New and traditional surgical approaches to hidradenitis suppurativa

Hidradenitis suppurativa treated with wide excision and second intention healing: a meaningful local cure rate after 253 procedures

“…Patients are generally treated with several courses of antibiotics, or in more severe cases, with tumour necrosis factor alpha (TNF-a) inhibitors. [4][5][6] Deroofing is a surgical technique whereby the lesions are explored using a probe and the roof is excised; it is most effective for recurrent lesions in a mild phase of the disease. 1, 3 The most common surgical procedures are incision with drainage, deroofing, and limited or wide excision.…”

Longitudinal observational study of hidradenitis suppurativa: impact of surgical intervention with adjunctive biologic therapy

“…Surgery has been a mainstay of HS management for some time and is often used for patients with extensive Hurley stage III disease . The best results are achieved with wide local excision, but the disease often recurs, and this has led to a recent interest in the use of targeted biologic therapy in the management of HS …”

Update on Hidradenitis Suppurativa (Part I): Epidemiology, Pathogenesis, Severity assessment and Comorbidities

“…1 As surgical wounds heal best if inflammation is reduced beforehand, antibiotics, especially those with anti-inflammatory properties, can be supplemented with short courses of prednisone, cyclosporine, or biologic agents to reduce tissue inflammation in patients with severe disease. 120 Recently, the role of noninvasive imaging techniques, as ultrasound and MRI, has been highlighted to guide surgeons in the complete removal of chronic HS lesions. 11 Local destruction of individual small lesions may be attempted.…”

“…122 Patients with chronic and extensive Hurley stage III disease, if not amenable to deroofing, may be managed by wide excision of the entire affected area. 120 After extensive tissue removal, the different options regarding closure will influence both the esthetic outcome and recurrence rate. Even large surgical defects may be allowed to heal by secondary intention, without contractures or reduced range of motion, with success rates as high as 89% -72% at 1 year.…”

“…Even large surgical defects may be allowed to heal by secondary intention, without contractures or reduced range of motion, with success rates as high as 89% -72% at 1 year. 1,120,123 Another systematic review found 15% recurrence rate for primary closure, 8% for flaps, and 6% for grafts, after wide local excision. 124 Pagliarello et al 125 recently described a new technique, cryoinsufflation, a modified spray cryotherapy performed by injecting liquid nitrogen through a needle directly into HS tracts with good results.…”