Reconstructive options in severe cases of Hidradenitis suppurativa

Abstract

<jats:title>Abstract</jats:title><jats:p>Hidradenitis suppurativa is a chronic, debilitating inflammatory disease of apocrine glands characterized with abscesses and nodular lesions. The treatment of Hidradenitis suppurativa consists of topical antibacterial or antiseptic solutions, systemic antibiotics, steroids, hormonal therapy, anti-tumor necrosis factor, and various surgical procedures. In this report, we present a series of 14 cases with severe Hidradenitis suppurativa. Surgical options are reviewed to show the best outcomes in the long term. A total of 14 patients (9 female, 5 male) were treated for advanced cases of Hidradenitis suppurativa. They underwent excision of the affected regions followed by reconstruction. The reconstruction methods consisted of split-thickness skin grafting and various cutaneous and myocutaneous flaps. There was no flap necrosis or dehiscence. One patient developed contracture in the axilla, for which he underwent release surgery. There were recurrences in 4 cases. There was no limitation of the arm movements in cases with flap reconstruction. In the long-term, they were satisfied with the results. In conclusion, incision and drainage should be avoided because it is of limited value. Surgical removal of the involved tissue should be the first treatment of choice. Depending on the defect following excision, local flaps should be preferred over the grafts for recurrence prevention.</jats:p>

Axillary Reconstruction for Hidradenitis Suppurativa with an Inner-Arm Transposition Flap Creating a Brachioplasty Effect

“…Soldin et al [ 13 ], concluded that different flaps can be used depending on size of the excised defect, recommending a fasciocutaneous flap for small to medium defects and pedicled parascapular flaps for larger defects. It is reasonable to conclude that most studies agree that flap reconstruction is superior to direct closure, STSG, and healing by secondary intention [ 8 9 15 22 ].…”

“…Axillary HS is bilateral in 75% of cases [ 7 ]. The exact aetiology of HS still remains unclear; however, possible cited associations include cigarette smoking, obesity, diabetes mellitus, and Crohn's disease [ 8 9 ].…”

Surgical Approach to Extensive Hidradenitis Suppurativa

“…Contracture development and limitation of movement frequently seen in secondary healing, primary suture, and wound closure with graft suture are observed less frequently in flap repair method. Especially in axillary, perineal, and perianal sites, repair with fasciocutaneous or musculocutaneous flap is recommended 22,29,30 …”

Surgical Approach to Extensive Hidradenitis Suppurativa

“…Especially in axillary, perineal, and perianal sites, repair with fasciocutaneous or musculocutaneous flap is recommended. 22,29,30 Wound complications such as infection and dehiscence are seen frequently in perianal, perineal, and buttocks disease. In the presence of prevalent and acute disease in these sites, colostomy may help control of infection and contribute to the success of radical surgical treatment methods.…”