Topical negative pressure coupled with split-thickness skin grafting for the treatment of hidradenitis suppurativa: a case report

Comparison of Negative Pressure Wound Therapy with or without a Split-Thickness Skin Graft in the Surgical Management of Axillary Hidradenitis Suppurativa: A Retrospective Cohort Study

Introduction: Negative pressure wound therapy (NPWT) alone or with the addition of a split-thickness skin graft (STSG) are 2 reconstructive options available after surgical excision of axillary hidradenitis suppurativa (HS). The aim of this study was to retrospectively examine patients undergoing these treatments and to assess clinical and patient-related outcome measures. Methods: A single-centre, retrospective analysis was conducted, evaluating surgical excision of axillary HS, with STSG and NPWT, or NPWT alone. Data collected included No. of post-operative clinic visits, time to heal, size of wound, disease recurrence, follow-up time, Dermatology Life Quality Index (DLQI), the Generalised Anxiety Disorder Assessment (GAD-7), the Patient Health Questionnaire Depression Scale (PHQ-9), Pain Visual Analogue Scale (PAINVAS2), the Brief Illness Perception Questionnaire (BIPQ), and Dermatology Visual Analogue Scale (DERMVAS). Two-tailed t-test and Mann-Whitney Wilcoxon U-tests were used to assess for significant relationships. Results: One hundred five patients were included in the study, 44 who received NPWT alone, and 61 who received NPWT + STSG. There was no significant difference in follow-up time (P = .934) or No. of follow-up appointments between groups (P = .287). There was a significant difference in time to heal between groups, with STSG + NPWT observing a mean time of 2.77 months and NPWT alone observing a mean time of 4.40 months (P = .0006). There was no difference in patient-reported outcomes between the 2 groups. Conclusion: There is no difference in patient-reported outcomes with the addition of an STSG to NPWT after surgical excision of HS. Wide excision and use of NPWT alone is an effective procedure for the treatment of axillary HS.

The Value of Negative-Pressure Wound Therapy and Flap Surgery in Hidradenitis Suppurativa – A Single Center Analysis of Different Treatment Options

Background

Hidradenitis suppurativa is manifested by painful abscesses and scarring of sweat glands. Axillary, inguinal and genital regions are mostly affected. Multiple options exist in the treatment of hidradenitis suppurativa. The aim of this retrospective, mono-center cohort study was to analyze the outcome of different treatment methods after radical excision of hidradenitis suppurativa.

Methods

We retrospectively evaluated the treatment strategy and recurrence rate of hidradenitis suppurativa. We included all eligible patients of legal age between February 2003 and October 2021, with the diagnosis of Hidradenitis suppurativa and the necessity for surgical treatment. All patients with surgical treatment and direct wound closure by suture were excluded. Bacterial load and flora were analyzed for primary and secondary reconstruction in combination with negative-pressure wound therapy. Patient data were analyzed for recurrence rate and remission time according to different reconstructive techniques.

Results

In 44 affected anatomical sites (n = 23 patients) we treated 15 patients with negative-pressure wound therapy. Bacterial load and flora were lower in the last wound swab of patients with multi-surgical procedures (22 localizations) compared to the first wound swab independent of the use of negative-pressure wound therapy.

Wound closure, independent of a direct and multi-stage procedure was achieved by local fasciocutaneous flaps (n = 12), secondary intention healing (n = 7), secondary intention healing with buried chip skin grafts (n = 10), or split-thickness skin grafts (n = 15). Radical excision combined with split-thickness skin grafts showed the lowest recurrence rate in the follow-up (16%; n = 4).

Conclusion

Radical excision of hidradenitis suppurativa as gold standard for surgical treatment combined with negative-pressure wound therapy as multi-stage procedures ultimately reduced bacterial load and flora in our study. The use of split-thickness skin grafts showed the lowest recurrence rate.

Hidradenitis Suppurativa: Surgical and Postsurgical Management

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.

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

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.

[Surgical treatment options for hidradenitis suppurativa/acne inversa]

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.

Successful surgical treatment for squamous cell carcinoma arising from hidradenitis suppurativa: A case report and literature review

RATIONALE

Hidradenitis suppurativa (HS) is a disabling inflammatory disease mainly affecting apocrine glands. Marjolin ulcer (MU) is a term used to describe a rare type of squamous cell carcinoma (SCC) arising within sites of chronic wounds or preexisting scars. Chronic HS may result in a rare type of SCC, MU, which has a poor prognosis due to its high metastatic rate.

CONCERNS OF THE PATIENT

Here we reported a 60-year-old male who developed SCC on the right buttock after suffering from HS for 15 years.

INTERVENTIONS

Radical resection with clear margin was performed, after which topical negative pressure (TNP) was applied followed by split-thickness skin grafting.

OUTCOMES

In a 1-year follow-up, there was no recurrence of malignancy.

LESSONS

Cases reported in English literature since 1991 were reviewed to get a general grasp of status quo. The authors conclude that chronic HS lesion especially in the gluteal region should be cautiously observed. Once tumor arisen from HS lesion, immediate radical excision should be performed. With assured clear margin, TNP could be chosen to offer a favorable environment for the survival of skin grafting.

The role of negative pressure wound therapy in the management of hidradenitis suppurativa: a case report and literature review

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic, recurrent inflammatory disease affecting skin that bears apocrine glands. It is characterised by the presence of tender subcutaneous nodules that may rupture, resulting in deep dermal abscesses, fibrosis with dermal contractures and induration of the skin. The management of HS is a challenge for physicians as the pathogenesis is not clearly defined and prevents the use and development of directed therapies. Treatment options are oral agents (antibiotics, immunomodulators) and surgical excision. Historically, surgical management has been complicated by difficult closure and high recurrent rates. In the last 10 years, negative pressure wound therapy (NPWT) has proven to be a great adjunct for wound management as it provides the adequate conditions for wound healing, promotes granulation and helps to control infection. Here, we report a case of severe perineal HS treated with radical excision and NPWT as an adjunct. The patient only had a recurrence 3 years after primary treatment and was surgically treated for cosmetic reasons without any complications. Finally, we present a review of the relevant literature.