Wide Local Excisions and Pedicled Perforator Flaps in Hidradenitis Suppurativa

Abstract

Background Hidradenitis suppurativa (HS) is a chronic skin pathology characterized by the occurrence of inflamed and swollen lesions, with a devastating impact of the disease on patient's quality of life. Wide local excision (WLE) of the affected tissue is the criterion-standard treatment, but there is no general consensus on the best reconstructive technique. The aim of this article is to evaluate the quality of life before and after WLE combined with pedicled perforator flap reconstruction, in patients suffering from HS. Methods We analyzed 26 consecutive patients suffering from Hurley stage III HS. Every patient underwent WLE, followed by reconstruction with pedicled perforator flap. Dermatology Quality of Life Index (DLQI) tests were administered to every patient preoperatively and 6 months after surgery, when the clinical condition was considered stable. Dermatology Quality of Life Index scores were compared in terms of means with Student t test. Linear regression studies were used to compare the changes in DLQI score with the surgical and clinical variables. Results Axillary area involvement was found in 21 of 27 patients; 6 patients had more than 1 body region involved. Thirty-two pedicled perforator flaps were performed, and 22 were thoracodorsal artery perforator flaps. Mean DLQI test score before the first operation was 21.31 ± 4.79; the average DLQI score after the last follow-up was 5 ± 2.95 (P < 0.0001). Dermatology Quality of Life Index scores were not influenced by complications including reoperation. There were also no correlations found between DLQI score delta and number of reoperation (−0.18) or days of hospital stay (−0.13). Conclusions Wide local excision followed by pedicled perforator flap reconstruction allows a radical excision of HS areas with short postoperative healing periods. Dermatology Quality of Life Index scores confirmed high levels of patients' satisfaction. Disadvantages of this technique include difficult learning curve, long operating time, and a nonnegligible complications rate.

Quality of Life in Hidradenitis Suppurativa: An Update

“…The mean DLQI score significantly improved after six months, from 21.3 ± 4.8 to 5.0 ± 3.0 at the last follow-up ( p < 0.0001). Furthermore, DLQI scores were not influenced by complications such as having to have a further operation [ 56 ]. Another study compared QoL in 47 HS patients after WLE with either artificial dermal or pedicled perforator flap closure [ 53 ].…”

Surgical management of hidradenitis suppurativa: A review of techniques, data, and future directions

“…For wide excisions, recurrence rates range from 0.0% to 43.0% 22,23 . A recent meta‐analysis in 2020 showed a recurrence rate of 5.0% when examining 3917 procedures 12 .…”

“…While we have already touched on the importance of addressing some of these, other critical gaps remain. These include better understanding the impact surgery has on quality of life and function, postoperative pain management, and data on outcomes in specific populations such as pediatric and geriatric patients 22,24,28–30 . For example, only four studies, the most robust of which is a case series, examine surgical outcomes in pediatric HS patients 23 …”

“…For wide excisions, recurrence rates range from 0.0% to 43.0%. 22,23 A recent meta-analysis in 2020 showed a recurrence rate of 5.0% when examining 3917 procedures. 12 Two large systematic reviews by Mehdizadeh 13 published in 2015 and Buozzi et al 19 in 2020 showed rates of 13.0% and 14.0%, respectively.…”

“…T A B L E 2 Recurrence and complication rates following surgical management of hidradenitis suppurativa Recurrence and complication rates for surgical management of hidradenitis suppurativa Recurrence rates (range) Complication rates (range) Unroofing 0.0%-21.7% 11,[13][14][15] 0.0%-7.2% 11,14,16 Local excision 0.0%-67.8% 11,17,18 0.0%-61.1% 11,[19][20][21] Wide excision 0.0%-43.0% 12,13,19,22,23 0.0%-87.0% 13,19,23,24 Laser (carbon dioxideablative) Finally, very little data exists on how anatomic location impacts recurrence. However, in their meta-analysis, Ovadja et al 12 noted that HS caudal to the umbilicus was noted to have worse outcomes.…”