The utility of incisional vacuum-assisted closure in surgical Management of Hidradenitis Suppurativa: a retrospective cohort study

Abstract

Wide local excision is the gold standard treatment for severe hidradenitis suppurativa but remains challenging due to high rates of complications and recurrence. Incisional vacuum-assisted closure devices are powerful adjuncts to enhance postoperative wound healing. We performed a retrospective cohort study of all patients who underwent surgical excision for hidradenitis over a 10-year period. The cohort was divided into patients who received standard sterile dressings and those who received incisional vacuum-assisted closure. The primary outcomes were surgical site complications and recurrence of disease. The data were analysed using univariate and multivariable logistic regression analyses. We included 79 patients; patients had multifocal disease which resulted in 220 operative sites. Fifty-eight operative sites (26%) received vacuum-assisted closure and 162 (74%) did not. Operative sites with vacuum-assisted closure were larger (140 vs 60 cm2, p < 0.001) and had longer operations (72 vs 46 min, p < 0.001), and longer hospital stays (6 vs 0 days, p < 0.001). When adjusted for preoperative and operative factors, vacuum-assisted closure did not significantly decrease the odds of experiencing a complication (OR 0.70, p = 0.409) but, however, did significantly reduce the odds of disease recurrence (OR 0.28, p = 0.020). The use of vacuum-assisted closure does not alter risk of complications but may play a role in preventing hidradenitis recurrence. Given the high costs associated with long hospitalisations, more cost-effective solutions should be investigated, such as home vacuum-assisted closure therapy. Level of evidence: Level III, therapeutic study.