Radical resection and local coverage of hidradenitis suppurativa - acne inversa: analysis of results.

Rogério Rafael Da Silva Mendes,Fábio De Freitas Busnardo,Rolf Gemperli,Rafael Ferreira Zatz,Miguel Luiz Antonio Modolin

doi:10.1590/0100-6991e-20181719

Rogério Rafael Da Silva Mendes, Fábio De Freitas Busnardo + Show 3 more

Open Access

https://doi.org/10.1590/0100-6991e-20181719

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Abstract

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

Highlights

Hidradenitis suppurativa (HS), or acne inversa, consists of a cutaneous pathology of affection of the apocrine glands and the pilosebaceous complex, characteristic of the intertriginous regions, more frequent in the axillary and inguinal areas
We present the retrospective analysis of the experience of the Plastic Surgery Service of the Clinics Hospital of the Faculty of Medicine of the University of São Paulo in the treatment of advanced hidradenitis suppurativa lesions with radical resection and local coverage
We designed the study as a retrospective analysis based on the review of medical charts, evaluating the patients seen between 2010 and 2016 with the diagnosis of advanced stage (Hurley III) hidradenitis suppurativa, submitted to surgery according to defined inclusion criteria: radical resection under general anesthesia and immediate or late reconstruction

Summary

Introduction

Hidradenitis suppurativa (HS), or acne inversa, consists of a cutaneous pathology of affection of the apocrine glands and the pilosebaceous complex, characteristic of the intertriginous regions, more frequent in the axillary and inguinal areas. There is recurrent infection followed by chronic inflammatory process and consequent cicatricial retraction It begins with erythema and papules, advancing to the formation of abscesses, fistulas and fibrotic bands, and causes pain and suppuration of characteristic fetid odor, with local architectural disfiguration. The literature shows several classifications for gradation of HS, among them the Hurley classification, which defines conservative or surgical treatment according to the degree of evolution of the lesions, but does not confer treatment efficacy[1,2,3,4] It is a disease of great repercussion in the quality of life and socioeconomic commitment of the affected individuals. The primary objective of this study is to evaluate the incidence of complications and late recurrence regarding the studied variables, with emphasis on the reconstruction employed

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