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Resident PGY 3
Henry Ford Hospital
Background: Hidradenitis suppurativa (HS) is a chronic and debilitating condition which causes recurrent painful nodules. Patients often progress to develop subdermal abscesses, chronic induration, and suppurative draining sinus tracts. HS causes significant debility and morbidity in patients’ body image, and overall quality of life. Despite this, there is typically a 5-14 year delay in diagnosis from symptom onset. Treatment of HS depends on disease stage, goals of care, access to care, and frequency of symptoms. We have developed a hidradenitis suppurativa multidisciplinary program (HSMP). We present our experience with surgical treatment for patients with HS who follow in the HSMP. Methods: We retrospectively reviewed the outcomes of all patients referred through the HSMP for surgical treatment to plastic surgery at a single institution from January 2013December 2015. Inclusion criteria included adults with a diagnosis of HS and exclusion criteria included patients with less than 2 years follow up after surgery. Types of surgical interventions included incision and drainage with fulguration, excision with wound left open, and excision with primary repair. Demographic data, participation in a multidisciplinary program, type of surgery, healing rates, and potential factors contributing to wound healing were retrospectively reviewed in all cases using multivariate analysis.
Results: Two hundred forty eight patients met inclusion criteria with a total of 810 involved sites. Overall, 59% of patients had Hurley stage 3 disease at the time of surgery. Healing rates of 80% were observed in stage 1 and 2 and 74% observed in stage 3. Hurley stage was not a significant predictor of healing (P = 0.09). Surgical treatment consisted of 38% incision and drainage, 44% excision without closure, and 17% excision with primary closure. Incisional and excisional treatments healed 78% and 79%, respectively, at 2 years. Primarily repaired defects (grafts and flaps) were 68% healed at 2 years. Observed healing rates were uniform regardless of the number of sites involved (P = 0.959). Participation in the multidisciplinary program was the strongest predictor of healing (78% vs 45%, P = 0.004). Gender, age, body mass index, tobacco use, diabetes, pre-surgery hemoglobin, and family history of HS were statistically not significant. Continuation of immune modulating therapy within 2 weeks of surgery was a predictor of reduced healing (odds ratio 0.23, P = 0.004), while holding biologics for at least 2 weeks was not significant (odds ratio 1.99, P = 0.146).
Conclusion: Participation in a multidisciplinary program is a strong predictor of longterm success when treating HS. Hurley score and number of involved sites did not correlate with successful healing after surgery. If taking biologics, we identified 2 weeks as an appropriate break from biologics before and after surgical intervention. Healing rates were highest with ablative procedures (incision and drainage, excision) alone.
Worden, Andrew; Yoho, Daniel; Saab, Ihab; and Siddiqui, Aamir, "Factors Affecting Healing in the Treatment of Hidradenitis Suppuritiva" (2019). Clinical Research. 49.