Radical resection and local coverage of hidradenitis suppurativa - <i>acne inversa</i>: analysis of results

to evaluate the primary outcome of local complications and late recurrence in patients with hidradenitis suppurativa undergoing radical resection and specific reconstruction.

Methods:

we conducted a retrospective analysis of the medical records of patients attended by the Plastic Surgery Service of the Clinics Hospital, Medical School, USP, between 2010 and 2016. We included patients who underwent radical resection of hidradenitis suppurativa in advanced stage and reconstruction through primary closure, grafts or flaps.

Results:

we analyzed 34 lesions in 19 patients, of which 64.5% had local complications, though with 73.5% efficient healing after 12 weeks postoperatively. We observed late recurrence in 47%, but in isolation, 22.2% of the reconstructions with locoregional flaps had recurrence after one year.

Conclusion:

extensive and radical resection of the disease associated with locoregional flap coverage (pedicled or perforating) has been shown to be the best management in terms of late results.

Keywords:
Hidradenitis Suppurativa; Surgical Flaps; Folliculitis; Cutaneous Fistula; Skin Abnormalities; Reconstruction.

Authorship

ROGÉRIO RAFAEL DA SILVA MENDES

- Hospital das Clínicas, School of Medicine, University of São Paulo (USP), Discipline of Plastic Surgery, São Paulo, SP, Brazil.University of São PauloBrazilSão Paulo, SP, Brazil - Hospital das Clínicas, School of Medicine, University of São Paulo (USP), Discipline of Plastic Surgery, São Paulo, SP, Brazil.

RAFAEL FERREIRA ZATZ

MIGUEL LUIZ ANTONIO MODOLIN ECBC-SP

FÁBIO DE FREITAS BUSNARDO

ROLF GEMPERLI TCBC-SP

Mailing address: Rafael Ferreira Zatz E-mail: rafaelzatz@yahoo.com.br / zatzrafael@gmail.com

Conflict of interest:

none.

SCIMAGO INSTITUTIONS RANKINGS

Figures | Tables

Figures (2)
Tables (5)

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Figure 1
A) Example of Hurley III perineal hidradenitis suppurativa, refractory to clinical treatment. B) Area to be reconstructed after resection of the lesion. C) Late postoperative outcome of reconstruction with bilateral, VY-advancement fasciocutaneous flaps of the medial thigh based on femoral artery perforators.

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Figure 2
A) Example of Hurley III axillary hidradenitis suppurativa, refractory to clinical treatment. B) Dissected fasciocutaneous transposition flap based on thoracic-dorsal and lateral thoracic arteries perforators at rest in its bed, adjacent to the area to be reconstructed. C) Surgical outcome on the 17th postoperative day.

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Table 1
Data categorized according to the injuries approached and performed procedures.

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Table 2
Data categorized according to complications, wound healing and late recurrence.

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Table 3
Data categorized according to the incidence of local complications and the reconstruction used.

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Table 4
Data categorized according to the incidence of late recurrence and the reconstruction used .

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Table 5
Late recurrence in absolute figures according to the lesion approached and reconstruction used.

Figure 1 A) Example of Hurley III perineal hidradenitis suppurativa, refractory to clinical treatment. B) Area to be reconstructed after resection of the lesion. C) Late postoperative outcome of reconstruction with bilateral, VY-advancement fasciocutaneous flaps of the medial thigh based on femoral artery perforators.

Figure 2 A) Example of Hurley III axillary hidradenitis suppurativa, refractory to clinical treatment. B) Dissected fasciocutaneous transposition flap based on thoracic-dorsal and lateral thoracic arteries perforators at rest in its bed, adjacent to the area to be reconstructed. C) Surgical outcome on the 17th postoperative day.

Table 1 Data categorized according to the injuries approached and performed procedures.

Injury Approached	Number of Cases	Time of Reconstruction		Reconstruction Employed
Axillary	19 (56%)	Immediate Late *	16 (84.3%) 3 (15.7%)	Primary Closure	2 (10.5%)
				Partial Skin Graft	2 (10.5%)
				Local Flap	5 (26.5%)
				Locoregional Flap	10 (52.5)
Gluteal	8 (23%)	Immediate Late *	7 (87.5%) 1 (12.5%)	Primary Closure	1 (12.5%)
				Partial Skin Graft	0 (0%)
				Local Flap	1 (12.5%)
				Locoregional Flap	6 (75%)
Inguinal	7 (21%)	Immediate Late *	7 (100%) 0 (0%)	Primary Closure	4 (57%)
				Partial Skin Graft	0 (0%)
				Local Flap	1 (14%)
				Locoregional Flap	2 (28%)
Total	34 (100%)	Immediate Late *	30 (88.3%) 4 (11.7%)	Primary Closure	7 (20.5%)
				Partial Skin Graft	2 (6%)
				Local Flap	7 (20.5%)
				Locoregional Flap	18 (53%)

* Use of vacuum therapy between debridement and definitive reconstruction.

Table 2 Data categorized according to complications, wound healing and late recurrence.

Injury Approached	Number of Cases	Local Complications **	Reoperation	Efficient healing after 12 weeks	Late recurrence after 1 year
Axillary	19 (56%)	11 (58%)	4 (21%)	15 (78%)	6 (33%) *
Gluteal	8 (23%)	6 (75%)	2 (25%)	7 (87.5%)	3 (37.5%)
Inguinal hernia	7 (21%)	5 (71%)	1 (14%)	3 (57%)	7 (100%)
Total	34	22 (64.5%)	7 (20.5%)	25 (73.5%)	16 (47%)

* Local Complications involved dehiscence, infection, hematoma, seroma, graft loss. There are cases with concomitant complications; ** Computation for a total of 18 cases (one case with loss of follow-up).

Table 3 Data categorized according to the incidence of local complications and the reconstruction used.

Reconstruction Used	Complication		Total
Reconstruction Used	yes	no
Graft	1 (50%)	1 (50%)	2
Primary closure	6 (85.71%)	1 (14.29%)	7
Local Random Flap	4 (57.14%)	3 (42.86%)	7
Pedicled/perforating Flap	11 (61.11%)	7 (38.89%)	18
Total	22 (64.71%)	12 (35.29%)	34

Table 4 Data categorized according to the incidence of late recurrence and the reconstruction used .

Reconstruction Used	Late recurrence		Total
Reconstruction Used	yes	no
Grafting	1 (50%)	1 (50%)	2
Primary Closure	7 (100%)	0 (0%)	7
Local Random Flap	4 (66.67%)	2 (33.33%)	6
Pedicled/perforating Flap	4 (22.22%)	14 (77.78%)	18
Total	16 (48.48%)	17 (51.52%)	33

Table 5 Late recurrence in absolute figures according to the lesion approached and reconstruction used.

Lesion + Reconstruction	Late recurrence
Lesion + Reconstruction	yes	no	unavailable
Axillary + skin graft	1	1	-
Axillary + Primary Closure	3	0	-
Axillary + Local Random Flap	2	2	1
Axillary + Pedicled/perforating Flap *	1	9	-
Inguinal + skin graft	0	0	-
Inguinal + Primary Closure	4	0	-
Inguinal + Local Random Flap	1	0	-
Inguinal + Pedicled/perforating Flap **	1	0	-
Gluteal + skin graft	0	0	-
Gluteal + Primary Closure	1	0	-
Gluteal + Local Random Flap	1	0	-
Gluteal + Pedicled/perforating Flap ***	2	4	-

* Recurrence in one latissimus dorsi myocutaneous flap and none in seven TAP flaps and one latissimus dorsi myocutaneous flap; ** Recurrence in one gluteal- thigh flap; *** Recurrence in one gluteal VY-advancement fasciocutaneous flap and in one medial thigh flap, and no recurrence in one gluteal fold flap, two posterior thigh VY-advancement fasciocutaneous flaps and one medial thigh VY-advancement fasciocutaneous flap.

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Radical resection and local coverage of hidradenitis suppurativa - <i>acne inversa</i>: analysis of results

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[1] Mailing address: Rafael Ferreira Zatz E-mail: rafaelzatz@yahoo.com.br / zatzrafael@gmail.com