Two-Stage Surgery for Hidradenitis Suppurativa: Staged Artificial Dermis and Skin Grafting

Abstract

Hidradenitis suppurativa is a chronic and often refractory skin disease that can require radical excision of the full layer of fatty tissue under the lesion. Closure using a split-thickness skin graft often results in depression deformity and lack of tissue flexibility. We have developed a two-stage procedure to preserve fatty tissue during radical excision and apply an artificial dermis graft, and we have performed this procedure in 18 patients (33 lesions). To describe our two-stage procedure and report results of the procedure in our patient series. In the first step, all diseased skin including the superficial subcutaneous fatty tissue is excised; normal deep subcutaneous fatty tissue is preserved. Artificial dermis is then grafted to the preserved fatty tissue. Two weeks later, split-thickness skin grafts are applied to the skin defects. We evaluated graft success, any recurrence, and postoperative appearance in our patients, who were followed up for 8 to 36months. All 32 skin grafts were successful. There was only one recurrence, which was treated using reoperation, and postoperative appearances were good. Our new procedure incorporating artificial dermis appears to be a good treatment option for advanced hidradenitis suppurativa.