BACKGROUND Surgery is considered to be the best treatment for recurrent hidradenitis suppurativa (HS). Varying recurrence rates have been reported in the literature. OBJECTIVE To provide an up-to-date systematic review of the complete literature for different excision strategies and their recurrence rates in HS. METHODS A systematic literature search of the complete available literature and a meta-analysis of proportions were performed on the included studies. RESULTS Of a total of 1,593 retrieved articles, 125 were included in the analysis. Most of these studies were retrospective with 8 prospective analyses and one randomized controlled trial (RCT). The techniques described were divided into partial excision (PE) and wide excision (WE), described in 33 and 97 included studies, respectively. The average estimated recurrences were 26.0% (95% confidence interval [CI], 16.0%–37.0%) for PE and 5.0% (95% CI, 3.0%–9.0%) for WE (p < .01). Female sex (p = .016) and HS caudal of the umbilicus (p = .001) were significantly associated with the overall recurrence rate. Quality of evidence was poor, and the reporting of results was mostly heterogeneous. CONCLUSION This systematic review showed higher recurrence rates when it was not intended to resect affected HS tissue with a radical margin. There is a need for more RCT's and uniformly reported treatment outcomes.

SummaryBackgroundHidradenitis suppurativa (HS) is a chronic, inflammatory and recurrent skin disease. Different staging instruments have been suggested, but none has achieved universal acceptance. Despite the fact that Hurley staging is one of the most widely applied HS disease severity staging instruments, it has not been validated.ObjectivesTo determine the inter‐ and intrarater reliability of the Hurley staging system.MethodsFifteen raters (five plastic surgeons, five general surgeons and five dermatologists) independently staged 30 photos of patients with HS according to Hurley staging at two time points. Reliability was assessed using kappa (&kgr;) statistics, and multivariable logistic regressions were used to determine independent risk factors for photos with discordant staging.ResultsInter‐rater reliability was moderate for the three stages of HS [κ = 0·59, 95% confidence interval (CI) 0·48–0·70]. It was moderate for Hurley stage I (κ = 0·45, 95% CI 0·32–0·55) and stage II (κ = 0·51, 95% CI 0·31–0·71) and it was almost perfect for stage III (κ = 0·81, 95% CI 0·62–1·00). The intrarater reliability was substantial for all stages and all raters (κ = 0·65, 95% CI 0·58–0·72). For stage I it was moderate (κ = 0·50, 95% CI 0·38–0·62), for stage II it was substantial (κ = 0·62, 95% CI 0·51–0·73) and for stage III it was almost perfect (κ = 0·82, 95% CI 0·77–0·87). Hurley stages II and III were less likely to result in discordant staging than Hurley stage I (odds ratios 0·47, 95% CI 0·29–0·77 and 0·21, 95% CI 0·12–0·38, respectively). The mean time spent on staging a photo was 14 s.ConclusionsHurley staging is reliable for rapid severity assessment of HS, with moderate inter‐rater and substantial intrarater reliability for all stages. It is best for assessing Hurley stage III HS, which is an indication for surgery.

BACKGROUND Wide excision (WE) is generally considered to be the most common treatment for recurrent hidradenitis suppurativa. When performed, excision is followed by decisions regarding best options for management of the surgical defect. Different reconstructive strategies (RSs) have been used, with varying rates of recurrence. OBJECTIVE To provide an up-to-date systematic review of the complete literature for different RS after WE and their recurrence rates. METHODS A systematic literature search of the complete available literature and a meta-analysis of proportions were performed on the included studies. RESULTS Of a total of 1,813 retrieved articles, 79 were included in the analysis. Most were retrospective analyses, with only one randomized controlled trial (RCT) and 7 prospective analyses. The RS described were divided into primary closure (PC), secondary intention healing (SIH), skin graft (SG), and fasciocutaneous flaps (FCF). The average estimated recurrence for PC was 22.0% (95% confidence interval [CI], 8.0%–40.0%), for SIH 11.0% (95% CI, 5.0%–20.0%), for SG 2.0% (95% CI, 0.0%–5.0%), and for FCF 2.0% (95% CI, 1.0%–5.0%) (p < .001). Hidradenitis suppurativa below the umbilicus was significantly associated with overall recurrence (p = .006). Quality of evidence was poor, and the reporting of results was mostly heterogeneous. CONCLUSION After WE, PC has the highest recurrence rates, whereas SG and FCF have the lowest rates. There is a need for more RCTs and guidelines, to be able to report uniformly on treatment outcomes.

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Background An appropriate reconstruction strategy after wide excision for severe cases of anogenital hidradenitis suppurativa (aHS) is important to optimize outcomes, but there is no consensus on which reconstruction strategy should be preferred. Objective Evaluate which reconstruction strategy after wide excision in patients with severe aHS is associated with the best outcomes in terms of recurrence rate, complications and patient-reported outcomes on range of motion, pain, appearance, sexual health and satisfaction. Methods Multicenter retrospective analysis between 2009 and 2019 of wide excision and reconstruction by primary closure, secondary intention healing, split-thickness skin grafts or fasciocutaneous flaps (FCF). The recurrence rate was the primary endpoint of multivariable logistic regressions to determine variables with an independent effect on recurrence. Results A total of 93 patients were included. The overall recurrence rate was 62% after a median follow-up of 43 months, without statistical significance between reconstruction strategies (P = 0.737). The number of interventions during follow-up was an independent risk factor for recurrence (odds ratio, 2.55; confidence interval, 1.24–5.25; P = 0.011). Complications (37%) were more severe after FCF (P = 0.007). The mean score regarding patient-reported outcomes was 14.9 ± 2.8, of 24, with best appearance after FCF (P = 0.042). Conclusions These long-term follow-up data on severe aHS demonstrate a high recurrence rate after wide excision and reconstruction. Patients should be informed that treatment consists of long-term medicinal and surgical interventions with high recurrence rates, and surgeons may choose their own preferred reconstruction methods. Furthermore, more attention should be paid to the sexual health of patients with aHS.

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The triquetrum is rarely affected by avascular necrosis compared with other carpal bones. We report a case of avascular necrosis of the triquetrum in a 50-year-old patient, with a history of wrist trauma, local corticosteroid injections, and heavy smoking. She presented with severe wrist pain and signs of cystic changes and avascular necrosis determined by magnetic resonance imaging. She was effectively treated with a proximal row carpectomy. We suspect that the combination of the injury in combination with local corticosteroids and smoking may have led to the necrosis.

Background: An appropriate reconstruction strategy after surgical resection of chest wall tumors in children is important to optimize outcomes, but there is no consensus on the ideal approach. Objective: To provide an up-to-date systematic review of the literature for different reconstruction strategies for chest wall defects in patients < 18 year. Methods: A systematic literature search of the complete available literature was performed and results were analyzed. Results: A total of 22 articles were included in the analysis, which described a total of 130 chest wall reconstructions. All were retrospective analyses, including eight case-reports. Reconstructive options were divided into primary closure (n = 21 [16.2%]), use of non-autologous materials (n = 83 [63.8%]), autologous tissue repair (n = 2 [1.5%]) or a combination of the latter two (n = 24 [18.5%]). Quality of evidence was poor, and the results mostly heterogeneous. Conclusions: Reconstruction of chest wall defects can be divided into four major categories, with each category including its own advantages and disadvantages. There is a need for higher quality evidence and guidelines, to be able to report uniformly on treatment outcomes and assess the appropriate reconstruction strategy.