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Published in: BMC Dermatology 1/2012

Open Access 01-12-2012 | Research article

A review of wide surgical excision of hidradenitis suppurativa

Authors: Ziyad Alharbi, Jens Kauczok, Norbert Pallua

Published in: BMC Dermatology | Issue 1/2012

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Abstract

Background

Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disorder that involves the infundibular terminal follicles in areas rich of apocrine glands. It can be associated with fistulating sinus, scarring and abscesses formation. Hidradenitis suppurativa is a challenging aspect and requires a proper treatment plan which may involve different specialties. We present herein the option of surgical treatment involving wide surgical excision and methods of reconstruction as well as the rate of recurrence. Furthermore, review of the literature regarding surgical treatment of hidradenitis suppurativa is provided.

Methods

A retrospective analysis reviewed 50 operative procedures for 32 patients in 5 anatomical sites. These anatomical sites have been divided to 23 sites involving the axilla, 17 sites involving the inguinal region and 8 sites involving the perianal/perineal area, 1 site involving the gluteal region and 1 site involving the trunk region.

Results

Twenty six patients (81, 25 %) showed no recurrence after surgery and the average time of hospital stay period was 5 days. Recurrence was observed only in 6 patients (18, 75 %).

Conclusion

Elimination of the acute inflammatory process should occur in advance, including the use of antibiotics and minor surgeries such as abscess drainage with proper irrigations. After stabilizing the acute phase, wide surgical excision is recommended. Herein, planning of surgical reconstruction should be initiated to achieve the best outcome and consequently decreasing the risk of recurrence and complications after surgery.
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Literature
1.
go back to reference Verneuil AS: Etudes sur les tumeurs de la peau et quelques maladies de glandes sudoripares. Arch Gen Med 1854, 94: 693–705. Verneuil AS: Etudes sur les tumeurs de la peau et quelques maladies de glandes sudoripares. Arch Gen Med 1854, 94: 693–705.
2.
go back to reference Plewig G, Steger M: Acne inversa (alias acne triad, acne tetrad or hidradenitis suppurativa). Martin Dunitz, London; 1989:345–57. Plewig G, Steger M: Acne inversa (alias acne triad, acne tetrad or hidradenitis suppurativa). Martin Dunitz, London; 1989:345–57.
3.
go back to reference Scheinfeld N: Hidradenitis should not be renamed acne inversa. Dermatol. Online J 2006,12(7):6. Scheinfeld N: Hidradenitis should not be renamed acne inversa. Dermatol. Online J 2006,12(7):6.
4.
go back to reference Balik E, Eren T, Bulut T, Büyükuncu Y, Bugra D, Yamaner S: Surgical Approach to Extensive Hidradenitis Suppurativa in the Perineal/Perianal and Gluteal Regions. World J Surg 2009, 33: 481–487. 10.1007/s00268-008-9845-9CrossRefPubMed Balik E, Eren T, Bulut T, Büyükuncu Y, Bugra D, Yamaner S: Surgical Approach to Extensive Hidradenitis Suppurativa in the Perineal/Perianal and Gluteal Regions. World J Surg 2009, 33: 481–487. 10.1007/s00268-008-9845-9CrossRefPubMed
5.
go back to reference Yazdanyar S, Jemec GB: Hidradenitis suppurativa: a review of cause and treatment. Curr Opin Infect Dis 2011,24(2):118–23. 10.1097/QCO.0b013e3283428d07CrossRefPubMed Yazdanyar S, Jemec GB: Hidradenitis suppurativa: a review of cause and treatment. Curr Opin Infect Dis 2011,24(2):118–23. 10.1097/QCO.0b013e3283428d07CrossRefPubMed
6.
go back to reference Slade DEM, Powell BW, Mortimer PS: Hidradenitis suppurativa: pathogenesis and management. Brit Assoc Plastic Surg 2003, 56: 451–41.CrossRef Slade DEM, Powell BW, Mortimer PS: Hidradenitis suppurativa: pathogenesis and management. Brit Assoc Plastic Surg 2003, 56: 451–41.CrossRef
7.
8.
go back to reference Tanaka A, Hatoko M, Tada H, Kuwahara M, Mashiba K, Yurugi S: Experience with surgical treatment of hidradenitis suppurativa. Ann Plast Surg 2001, 47: 636–642. 10.1097/00000637-200112000-00010CrossRefPubMed Tanaka A, Hatoko M, Tada H, Kuwahara M, Mashiba K, Yurugi S: Experience with surgical treatment of hidradenitis suppurativa. Ann Plast Surg 2001, 47: 636–642. 10.1097/00000637-200112000-00010CrossRefPubMed
9.
go back to reference Matusiak Ł, Bieniek A, Szepietowski JC: Soluble interleukin-2 receptor serum level is a useful marker of hidradenitis suppurativa clinical staging. Biomarkers 2009,14(6):432–7. 10.1080/13547500903075218CrossRefPubMed Matusiak Ł, Bieniek A, Szepietowski JC: Soluble interleukin-2 receptor serum level is a useful marker of hidradenitis suppurativa clinical staging. Biomarkers 2009,14(6):432–7. 10.1080/13547500903075218CrossRefPubMed
10.
go back to reference Kagan RJ, Yakuboff KP, Warner P, Warden GD: Surgical treatment of hidradenitis suppurativa: A 10-year experience. Surgery 2005, 138: 734–41. 10.1016/j.surg.2005.06.053CrossRefPubMed Kagan RJ, Yakuboff KP, Warner P, Warden GD: Surgical treatment of hidradenitis suppurativa: A 10-year experience. Surgery 2005, 138: 734–41. 10.1016/j.surg.2005.06.053CrossRefPubMed
11.
go back to reference Sartorius K, Lapins J, Emtestam L, Jemec GB: Suggestions for uniform outcome variables when reporting treatment effects in hidradenitis suppurativa. Br J Dermatol 2003,149(1):211–213. 10.1046/j.1365-2133.2003.05390.xCrossRefPubMed Sartorius K, Lapins J, Emtestam L, Jemec GB: Suggestions for uniform outcome variables when reporting treatment effects in hidradenitis suppurativa. Br J Dermatol 2003,149(1):211–213. 10.1046/j.1365-2133.2003.05390.xCrossRefPubMed
12.
go back to reference Thielen AM, Barde C, Saurat JH: Long-term infliximab for severe hidradenitis Suppurativa. British Journal of Dermatology 2006, 154: 1074–1208. Thielen AM, Barde C, Saurat JH: Long-term infliximab for severe hidradenitis Suppurativa. British Journal of Dermatology 2006, 154: 1074–1208.
14.
go back to reference Mitchell KM, Beck DE: Hidradenitis suppurativa. Surg Clin North Am 2002,82(6):1187–97. 10.1016/S0039-6109(02)00060-9CrossRefPubMed Mitchell KM, Beck DE: Hidradenitis suppurativa. Surg Clin North Am 2002,82(6):1187–97. 10.1016/S0039-6109(02)00060-9CrossRefPubMed
15.
go back to reference Büyükaşik O, Hasdemir AO, Kahramansoy N, Cöl C, Erkol H: Surgical Approach to Extensive Hidradenitis Suppurativa. Dermatol Surg 2011,37(6):835–42. 10.1111/j.1524-4725.2011.01961..xPubMed Büyükaşik O, Hasdemir AO, Kahramansoy N, Cöl C, Erkol H: Surgical Approach to Extensive Hidradenitis Suppurativa. Dermatol Surg 2011,37(6):835–42. 10.1111/j.1524-4725.2011.01961..xPubMed
16.
go back to reference Conway H, Stark RB, Climo S, Weeter JC, Garcia FA: The surgical treatment of chronic hidradenitis suppurativa. Surg Gynecol Obstet 1952,95(4):455–64.PubMed Conway H, Stark RB, Climo S, Weeter JC, Garcia FA: The surgical treatment of chronic hidradenitis suppurativa. Surg Gynecol Obstet 1952,95(4):455–64.PubMed
17.
go back to reference Paletta FSX: Hidradenitis Suppurativa: Pathologic Study and Use of Skin Flaps. Plastic & Reconstructive Surgery 1963,31(4):307–315. 10.1097/00006534-196304000-00001CrossRef Paletta FSX: Hidradenitis Suppurativa: Pathologic Study and Use of Skin Flaps. Plastic & Reconstructive Surgery 1963,31(4):307–315. 10.1097/00006534-196304000-00001CrossRef
18.
go back to reference Cocke WM: Surgery of Hidradenitis Suppurativa of the Perineum. Plastic & Reconstructive Surgery 1967,39(2):178–181. 10.1097/00006534-196702000-00009CrossRef Cocke WM: Surgery of Hidradenitis Suppurativa of the Perineum. Plastic & Reconstructive Surgery 1967,39(2):178–181. 10.1097/00006534-196702000-00009CrossRef
19.
go back to reference Tasche C, Angelats J, Jayaram B: Surgical Treatment of Hidradenitis Suppurativa of the Axilla. Plast Reconstr Surg 1975,55(5):559–562. 10.1097/00006534-197505000-00005CrossRefPubMed Tasche C, Angelats J, Jayaram B: Surgical Treatment of Hidradenitis Suppurativa of the Axilla. Plast Reconstr Surg 1975,55(5):559–562. 10.1097/00006534-197505000-00005CrossRefPubMed
20.
go back to reference Bieniek A, Matusiak L, Okulewicz-Gojlik D, Szepietowski JC: Surgical treatment of hidradenitis suppurativa: experiences and recommendations. Dermatol Surg 2010,36(12):1998–2004. 10.1111/j.1524-4725.2010.01763.xCrossRefPubMed Bieniek A, Matusiak L, Okulewicz-Gojlik D, Szepietowski JC: Surgical treatment of hidradenitis suppurativa: experiences and recommendations. Dermatol Surg 2010,36(12):1998–2004. 10.1111/j.1524-4725.2010.01763.xCrossRefPubMed
21.
go back to reference Rompel R, Petres J: Long-term results of wide surgical excision in 106 patients with hidradenitis suppurativa. Dermatol Surg 2000,26(7):638–43. 10.1046/j.1524-4725.2000.00043.xCrossRefPubMed Rompel R, Petres J: Long-term results of wide surgical excision in 106 patients with hidradenitis suppurativa. Dermatol Surg 2000,26(7):638–43. 10.1046/j.1524-4725.2000.00043.xCrossRefPubMed
22.
go back to reference Bohn J, Svensson H: Surgical treatment of hidradenitis suppurativa. Scand J Plast Reconstr Surg Hand Surg 2001,35(3):305–9. 10.1080/028443101750523230CrossRefPubMed Bohn J, Svensson H: Surgical treatment of hidradenitis suppurativa. Scand J Plast Reconstr Surg Hand Surg 2001,35(3):305–9. 10.1080/028443101750523230CrossRefPubMed
23.
go back to reference Rhode JM, Burke WM, Cederna PS, Haefner HK: Outcomes of surgical management of stage III vulvar hidradenitis suppurativa. J Reprod Med 2008,53(6):420–8.PubMed Rhode JM, Burke WM, Cederna PS, Haefner HK: Outcomes of surgical management of stage III vulvar hidradenitis suppurativa. J Reprod Med 2008,53(6):420–8.PubMed
24.
go back to reference Bocchini SF, Habr-Gama A, Kiss DR, Imperiale AR, Araujo SE: Gluteal and perianal hidradenitis suppurativa: surgical treatment by wide excision. Dis Colon Rectum 2003,46(7):944–9. 10.1007/s10350-004-6691-1CrossRefPubMed Bocchini SF, Habr-Gama A, Kiss DR, Imperiale AR, Araujo SE: Gluteal and perianal hidradenitis suppurativa: surgical treatment by wide excision. Dis Colon Rectum 2003,46(7):944–9. 10.1007/s10350-004-6691-1CrossRefPubMed
25.
go back to reference Chen E, Friedman HI: Management of Regional Hidradenitis Suppurativa With Vacuum-Assisted Closure and Split Thickness Skin Grafts. Ann Plast Surg 2011,67(4):397–401. 10.1097/SAP.0b013e3181f77bd6CrossRefPubMed Chen E, Friedman HI: Management of Regional Hidradenitis Suppurativa With Vacuum-Assisted Closure and Split Thickness Skin Grafts. Ann Plast Surg 2011,67(4):397–401. 10.1097/SAP.0b013e3181f77bd6CrossRefPubMed
26.
go back to reference Blackburn JH, Boemi L, Hall WW, Jeffords K, Hauck RM, Banducci DR, Graham WP: Negative-pressure dressings as a bolster for skin grafts. Ann Plast Surg 1998,40(5):453–7. 10.1097/00000637-199805000-00001CrossRefPubMed Blackburn JH, Boemi L, Hall WW, Jeffords K, Hauck RM, Banducci DR, Graham WP: Negative-pressure dressings as a bolster for skin grafts. Ann Plast Surg 1998,40(5):453–7. 10.1097/00000637-199805000-00001CrossRefPubMed
27.
go back to reference Elwood ET, Bolitho DG: Negative-pressure dressings in the treatment of hidradenitis suppurativa. Ann Plast Surg 2001,46(1):49–51. 10.1097/00000637-200101000-00010CrossRefPubMed Elwood ET, Bolitho DG: Negative-pressure dressings in the treatment of hidradenitis suppurativa. Ann Plast Surg 2001,46(1):49–51. 10.1097/00000637-200101000-00010CrossRefPubMed
28.
go back to reference Varkarakis G, Daniels J, Coker K, Oswald T, Akdemir O, Lineaweaver WC: Treatment of axillary hidradenitis with transposition flaps: a 6-year experience. Ann Plast Surg 2010,64(5):592–4.PubMed Varkarakis G, Daniels J, Coker K, Oswald T, Akdemir O, Lineaweaver WC: Treatment of axillary hidradenitis with transposition flaps: a 6-year experience. Ann Plast Surg 2010,64(5):592–4.PubMed
29.
go back to reference Sharma RK, Kapoor KM, Singh G: Reconstruction in extensive axillary hidradenitis suppurativa with local fasciocutaneous V-Y advancement flaps. Ind J. Plast. Surj 2006, 39–1: 81–21. Sharma RK, Kapoor KM, Singh G: Reconstruction in extensive axillary hidradenitis suppurativa with local fasciocutaneous V-Y advancement flaps. Ind J. Plast. Surj 2006, 39–1: 81–21.
30.
go back to reference Geh JL, Niranjan NS: Perforator-based fasciocutaneous island flaps for the reconstruction of axillary defects following excision of hidradenitis suppurativa. Br J Plast Surg 2002,55(2):124–8. 10.1054/bjps.2001.3783CrossRefPubMed Geh JL, Niranjan NS: Perforator-based fasciocutaneous island flaps for the reconstruction of axillary defects following excision of hidradenitis suppurativa. Br J Plast Surg 2002,55(2):124–8. 10.1054/bjps.2001.3783CrossRefPubMed
31.
go back to reference Chuang CJ, Lee CH, Chen TM, Wang HJ, Chen SG: Use of a versatile transpositional flap in the surgical treatment of axillary hidradenitis suppurativa. J Formos Med Assoc 2004,103(8):644–7.PubMed Chuang CJ, Lee CH, Chen TM, Wang HJ, Chen SG: Use of a versatile transpositional flap in the surgical treatment of axillary hidradenitis suppurativa. J Formos Med Assoc 2004,103(8):644–7.PubMed
32.
go back to reference Rehman N, Kannan RY, Hassan S, Hart NB: Thoracodorsal artery perforator (TAP) type I V-Y advancement flap in axillary hidradenitis suppurativa. Br J Plast Surg 2005,58(4):441–4. 10.1016/j.bjps.2004.10.022CrossRefPubMed Rehman N, Kannan RY, Hassan S, Hart NB: Thoracodorsal artery perforator (TAP) type I V-Y advancement flap in axillary hidradenitis suppurativa. Br J Plast Surg 2005,58(4):441–4. 10.1016/j.bjps.2004.10.022CrossRefPubMed
33.
go back to reference Kandal S, Ayhan S, Sariguney Y, Tuncer S, Findikcioglu F: Thoracodorsal Artery Perforator Flap for the Treatment of the Axillary Hidradenitis Suppurativa. Plastic & Reconstructive Surgery 2005,116(3):226–227.CrossRef Kandal S, Ayhan S, Sariguney Y, Tuncer S, Findikcioglu F: Thoracodorsal Artery Perforator Flap for the Treatment of the Axillary Hidradenitis Suppurativa. Plastic & Reconstructive Surgery 2005,116(3):226–227.CrossRef
34.
go back to reference Schwabegger AH, Herczeg E, Piza H: The lateral thoracic fasciocutaneous island flap for treatment of recurrent hidradenitis axillaris suppurativa and other axillary skin defects. Br J Plast Surg 2000,53(8):676–8. 10.1054/bjps.2000.3443CrossRefPubMed Schwabegger AH, Herczeg E, Piza H: The lateral thoracic fasciocutaneous island flap for treatment of recurrent hidradenitis axillaris suppurativa and other axillary skin defects. Br J Plast Surg 2000,53(8):676–8. 10.1054/bjps.2000.3443CrossRefPubMed
35.
go back to reference Solanki NS, Roshan A, Malata CM: Pedicled gracilis myocutaneous flap for treatment of recalcitrant hidradenitis suppurativa of the groin and perineum. J Wound Care 2009,18(3):111–2.CrossRefPubMed Solanki NS, Roshan A, Malata CM: Pedicled gracilis myocutaneous flap for treatment of recalcitrant hidradenitis suppurativa of the groin and perineum. J Wound Care 2009,18(3):111–2.CrossRefPubMed
36.
go back to reference Rieger UM, Erba P, Pierer G, Kalbermatten DF: Hidradenitis suppurativa of the groin treated by radical excision and defect closure by medial thigh lift. aesthetic surgery meets reconstructive surgery. J Plast Reconstr Aesthet Surg 2009,62(10):1355–60. 10.1016/j.bjps.2008.04.035CrossRefPubMed Rieger UM, Erba P, Pierer G, Kalbermatten DF: Hidradenitis suppurativa of the groin treated by radical excision and defect closure by medial thigh lift. aesthetic surgery meets reconstructive surgery. J Plast Reconstr Aesthet Surg 2009,62(10):1355–60. 10.1016/j.bjps.2008.04.035CrossRefPubMed
37.
go back to reference Adam R: Modified Abdominoplasty as a Functional Reconstruction for Recurrent Hydradenitis Suppurativa of the Lower Abdomen and Groin. Plastic & Reconstructive Surgery 2007,119(2):764–766. 10.1097/01.prs.0000254928.05386.d7CrossRef Adam R: Modified Abdominoplasty as a Functional Reconstruction for Recurrent Hydradenitis Suppurativa of the Lower Abdomen and Groin. Plastic & Reconstructive Surgery 2007,119(2):764–766. 10.1097/01.prs.0000254928.05386.d7CrossRef
38.
go back to reference Rees L, Moses M, Clibbon J: The anterolateral thigh (ALT) flap in reconstruction following radical excision of groin and vulval hidradenitis suppurativa. J Plast Reconstr Aesthet Surg 2007,60(12):1363–5. 10.1016/j.bjps.2007.08.013CrossRefPubMed Rees L, Moses M, Clibbon J: The anterolateral thigh (ALT) flap in reconstruction following radical excision of groin and vulval hidradenitis suppurativa. J Plast Reconstr Aesthet Surg 2007,60(12):1363–5. 10.1016/j.bjps.2007.08.013CrossRefPubMed
39.
go back to reference O'Dey DM, Bozkurt A, Pallua N: The anterior Obturator Artery Perforator (aOAP) flap: surgical anatomy and application of a method for vulvar reconstruction. Gynecol Oncol 2010,119(3):526–30. 10.1016/j.ygyno.2010.08.033CrossRefPubMed O'Dey DM, Bozkurt A, Pallua N: The anterior Obturator Artery Perforator (aOAP) flap: surgical anatomy and application of a method for vulvar reconstruction. Gynecol Oncol 2010,119(3):526–30. 10.1016/j.ygyno.2010.08.033CrossRefPubMed
40.
go back to reference Kishi K, Nakajima H, Imanishi N: Reconstruction of skin defects after resection of severe gluteal hidradenitis suppurativa with fasciocutaneous flaps. J Plast Reconstr Aesthet Surg 2009,62(6):800–5. 10.1016/j.bjps.2007.09.063CrossRefPubMed Kishi K, Nakajima H, Imanishi N: Reconstruction of skin defects after resection of severe gluteal hidradenitis suppurativa with fasciocutaneous flaps. J Plast Reconstr Aesthet Surg 2009,62(6):800–5. 10.1016/j.bjps.2007.09.063CrossRefPubMed
41.
go back to reference Kishi K, Nakajima H, Imanishi N, Nakajima T: Extended split superior gluteus maximus musculocutaneous flap and reconstruction after resection of perianal and lower gluteal hidradenitis suppurativa. J Plast Reconstr Aesthet Surg 2009,62(8):1081–6. 10.1016/j.bjps.2008.01.012CrossRefPubMed Kishi K, Nakajima H, Imanishi N, Nakajima T: Extended split superior gluteus maximus musculocutaneous flap and reconstruction after resection of perianal and lower gluteal hidradenitis suppurativa. J Plast Reconstr Aesthet Surg 2009,62(8):1081–6. 10.1016/j.bjps.2008.01.012CrossRefPubMed
Metadata
Title
A review of wide surgical excision of hidradenitis suppurativa
Authors
Ziyad Alharbi
Jens Kauczok
Norbert Pallua
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Dermatology / Issue 1/2012
Electronic ISSN: 1471-5945
DOI
https://doi.org/10.1186/1471-5945-12-9

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