Wide Excision with Secondary Intention Healing: Proper Procedure for Nonextensive Gluteal Hidradenitis Suppurativa

Abstract

Purpose. Hidradenitis suppurativa (HS) is a chronic disease that presents with abscesses, odiferously draining sinus tracts, and scarring. It arises most commonly, but not exclusively, from apocrine-gland-bearing areas. Because many patients do not respond to medical therapies, with progressive disability, we undertook to determine the most appropriate operation for gluteal HS.Methods. We studied 152 patients with gluteal HS who had undergone surgical treatment from August 1996 to August 2006. Charts were reviewed for demographic, treatment, and outcome data. The operative procedures were divided into drainage procedures (n = 56), excision with primary suture (n = 42), and wide excision with secondary intention healing (n = 54). The extent of surgery was examined in terms of clinical course and lesion size.Results. The mean age at presentation was 29.6 years. At a mean follow-up of 36 months, local recurrent HS had developed in 32.2% of patients. There was 57.1% recurrence after drainage, 19% after excision with primary suture, and 16.6% after wide excision with secondary intention (p ＜ 0.05). The wound-healing period was 1.1 weeks after drainage, 2.4 weeks after excision with primary suture, and 7.3 weeks after wide excision with secondary intention healing (p ＜ 0.05).Conclusions. Gluteal HS is a chronic relapsing disease that frequently causes disabling pain, significant morbidity, and social isolation. In our study, inadequate excision was the main reason for recurrence, and wide excision with healing by secondary intention provided a good prognosis in most cases.