or curettage operations (28.5%); and incision and drainage procedures 2.9%. The procedures treated disease of the perianal/perineum (49.8%), axilla (21%), gluteal cleft (12.9%), inframammary (2%) and multiple surgical sites (14.2%). Mean follow-up for 554 patients was 632.9 days

Postsurgical complications, including cellulitis and skin graft losses, occurred in 2.5% of operations.

Almost a quarter of the patients (24.4%) experienced postoperative recurrence, with reoperation necessary in 11.7% of patients. Younger age (HR = 0.8; 95% CI, 0.7-0.9), multiple surgical sites (HR = 1.6; 95% CI, 1.1-2.5) and drainage-type procedures (HR = 3.5; 95% CI, 1.2-10.7) were associated with increased recurrence risk. However, the recurrence rate was not influenced by operative location, disease severity, gender and operative extent.

“With most patients with [hidradenitis suppurativa] managed medically, large series of patients analyzing surgical outcomes are not commonly reported and this limits the ability to define effective surgical care for this challenging group of patients,” the researchers wrote.

“Data from this surgical series of patients with [hidradenitis suppurativa] demonstrate that surgical management is a safe and effective treatment for advanced intractable [hidradenitis suppurativa] disease,” the researchers concluded. “Long-term follow-up suggests surgical excision and unroofing procedures, regardless of location, disease severity, gender or the extent of excision, resulted in good control of the disease process and modest of postoperative recurrence rates. The multidisciplinary approach to surgical care, which emphasizes collaboration across disciplines with specific areas of expertise and practice, provides optimal treatment for this challenging disease.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.