Hidradenitis Suppurativa Surgical Treatment: Our 20 Years Experience.

Introduction

Hidradenitis suppurativa surgical treatment is referred to patients
who cannot be assisted by medical, local e nutritional therapy.
Plastic and reconstructive surgical procedures aim to limit, in an
aesthetic/reconstructive point of view, scars and their visibility
even in case of minimum demolition, according to the mean young age of
the patients.

Materials and Methods

Inclusion criteria: all patients affected by diagnosed Hidradenitis
suppurativa not controlled by pharmacological therapy, patients with
age > 14 years old, patient who signed informed consent, patients
treated at our department. We applied the BODY-Q sexual function
post-operative module and satisfaction with outcome post-operative
module.
The sample was studied about age, BMI, comorbidity, bariatric surgical
procedures, follow up, type of surgical procedure, complications and
secondary procedures.

Experience

In the last 20 years, we treated 195 patients, with mean age of 32
years old, with mean follow up of 2 years. Surgical treatment was
considered in case of: nodular and/or abscessual singular recurrent
form, nodular confluent abscessual form, sub-total or total aesthetic
units extended form, extended genital form. Treatment of a singular
lesion consisted of a demolitive excision extended to the inflammatory
region next to the primary site of the pathology. Fistulography using
methylene blue sometimes could be performed to obtain a complete
removing of the fistula. Scars usually should follow minor tension
lines of the body or could be done into cutaneous natural sulcus or
plica to optimize aesthetic results. Multiple confluent nodular
lesions must be removed by extended demolitive surgery followed by
reconstructive strategy using local or loco-regional cutaneous flaps.
Loco-regional cutaneous flaps sometimes were preferred by the
reconstructive surgeon, even if they cause poor aesthetic results,
because they are adjacent to the lesions and less involved in an
inflammatory process which could cause recurrence. Nodular confluent
abscessual form, which involves sub-total or total aesthetic units, is
treated by removing all the interested area (axilla and groin); it is
necessary to consider a reconstructive strategy in this case
harvesting loco-regional cutaneous flaps which allows a huge
transposition of healthy tissue limiting the scars into natural
sulcus.  Extended nodular/abscessual genital form usually showed local
infections which causes emotional and sexual discomfort; immediate
reconstruction is preferred in order to use technique based on
harvesting pedicled or perforator island flaps.
It is possible to obtain excellent aesthetic and functional results
using, for selected patients, common aesthetic procedure as
abdominoplasty, thigh lift or mammaplasty.
In case of severe extended anatomic region involved by hidradenitis
suppurativa, for example the gluteal region, it is possible to follow
a flowchart: total excision of the lesion or the involved region,
therapy ex- vacuum (VAC Therapy), healing by secondary intention
and/or by using skin grafts in a selected cases similar to the
treatment of II and III degree burned patients.

Results

From BODY-Q questionnaire the group of patient with severe
hidradenitis suppurativa had the highest level of post-operative
satisfaction.

Conclusions

Considering age, sex, functional and relational discomfort and
aesthetic outcomes according to the stage of disease, it is possible
to get the best surgical strategy.