Hidradenitis suppurativa (HS) is a chronically relapsing skin disorder characterized by recurring inflammatory lesion in hair and apocrine gland-bearing skin creases in the axilla; groin or perineum, buttocks, and/or breast. HS may lead to painful eruptions and malodorous discharge significantly detracting from quality of life. HS causes a high degree of morbidity with the highest scores obtained for the level of pain caused by the disease. The majority of patients rated their pain on a Numerical Rating Scale-11 ranging from 4/10 to 10/10 and described it at various times as hot, burning, pressure, stretching, cutting, sharp, taut, splitting, gnawing, pressing, sore, throbbing, and aching. Despite the severe pain associated with this disease, HS has been essentially ignored in the pain medicine literature. It is hoped that greater understanding of the diagnosis, pathophysiology, and potential treatment options available for patients with HS, may help put pain specialists in a better position to contribute to the overall care of patients with significantly painful HS. This article reviews HS and pain. Potential mechanisms of modulating nociceptive processes in the skin are presented. A greater understanding of the diagnosis, pathophysiology, and potential treatment options for HS patients may help providers to be better able to contribute to care of patients with painful hidradenitis suppurativa.

Fibrin sealant was a useful adjunct during surgical wound closure and significantly decreased seroma formation in patients undergoing postbariatric abdominoplasty.

S eroma formation remains one of the most common complications following abdominoplasty (1). The presence of a seroma may lead to the development of infection and cause significant disability by delaying recovery times and impairing normal wound healing (2). Current modalities for prevention and treatment of seroma include needle aspiration, doxycycline or bleomycin sclerotherapy, and the placement of drainage catheters (2). Although effective, these modalities are not without consequence. Prolonged drain placement can significantly increase the likelihood of bacterial infection and may become obstructed in the course of treatment, necessitating replacement. Furthermore, drains may directly interfere with proper wound healing (3). Lowering the risk of seroma formation and the duration of drain placement can further reduce complications of infection and impaired wound healing. Fibrin sealant/glue is a readily available preparation that is believed to function by promoting closure of microvascular leaks caused by surgical trauma (4). Its use as a method for seroma prevention has been studied-with varying results-in mastectomy and rhytidectomy patients (3-8). In Germany, Toman et al (9) suggested that lowconcentration fibrin sealant may be effective in reducing seroma formation in the population undergoing abdominoplasty (9). Although fibrin application has been used by surgeons worldwide for seroma prevention in abdominoplasty, no studies involving the United States postbariatric population currently exist to provide evidence for or against the use of fibrin sealant in this fashion (10). The purpose of the present study was to determine whether there is a significant reduction in seroma formation and immediate postoperative drainage output in postbariatric patients who have undergone abdominoplasty using fibrin sealant.

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