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La Padula S, Pensato R, Pizza C, D'Andrea F, Roccaro G, Meningaud JP, Hersant B. The Thoracodorsal Artery Perforator Flap for the Treatment of Hidradenitis Suppurativa of the Axilla: A Prospective Comparative Study. Plast Reconstr Surg 2023; 152:1105-1116. [PMID: 36946904 DOI: 10.1097/prs.0000000000010435] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a common chronic condition that is often resistant to conservative treatment and requires a wide and aggressive surgical approach to prevent recurrence. A prospective study was performed comparing the outcomes of thoracodorsal artery perforator (TDAP) flap-based reconstruction and secondary intention closure (SIC) after wide local excision (WLE) of axillary HS. METHODS A prospective study was conducted on 68 patients with stage 3 axillary HS. Thirty-three patients underwent a WLE procedure and were left to heal by secondary intention (SIC group), and 35 patients underwent immediate reconstruction with a homolateral TDAP flap (TDAP group). Inpatient stay, healing time, postoperative complications rate, and pain were analyzed in both groups, comparing preoperative shoulder function (using Constant-Murley shoulder outcome score) and quality of life (using a dermatology life quality index) with postoperative shoulder function and quality of life. RESULTS Patients receiving TDAP flaps had significantly faster recovery, fewer complications, and fewer overall number of procedures than those who underwent SIC. All patients reported an improved quality of life after their operation. The TDAP group showed significantly more improvement than the SIC group ( P < 0.001). Patients receiving TDAP flaps reported a significant reduction in pain and discomfort and better shoulder function compared with patients in the SIC group ( P < 0.001). CONCLUSIONS WLE and TDAP flap-based reconstruction for axillary stage 3 HS provide optimal postprocedural functional results with a low complication rate. Complete remission of the disease was observed after the procedure. Despite the relatively slow learning curve of this procedure, the authors strongly recommend this technique as a very good option for the management of stage 3 axillary HS. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Simone La Padula
- From the Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII
- Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II
| | - Rosita Pensato
- Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II
| | - Chiara Pizza
- From the Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII
| | - Francesco D'Andrea
- Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II
| | - Giovanni Roccaro
- From the Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII
| | - Jean Paul Meningaud
- From the Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII
| | - Barbara Hersant
- From the Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII
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Bui H, Bechara FG, George R, Goldberg S, Hamzavi I, Kirby JS, Saylor D, Sayed CJ. Surgical Procedural Definitions for Hidradenitis Suppurativa Developed by Expert Delphi Consensus. JAMA Dermatol 2023; 159:441-447. [PMID: 36811866 DOI: 10.1001/jamadermatol.2022.6266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Importance Various surgical approaches for hidradenitis suppurativa (HS) have been described in the literature, but the nomenclature is inconsistent. Excisions have been described as wide, local, radical, and regional with variable descriptions of margins. Deroofing procedures have been described with various approaches though descriptions of the approach are generally more uniform. No international consensus has been formed to globally standardize terminology for HS surgical procedures. Lack of such agreement may contribute to misunderstanding or misclassification in HS procedural research studies and impair clear communication among clinicians or between clinicians and patients. Objective To create a set of standard definitions for HS surgical procedures. Design, Setting, and Participants This consensus agreement study was conducted from January to May 2021 using the modified Delphi consensus method to reach agreement among a group of international HS experts regarding standardized definitions for an initial set of HS surgical terms, including "incision and drainage," "deroofing/unroofing," "excision," "lesional excision," and "regional excision," ultimately expanded to 10 terms. Provisional definitions were drafted based on existing literature and discussion among an expert 8-member steering committee. Online surveys were disseminated to members of the HS Foundation, direct contacts of the expert panel, and the HSPlace listserv to reach physicians with considerable experience with HS surgery. Consensus was defined as greater than 70% agreement to accept a definition. Results In the first and second modified Delphi round, 50 and 33 experts participated, respectively. Ten surgical procedural terms and definitions reached consensus with greater than 80% agreement. Overall, the term "local" excision was abandoned and replaced with the descriptors "lesional" or "regional" excision. Of note, "regional" replaced the terms "wide" and "radical" excision. Furthermore, modifiers such as "partial" vs "complete" should also be included when describing surgical procedures. A combination of these terms helped formulate the final glossary of HS surgical procedural definitions. Conclusion and Relevance An international group of HS experts agreed on a set of definitions describing surgical procedures frequently used by clinicians and in the literature. The standardization and application of such definitions are vital to allow for accurate communication, reporting consistency, and uniform data collection and study design in the future.
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Affiliation(s)
- Helen Bui
- University of North Carolina School of Medicine, Chapel Hill
| | - Falk G Bechara
- Department of Dermatologic Surgery, Ruhr-University, Bochum, Germany
| | - Ralph George
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Stephanie Goldberg
- Department of Surgery, Mary Washington Healthcare, Fredericksburg, Virginia
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Joslyn S Kirby
- Department of Dermatology, Pennsylvania State Milton S Hershey Medical Center, Hershey
| | - Drew Saylor
- Department of Dermatology, University of California, San Francisco, San Francisco
| | - Christopher J Sayed
- University of North Carolina School of Medicine, Chapel Hill.,Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill
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Current Medical and Surgical Treatment of Hidradenitis Suppurativa-A Comprehensive Review. J Clin Med 2022; 11:jcm11237240. [PMID: 36498816 PMCID: PMC9737445 DOI: 10.3390/jcm11237240] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease presenting with recurrent inflammatory lesions in intertriginous body regions. HS has a pronounced impact on patients' quality of life and is associated with a variety of comorbidities. Treatment of HS is often complex, requiring an individual approach with medical and surgical treatments available. However, especially in moderate-to-severe HS, there is an urgent need for new treatment approaches. In recent years, increased research has led to the identification of new potential therapeutic targets. This review aims to give a comprehensive and practical overview of current treatment options for HS. Furthermore, the clinically most advanced novel treatment approaches will be discussed.
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Hidradenitis Suppurativa: A Comparison of Institutional Experience and the Tracking Operations and Outcomes for Plastic Surgeons Registry. Plast Reconstr Surg 2022; 149:1216-1224. [PMID: 35311802 DOI: 10.1097/prs.0000000000009024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hidradenitis suppurativa is a chronic inflammatory dermatologic condition occurring most commonly in areas with large numbers of apocrine sweat glands. Surgical excision and wound reconstruction are indicated for severe or refractory disease. This study aims to explore institutional reconstructive outcomes following hidradenitis suppurativa excision and compare these to the nationally recognized Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database to determine best-practice guidelines. METHODS A retrospective chart review of all patients with surgically treated hidradenitis suppurativa from January of 2004 to January of 2016 was performed. Data on patient characteristics, reconstructive methods, and outcomes were collected. Outcomes for each reconstructive method were analyzed and associations between reconstruction and complications were determined. These results were compared to TOPS data. RESULTS A total of 382 operative sites for 101 individual patients were reviewed. Overall complication rates were 80, 68.3, and 59.6 percent for simple, intermediate, and complex closure, respectively; 68.3 percent for adjacent soft-tissue rearrangement; and 100 percent for split-thickness skin grafts and perforator flaps. Statistical significance was identified between superficial wound dehiscence and adjacent tissue rearrangement compared to intermediate and complex closure (p = 0.0132). TOPS data revealed similar wound breakdown rates for primary closure methods but much lower rates with negative-pressure wound therapy, split-thickness skin grafts, and muscle flaps. CONCLUSIONS Primary closure techniques for hidradenitis suppurativa wound reconstruction possess high complication rates, whereas improved outcomes are observed with negative-pressure wound therapy, split-thickness skin grafts, and muscle flaps. The correlation in outcomes between our experience and that reported in the TOPS database provides a level of validation to this national database.
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Surgical Treatment in Hidradenitis Suppurativa. J Clin Med 2022; 11:jcm11092311. [PMID: 35566438 PMCID: PMC9101712 DOI: 10.3390/jcm11092311] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 02/06/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, progressive inflammatory disorder of follicular occlusion with pubertal onset that presents as painful inflammatory nodules, sinus tracts, and tunnelling in apocrine-gland-rich areas, such as the axilla, groin, lower back, and buttocks. The disease course is complicated by contractures, keloids, and immobility and is often associated with a low quality of life. It is considered a disorder of follicular occlusion with secondary inflammation, though the exact cause is not known. Management can often be unsatisfactory and challenging due to the chronic nature of the disease and its adverse impact on the quality of life. A multidisciplinary approach is key to prompt optimal disease control. The early stages can be managed with medical treatment, but the advanced stages most likely require surgical intervention. Various surgical options are available, depending upon disease severity and patient preference. In this review an evidence-based outline of surgical options for the treatment of HS are discussed. Case reports, case series, cohort studies, case-control studies, and Randomized Clinical Trials (RCT)s available in medical databases regarding surgical options used in the treatment of HS were considered for the review presented in a narrative manner in this article.
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Ezanno AC, Fougerousse AC, Guillem P. The role of negative-pressure wound therapy in the management of axillary hidradenitis suppurativa. Int Wound J 2021; 19:802-810. [PMID: 34590422 PMCID: PMC9013599 DOI: 10.1111/iwj.13678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Anne-Cecile Ezanno
- Department of Gastrointestinal and Endocrine Surgery, Bégin Military Hospital, Saint-Mandé, France
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Current Surgical Management of Hidradenitis Suppurativa: A Systematic Review and Meta-Analysis. Dermatol Surg 2021; 47:349-354. [PMID: 33481433 DOI: 10.1097/dss.0000000000002892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic dermatologic condition that often necessitates surgical treatment. Surgical approaches vary substantially with little data on efficacy and safety. OBJECTIVE Summarize the literature on HS surgery with regards to patient characteristics, surgical approaches, and study quality. Compare postsurgical recurrence rates with a meta-analysis. METHODS PubMed, Embase, and Scopus were searched for studies on surgical HS management published after 2004. A random effects meta-analysis of recurrence rates was performed on eligible studies. RESULTS Of 715 identified studies, 59 were included in the review and 33 in the meta-analysis. Twenty-two studies of wide excision had the lowest pooled recurrence rate at 8% (95% confidence interval [CI] 2%-16%); local excision had the highest at 34% (95% CI 24%-44%). For studies of wide/radical excision, flap repair had the lowest pooled recurrence rate at 0% (95% CI 0%-4%); delayed primary closure had the highest at 38% (95% CI 20%-59%). CONCLUSIONS Wide excision and flap-based reconstruction are associated with a lower postsurgical HS recurrence, although this must be balanced against potentially higher morbidity of extensive procedures. Heterogeneity and methodological limitations of the evidence limit the ability to make a strong conclusion about the relative recurrence rates associated with surgical techniques. REGISTRATION PROSPERO ID: CRD42020159948.
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[Hidradenitis suppurativa /acne inversa-surgical options, reconstruction and combinations with drug therapies-an update]. Hautarzt 2021; 72:692-699. [PMID: 34228137 PMCID: PMC8258492 DOI: 10.1007/s00105-021-04864-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 12/22/2022]
Abstract
Hidradenitis suppurativa/Acne inversa (HS/AI) ist eine chronisch-entzündliche Hauterkrankung, deren Behandlung sowohl konservative als auch chirurgische Behandlungsmöglichkeiten umfasst. In den Hurley-Stadien II und III ist die chirurgische Resektion irreversibel zerstörten Gewebes anzustreben. Hierzu existieren verschiedene Resektionstechniken, die sich vor allem in ihrer Invasivität und Rezidivneigung unterscheiden. Bis heute gibt es keinen allgemein akzeptierten Konsens hinsichtlich verschiedener Resektions- und Rekonstruktionstechniken sowie der Einbeziehung medikamentöser Therapien in das therapeutische Gesamtkonzept.
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Marchesi A, Amendola F, Garieri P, Steinberger Z, Vaienti L. Wide Local Excisions and Pedicled Perforator Flaps in Hidradenitis Suppurativa: A Study of Quality of Life. Ann Plast Surg 2021; 86:201-205. [PMID: 32881748 DOI: 10.1097/sap.0000000000002482] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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.
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Affiliation(s)
- Andrea Marchesi
- From the Plastic Surgery, Hand Surgery and Reconstructive Microsurgery Department, Ospedale San Gerardo, Monza
| | - Francesco Amendola
- Plastic and Reconstructive Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Pietro Garieri
- Plastic and Reconstructive Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Luca Vaienti
- Plastic and Reconstructive Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Systematic Review of Complications and Recurrences After Surgical Interventions in Hidradenitis Suppurativa. Dermatol Surg 2020; 46:914-921. [PMID: 32049703 DOI: 10.1097/dss.0000000000002323] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The possible connection between hidradenitis suppurativa (HS) patients undergoing surgery and higher complications/recurrences has been implied, but inconsistent results reported. OBJECTIVE To assess the complication and recurrence rates for HS patients undergoing surgery and to evaluate whether known HS comorbidities and habits (smoking, obesity and diabetes) have an effect on the complication and recurrence rates. MATERIALS AND METHODS A systematic review was conducted by 2 reviewers. PubMed and Embase were searched using a predefined search string created in collaboration between the authors and a librarian on January 23, 2019. RESULTS Of the 271 references in the original search, 54 relevant articles were identified. This systematic review indicates an overall mean complication rate of 24% and a mean recurrence rate of 20.1% for HS patients undergoing surgery. CONCLUSION No significant association between the known surgical risk factors and surgical complications-or recurrence rates in this patient group was found. This review revealed a lack of quality and quantity data in studying the complications/recurrences. The heterogeneity of the studies created limitations, and the presented mean complication/recurrence rates should be interpreted with the consequences thereof. It elucidates the need for better studies and a necessity for a standardized definition of postsurgical HS recurrence.
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Ayala D, Dhanasekara CS, Thomas K, Tran V, Le A, Hand A, Alhaj Saleh A, Griswold J, Dissanaike S. Surgical management of advanced hidradenitis suppurativa via a one-stage procedure: A single-center experience. Am J Surg 2020; 220:1462-1466. [PMID: 33051068 DOI: 10.1016/j.amjsurg.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/30/2020] [Accepted: 10/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a debilitating skin condition; in severe forms it requires excision and skin grafting for cure. This is commonly performed as a multi-stage procedure; we explored single-stage operation as a more efficient alternative. METHODS Retrospective review 2007-2018 evaluating outcomes of patients undergoing single-stage surgery. RESULTS 139 one-stage procedures were performed: 35 excision and primary closure, 104 split-thickness skin grafting (STSG). Success rate was higher for STSG at 75% versus 60% with primary closure. Of failed primary closures, 57% required revision by grafting due to recurrence. Axilla procedures were most successful at 91% compared to 70%, 54%, and 50% for inguinal, gluteal, and perineal areas, respectively. Infection was the most common complication (17%), with 38% requiring readmission. CONCLUSION Compared to prior literature on multi-stage HS treatment, one-stage operations are a feasible, cost-effective alternative. STSG should remain the procedure of choice, even when primary closure appears feasible.
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Affiliation(s)
- Donna Ayala
- Department of Surgery: Texas Tech University Health Science Center, Lubbock, TX, USA
| | | | - Kyle Thomas
- Department of Surgery: Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Virginia Tran
- Department of Surgery: Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Audrey Le
- Department of Surgery: Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Audrey Hand
- Department of Surgery: Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Adel Alhaj Saleh
- Department of Surgery: Texas Tech University Health Science Center, Lubbock, TX, USA
| | - John Griswold
- Department of Surgery: Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Sharmila Dissanaike
- Department of Surgery: Texas Tech University Health Science Center, Lubbock, TX, USA.
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Jalenques I, Ciortianu L, Pereira B, D'Incan M, Lauron S, Rondepierre F. The prevalence and odds of anxiety and depression in children and adults with hidradenitis suppurativa: Systematic review and meta-analysis. J Am Acad Dermatol 2020; 83:542-553. [DOI: 10.1016/j.jaad.2020.03.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/15/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022]
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Saylor DK, Brownstone ND, Naik HB. Office-Based Surgical Intervention for Hidradenitis Suppurativa (HS): A Focused Review for Dermatologists. Dermatol Ther (Heidelb) 2020; 10:529-549. [PMID: 32435998 PMCID: PMC7367977 DOI: 10.1007/s13555-020-00391-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Indexed: 12/28/2022] Open
Abstract
Easily accessible office-based procedures that require minimal resources may facilitate timely surgical management of hidradenitis suppurativa (HS). This review focuses on excision and unroofing as two surgical HS treatments that can be tailored to the outpatient setting. Fifty-five articles were included in our review, representing 3914 patients. The majority were retrospective studies (58%, n = 32), and the studies reported data both across patients and by number of treated lesions. Recurrence rates for unroofing (14.5%) were found to be half that of excision (30%) across patients (p = 0.015) and slightly lower across lesions [20% recurrence vs 26% for excision (p = 0.023)]. Complication rates at the lesion level were also significantly associated with procedure, with rates after excision more than double those after roofing (26% vs. 12%, p < 0.001). The complication rate after combined medical and surgical therapy did not differ between procedures. Studies also suggest that continuing medical therapy in the perioperative period may be associated with improved recurrence rates, although delayed wound healing with biologic therapy has been reported. The existing data are limited by low-quality uncontrolled studies with small sample sizes, variable reporting of outcomes, and lack of uniform definitions for recurrence and remission. Further systematic prospective studies are needed to better compare complication and recurrence rates across these procedures in HS, especially in the context of concomitant medical therapy.
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Affiliation(s)
- Drew K Saylor
- Department of Dermatology, University of California, San Francisco, CA, USA.
| | | | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
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Orenstein LAV, Nguyen TV, Damiani G, Sayed C, Jemec GBE, Hamzavi I. Medical and Surgical Management of Hidradenitis Suppurativa: A Review of International Treatment Guidelines and Implementation in General Dermatology Practice. Dermatology 2020; 236:393-412. [PMID: 32408306 PMCID: PMC8177083 DOI: 10.1159/000507323] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic painful skin disease that severely impairs patients' quality of life. While high-quality trials of HS therapies remain limited, medical knowledge of best treatment practices is rapidly evolving, leading to the recent publication of multiple international treatment guidelines for HS. SUMMARY This review compares international HS treatment guidelines, describes evidence for effectiveness of common and emerging HS therapies, and provides guidance for integrating evidence-based HS care into practice. Although over 50 medical and procedural treatments are mentioned across international HS guidelines, only adalimumab and infliximab have grade B/weak recommendation or higher across all major guidelines. This review describes the appropriate patient selection and effectiveness of the most commonly used medical and procedural treatments for HS. It also includes recommendations for counseling, dosing, and duration of medical therapies as well as procedure videos for the practicing dermatologist.
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Affiliation(s)
- Lauren A V Orenstein
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA,
| | - Tien V Nguyen
- Bellevue Dermatology Clinic and Research Center, Bellevue, Washington, USA
| | - Giovanni Damiani
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital Roskilde, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
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Manfredini M, Garbarino F, Bigi L, Pellacani G, Magnoni C. Hidradenitis Suppurativa: Surgical and Postsurgical Management. Skin Appendage Disord 2020; 6:195-201. [PMID: 32903939 DOI: 10.1159/000507297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/13/2020] [Indexed: 01/30/2023] Open
Abstract
Background Hidradenitis suppurativa (HS) is a chronic inflammatory disorder. Several medical treatments, with varying degrees of efficacy, have been developed. However, in most cases of advanced HS, the definitive treatment option is often represented by surgical excisions. Objective Surgical techniques, reconstructive approach, and local wound care should be accurately designed in order to obtain the best result. In this review we analyze the possible surgical treatments and local wound care. Methods A MEDLINE search was performed on the various surgical treatments, reconstructive techniques, and local wound care. Results Surgical treatment is a common therapeutic modality for HS. Different surgical reconstructive techniques and post-surgical wound care approaches are described for the management of HS patients. Conclusions There were few high-quality evidence-based studies evaluating the surgical management of HS. Many disparate HS severity scores were used in these studies, making comparisons between them difficult. Nonetheless, research on different surgical approaches and wound care management has increased substantially in the past decade and it has given patients more surgical therapeutic strategies. The description of the best combinations and timing of surgery, wound care, and medical therapies will be a matter of future research for the definition of the optimal management of the HS patient.
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Affiliation(s)
- Marco Manfredini
- Section of Dermatology. Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Garbarino
- Section of Dermatology. Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Bigi
- Section of Dermatology. Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Pellacani
- Section of Dermatology. Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Magnoni
- Section of Dermatology. Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Shavit E, Pawliwec A, Alavi A, George R. The surgeon’s perspective: a retrospective study of wide local excisions taken to healthy subcutaneous fat in the management of advanced hidradenitis suppurativa. Can J Surg 2020; 63:E94-E99. [PMID: 32109015 DOI: 10.1503/cjs.003119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Hidradenitis suppurativa (HS) is a chronic debilitating folliculopilosebaceous disease that affects the skin most commonly in the axilla, groin, inframammary, genital and buttock areas. Surgical intervention may be an appropriate option in selected cases, but there is a risk of recurrence. The purpose of this study was to assess the results of wide local excision (WLE) to healthy subcutaneous fat with secondary intention healing in patients with HS who were under concurrent surgical and dermatologic care. Methods We conducted a retrospective review of 192 consecutive HS consultations to a general surgical service, identifying patients treated with WLE. Cases involving minor procedures (deroofing, incision and drainage) were excluded. Data on patient demographics, surgical site, method of closure, complications and recurrence were extracted from patient charts. We also conducted a literature review of surgical procedures in the management of HS. Results A total of 66 patients underwent 133 WLE to healthy subcutaneous fat. All patients were under concurrent medical care directed by a dermatologist. No medical therapies, including biological treatments, were interrupted or withheld for surgery. One hundred procedures were closed primarily with rotation or advancement flaps and 33 by secondary intention healing. Local recurrence occurred in 18% of primary closures and 18% of secondary intention closures (p = 0.98, χ2 test, no difference between groups). One patient with secondary intention healing returned to the emergency department for bleeding; 34% of patients with primary closure experienced some dehiscence (23% major, 11% minor separation). Two patients with axillary disease had restrictions in their ability to raise their arm that required physiotherapy. Median follow-up was 14.5 (range 1–55) months. Conclusion Resection to healthy subcutaneous fat during WLE provides disease control comparable to that with deeper resections, simplifying care.
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Affiliation(s)
- Eran Shavit
- From the Department of Medicine, Women’s College Hospital, and the Department of Surgery, CIBC Breast Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ont
| | - Andrew Pawliwec
- From the Department of Medicine, Women’s College Hospital, and the Department of Surgery, CIBC Breast Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ont
| | - Afsaneh Alavi
- From the Department of Medicine, Women’s College Hospital, and the Department of Surgery, CIBC Breast Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ont
| | - Ralph George
- From the Department of Medicine, Women’s College Hospital, and the Department of Surgery, CIBC Breast Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ont
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Wu Y, Ngaage LM, Ge S, Rada EM, Silverman RP, Rasko YM. Reconstruction for axillary hidradenitis suppurativa using one-stage local tissue rearrangement: A retrospective analysis of 53 cases. Int Wound J 2020; 17:701-707. [PMID: 32067416 DOI: 10.1111/iwj.13319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/27/2020] [Indexed: 12/11/2022] Open
Abstract
Wide local excision offers a potential cure for severe axillary hidradenitis suppurativa. However, the gold standard for reconstruction has yet to be defined. Here, we describe our rotation advancement flap technique, which allows for one-stage closure of large axillary defects, with minimal functional morbidity to the axilla. We performed a retrospective review of all patients who underwent one-stage surgical management for axillary hidradenitis suppurativa at a single-centre tertiary care hospital from 2009 to 2018. We identified 34 patients, with a total of 53 operative sites. The majority were female (85%) with a mean age of 31 years and body mass index 35 kg/m2 . The median defect size was 84 cm2 and the majority were treated using the rotation advancement flap technique (86%). A quarter of operative sites experienced minor complications with only one requiring re-operation. At a median follow-up of 32 months, two (4%) sites showed decreased range of motion. However, all patients had achieved remission without any further recurrence of disease. We describe a one-stage rotation advancement flap technique for management of moderate to severe hidradenitis suppurativa that achieves a high local cure rate, minimal functional morbidity, and acceptable wound complication rates.
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Affiliation(s)
- Yinglun Wu
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Ledibabari M Ngaage
- Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shealinna Ge
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Erin M Rada
- Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ronald P Silverman
- Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.,Acelity Corporation, San Antonio, Texas
| | - Yvonne M Rasko
- Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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Lee JY, Chai SC, Mat Zain MA, Basiron N. A review of the reconstructive methods in the management of axillary hidradenitis suppurativa. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01608-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fertitta L, Hotz C, Wolkenstein P, Méningaud JP, Sawan D, Hersant B, Sbidian E. Efficacy and satisfaction of surgical treatment for hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2019; 34:839-845. [PMID: 31799758 DOI: 10.1111/jdv.16135] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/20/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Surgery is a radical treatment for hidradenitis suppurativa (HS) and may be considered as the only one potentially curative. OBJECTIVES To characterize HS recurrence in patients after surgery and assess the risk factors of recurrence. METHODS We conducted a monocentric retrospective cohort study. All consecutive patients who had surgery (January 1, 2012 to March 31, 2017) were included. We estimated the rate of recurrence of HS lesions after surgery (<1 cm from the scar), and recurrence-associated factors were analysed by univariate then multivariate logistic regression, estimating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS A total of 75 patients [median age 31.4 years (range 16-71); 36 females], corresponding to 115 interventions were included. The Hurley score at surgery was III for 70 (60%) patients. In total, 61/115 (53%) interventions involved wide excision and 50 (43%) limited local excision. The localizations were axillary folds (n = 46; 40%), buttocks (n = 15, 13%), genital area (n = 13; 11%), perineal area (n = 12; 10%) and inguinal folds (n = 18; 16%). We observed 11 (10%) complications and 40 (35%) recurrences. On multivariate analysis, probability of recurrence was associated with only one-stage surgical closure [OR 3.2 (95% CI 1.4-7.3), P = 0.005]. Overall, 44 (52%) patients were completely satisfied and 22 (26%) partially satisfied, and most (81%) considered the surgery the best treatment. CONCLUSIONS Hidradenitis suppurativa recurrence in our study was 35% and associated with one-stage surgical closures, but two-thirds of patients were satisfied with surgical treatment and would recommend surgery.
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Affiliation(s)
- L Fertitta
- Department of Dermatology, Hôpital Henri Mondor, Creteil, France
| | - C Hotz
- Department of Dermatology, Hôpital Henri Mondor, Creteil, France
| | - P Wolkenstein
- Department of Dermatology, Hôpital Henri Mondor, Creteil, France
| | - J P Méningaud
- Department of Plastic Surgery, Hôpital Henri Mondor, Creteil, France
| | - D Sawan
- Department of Plastic Surgery, Hôpital Henri Mondor, Creteil, France
| | - B Hersant
- Department of Plastic Surgery, Hôpital Henri Mondor, Creteil, France
| | - E Sbidian
- Department of Dermatology, Hôpital Henri Mondor, Creteil, France
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20
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Clinic-Based Surgical Treatment for Hidradenitis Suppurativa. CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-00266-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C, Crowell K, Eisen DB, Gottlieb AB, Hamzavi I, Hazen PG, Jaleel T, Kimball AB, Kirby J, Lowes MA, Micheletti R, Miller A, Naik HB, Orgill D, Poulin Y. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol 2019; 81:76-90. [PMID: 30872156 PMCID: PMC9131894 DOI: 10.1016/j.jaad.2019.02.067] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/21/2019] [Accepted: 02/27/2019] [Indexed: 01/28/2023]
Abstract
Hidradenitis suppurativa is a chronic inflammatory disorder affecting hair follicles, with profoundly negative impact on patient quality of life. Evidence informing ideal evaluation and management of patients with hidradenitis suppurativa is still sparse in many areas, but it has grown substantially in the last decade. Part I of this evidence-based guideline is presented to support health care practitioners as they select optimal management strategies, including diagnostic testing, comorbidity screening, and both complementary and procedural treatment options. Recommendations and evidence grading based on the evidence available at the time of the review are provided.
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Affiliation(s)
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Afsaneh Alavi
- Department of Medicine, Division of Dermatology, University of Toronto
| | - Raed Alhusayen
- Department of Medicine, Division of Dermatology, University of Toronto
| | - Alain Brassard
- Department of Dermatology, University of California at Davis, Sacramento
| | - Craig Burkhart
- Department of Dermatology, University of North Carolina at Chapel Hill
| | - Karen Crowell
- Health Sciences Library, University of North Carolina School of Medicine, Chapel Hill
| | - Daniel B. Eisen
- Department of Dermatology, University of California at Davis, Sacramento
| | - Alice B. Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt Sinai Hospital, New York
| | | | | | - Tara Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham
| | | | - Joslyn Kirby
- Department of Dermatology, Penn State Hershey Medical Center
| | | | - Robert Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Angela Miller
- Department of Dermatology, Henry Ford Hospital, Detroit
| | - Haley B. Naik
- Department of Dermatology, University of California San Francisco
| | - Dennis Orgill
- Division of Plastic Surgery, Brigham and Women’s Hospital, Boston
| | - Yves Poulin
- Centre de Recherche Dermatologique du Quebec Metropolitain
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Hendricks AJ, Hirt PA, Sekhon S, Vaughn AR, Lev-Tov HA, Hsiao JL, Shi VY. Non-pharmacologic approaches for hidradenitis suppurativa – a systematic review. J DERMATOL TREAT 2019; 32:11-18. [DOI: 10.1080/09546634.2019.1621981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Penelope A. Hirt
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA
| | - Sahil Sekhon
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Alexandra R. Vaughn
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Hadar A. Lev-Tov
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA
| | - Jennifer L. Hsiao
- Division of Dermatology, University of California Los Angeles, Los Angeles, CA, USA
| | - Vivian Y. Shi
- Division of Dermatology, University of Arizona Department of Medicine, Tucson, AZ, USA
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Scholl L, Hessam S, Reitenbach S, Bechara FG. [Surgical treatment options for hidradenitis suppurativa/acne inversa]. Hautarzt 2019; 69:149-161. [PMID: 29322225 DOI: 10.1007/s00105-017-4114-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic inflammatory skin disease. Therapy consists of conservative and surgical treatment options. In Hurley stages II and III, surgical intervention is regarded as the method of choice for areas with irreversible tissue destruction. Resection techniques with different grades of invasiveness are described in the literature. Nevertheless, there is no generally accepted concept regarding resection and reconstruction techniques or specific postoperative care. Due to lack of definitions of recurrence after surgery and poor study quality, recurrence rates are difficult to determine.
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Affiliation(s)
- L Scholl
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Klinik der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - S Hessam
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Klinik der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - S Reitenbach
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Klinik der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - F G Bechara
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Klinik der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
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Nail-Barthelemy R, Stroumza N, Qassemyar Q, Delage M, Nassif A, Atlan M. Evaluation of the mobility of the shoulder and quality of life after perforator flaps for recalcitrant axillary hidradenitis. ANN CHIR PLAST ESTH 2019; 64:68-77. [DOI: 10.1016/j.anplas.2018.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 01/04/2018] [Indexed: 01/12/2023]
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25
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Pedicled Thoracodorsal Artery Perforator and Muscle-Sparing Latissimus Dorsi Flaps in the Axillary Reconstruction After Hidradenitis Suppurativa Excision. Ann Plast Surg 2018; 81:694-701. [DOI: 10.1097/sap.0000000000001664] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Michel C, DiBianco JM, Sabarwal V, Stein DM. The Treatment of Genitoperineal Hidradenitis Suppurativa: A Review of the Literature. Urology 2018; 124:1-5. [PMID: 30391681 DOI: 10.1016/j.urology.2018.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 10/27/2022]
Abstract
Hidradenitis suppurativa is a chronic inflammatory condition affecting the axilla, genitals, perineum, and perianal regions. The pathophysiology of hidradenitis suppurativa is complex and requires a multidisciplinary approach to treatment involving medical and surgical management when indicated. We describe our multidisciplinary protocol for treatment, which includes rheumatology-monitored immunotherapy, medical management, wide surgical resection, wound care, and reconstruction. The multidisciplinary care team includes rheumatology, wound care, and reconstructive urologic surgery. Surgical management includes wide local surgical resection, negative pressure dressing, delayed reconstruction, and perioperative immunotherapy. Multimodal treatment with surgical, medical, wound, and immunotherapy care is vital to successful treatment.
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Affiliation(s)
- Chloe Michel
- Department of Urology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - John Michael DiBianco
- Department of Urology, The George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Vikram Sabarwal
- Department of Urology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Daniel M Stein
- Department of Urology, The George Washington University School of Medicine and Health Sciences, Washington, DC
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Riis PT, Andersen PL, Jemec GB. Arguments for a national questionnaire-based screening for hidradenitis suppurativa in Denmark. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018. [DOI: 10.15570/actaapa.2018.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Smith MK, Nicholson CL, Parks-Miller A, Hamzavi IH. Hidradenitis suppurativa: an update on connecting the tracts. F1000Res 2017; 6:1272. [PMID: 28794864 PMCID: PMC5538037 DOI: 10.12688/f1000research.11337.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 12/18/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a devastating disease involving abscesses, sinus tracts, and inflammation classically affecting the axilla, groin, and/or anogenital region. Although the disease pathogenesis is not fully understood, recent advances suggest that HS pathology runs much deeper than the cutaneous manifestations. It is now believed that HS is a systemic inflammatory disease that gives rise to the characteristic cutaneous manifestations. This disease is problematic for both patients and physicians to manage because of a variety of diagnostic and management difficulties. This article seeks to provide updates on the current understanding of HS to increase awareness and improve management.
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Polidori G, Renard Y, Lorimier S, Pron H, Derruau S, Taiar R. Medical Infrared Thermography assistance in the surgical treatment of axillary Hidradenitis Suppurativa: A case report. Int J Surg Case Rep 2017; 34:56-59. [PMID: 28359047 PMCID: PMC5374845 DOI: 10.1016/j.ijscr.2017.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/10/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The purpose of this case report is to highlight for the first time the way Medical Infrared Thermography can be a helpful tool to assist the surgeon in the surgical treatment of Hidradenitis Suppurativa inflammatory disease. METHODS A 36-year-old man with a 7-year history of Hidradenitis Suppurativa presented inflammatory nodules in the left axilla area corresponding to Hurley stage II. Choice is made to surgically treat this patient using a wide excision protocol combined with a postoperative second intention healing. For the study purpose, an IR FLIR SC620 camera (FLIR Systems, Wilsonville, OR), having a high resolution pixel detector of 640×480 pixels for greater accuracy and higher resolution, has been used. RESULTS For the first time in the literature, this case report on HS disease supports the idea that real-time medical infrared thermography may be helpful in establishing the true extent of disease preoperatively in the surgical room and in a similar manner, that this technique allows the surgeon to ensure all diseased lesions are removed during surgery. CONCLUSIONS At least, medical infrared thermography seems to be a powerful tool to control the final wide surgical wound, in order to minimize recurrence risk of such a disease.
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Affiliation(s)
- G Polidori
- GRESPI, EA 4694, Research Group in Engineering Sciences, University of Reims, Reims, France
| | - Y Renard
- Department of General, Digestive and Endocrine Surgery, Reims University Hospital, Reims, France
| | - S Lorimier
- GRESPI, EA 4694, Research Group in Engineering Sciences, University of Reims, Reims, France; Faculty of Dentistry, Department of Dendistry, Reims University Hospital, Reims, France
| | - H Pron
- GRESPI, EA 4694, Research Group in Engineering Sciences, University of Reims, Reims, France
| | - S Derruau
- Faculty of Dentistry, Department of Dendistry, Reims University Hospital, Reims, France; MEDYC, UMR CNRS 7369, Biophotonic and Technologies for Health Team, Reims, France
| | - R Taiar
- GRESPI, EA 4694, Research Group in Engineering Sciences, University of Reims, Reims, France.
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Brierley NA, Al-Ghazal S. Improving outcomes in hidradenitis suppurativa. J Plast Reconstr Aesthet Surg 2017; 70:143-144. [DOI: 10.1016/j.bjps.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
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Carbon Dioxide Laser Treatment Using Methylene Blue-Assisted Sinus Tract Identification in Hidradenitis Suppurativa. Dermatol Surg 2016; 42:1303-1304. [PMID: 27792671 DOI: 10.1097/dss.0000000000000824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Hidradenitis suppurativa (HS) is not easily treated. Although not uncommon, HS is often misdiagnosed outside specialized clinics and inappropriately treated as a simple boil or abscess. In recent years, guidelines have been developed on the basis of expert opinion and the available literature. A multifaceted approach is necessary as HS lesions include both inflammation (amenable to medical treatment) as well as fibrosis (amenable to surgery only). The recommended antiinflammatory therapies encompass both antimicrobials and regular anti-inflammatory drugs. We have, therefore, reviewed treatments with the following agents: clindamycin, tetracycline, rifampicin, ertapenem, dapsone, triamcinolone, infliximab, adalimumab, and anakinra. The development of new medical treatments, however, is an ongoing effort, and important new data have been presented since the publication of the guideline. The current approach to the management of fibrotic lesions is surgery. It is important, as manifest fibrosis is generally not susceptible to medical treatment. Here minor excision, carbon dioxide-laser, and major surgery are discussed, and current evidence supporting their use is provided. A comprehensive three-pronged approach with adjuvant therapy, medical therapy, and surgery is recommended. The importance of adjuvant therapy, that is, pain management, wound care, and attention, is stressed. Adjuvant therapy not only plays a major role in patients' perception of a successful treatment but also is of practical importance to their coping and self-management. HS presents a significant unmet need, and this review provides a mechanistic update on the current real-world therapeutic option for the management of this distressing disease.
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