Cost comparison of split thickness skin grafting with and without bilayer dermal regenerative templates for bilateral axillary hidradenitis suppurativa: A retrospective comparison study

Abstract

Abstract Objective Overview of our staged procedure for excision and placement of split thickness skin graft for bilateral axillary hidradenitis. Compare cost, outcomes, and timing of our staged excision to those utilizing bilayer dermal regenerative templates prior to placement of skin graft for axillary hidradenitis. Methods An IRB approved retrospective case analysis was performed on patients that underwent bilateral axillary hidradenitis skin excision with eventual placement of split thickness skin grafting utilizing the current LSUHSC/University Health hidradenitis surgical treatment protocol. Utilizing ICD-9 codes (705.83) and CPT codes (11041, 11042, 11451, 11600, 11601, 11602, 11603, 11604) we reviewed cases performed at our institution from 1/1/08 to 2/24/14 and we selected 7 patients based on bilateral axillary involvement (alone) and >1 year history of active disease. Patients were excluded if resection of tissue encompassed regions outside of the immediately adjacent axillary regions. Results A total of 7 patients were selected for analysis. Clinical course, cost, and surgical techniques were assessed. Six out of seven patients required admission throughout their treatment course secondary to lack of funding, making home use of negative pressure wound therapy devices not possible. Our patients stayed an average of 10 days with a mean hospital charge of $35,178 and a mean hospital provider charge of $10,019. No recurrence was demonstrated. All patients attained full range of motion, post grafting. No patients required return to operating room for failed graft. Conclusion Bilateral axillary hidradenitis is a chronic, suppurative, and scarring disease process that is most effectively treated by complete excision of all hair-bearing tissues. Split thickness skin grafting without use of bilayer dermal regenerative templates yielded definitive results with acceptable cosmesis and functionality without the added cost of the bilayer dermal regenerative template.