851 Hidradenitis Suppurativa: Our Institutional Experience over the Last 6 Months with Improved Definitive Management and Quality of Life

Abstract

Abstract Introduction Hidradenitis suppurativa (HS) has prevalence of 0.05–4.1% and is more common in women, with an onset typically occurring after puberty. HS is often under-recognized, mismanaged, and is associated with comorbidities and decreased quality of life. Currently, management is tailored to the phase of the disease; medically treating the inflammatory phase and surgically managing the fibrotic phase. The tissue-sparing surgery can be disfiguring and may not protect against recurrence. The aim of this case series is to highlight a novel therapy as a treatment option for chronic, recalcitrant HS. Methods Four HS patients underwent a novel treatment in the burn unit at our institution. Patients underwent excision of wounds, dermal regenerative template (DRT) placement, and were dressed with a silver-impregnated negative pressure therapy wound vac. On hospital day 5 the wound vac was changed and on day 10 the patient returned to the operating room for removal of the silastic layer of the DRT with formal split thickness skin grafting (STSG) over the neodermis and replacement of the silver-impregnated negative pressure therapy wound vac. On hospital day 15, the VAC was taken down, the graft site was transitioned to daily xeroform and bacitracin dressing, and the patients were discharged home. Results Four patients with ages ranging from 27–60 years with an average disease duration of six-years underwent the novel treatment at our institution. Two patients had HS more prominent on the buttock with the other two patients presenting with axilla involvement. One patient had limited range of motion to the shoulders secondary to chronic contractures. All patients had failed multiple local incision and drainage procedures as well as complex medical therapies including but not limited to chronic antibiotic suppression and immunotherapies. Each patient underwent two operative procedures with three patients requiring one additional bedside wound vac change. All patients were discharged home within fifteen days from the initial procedure with acceptable wound coverage. Conclusions Four patients with HS underwent a novel therapy; tolerated the procedures well, had excellent adherence, and were satisfied with the results. This provides evidence for the validity of this therapy utilizing the above described staged operative approach resulting in definitive management and acceptable cosmetic results. Applicability of Research to Practice By utilizing this novel approach and the multidisciplinary burn team, patients who suffer from long-standing HS may have improved quality of life.