Friday, April 12, 2024

Groin Area Hidradenitis Suppurativa Surgery

Leave Open To Heal By Secondary Intension

Hidradenitis Suppurativa (HS) | Pathophysiology, Triggers, Signs & Symptoms, Diagnosis, Treatment

Following surgical excision of the involved area, the wound is left to heal by granulation, contraction, and epithelialisation. Secondary intention healing is recommended as a safe and efficient form of healing of postoperative defects in certain areas of the body.36 This technique avoids the morbidity associated with donor site healing as in grafts and flaps however, a long duration is required for complete healing and is limited in terms of size of wound.

The Hidradenitis Suppurativa Severity Index

HSSI is another HS-specific severity index . This score incorporates categorical objective parameters with categorical subjective parameters considering body surface area involved, number of skin lesions, pain through a visual analog scale and drainage . Severe disease is defined by an HSSI score 13, whereas a score between 8 and 12 and a score between 0 and 7 define moderate and mild disease, respectively.

Surgical Management Of Hidradenitis Suppurativa

Adnan Menderes, Ozgur Sunay, Haluk Vayvada, Mustafa Yilmaz

Plastic Rec. and Aesthetic Surgery, Medical Faculty, Dokuz Eylul University, Inciralt-Izmir, Turkey

Corresponding author: Ozgur Sunay, M.D., Dokuz Eylul Universitesi Tp Fakultesi Plastik Rek. ve Estetik Cerrahi A.D. Inciralt-Izmir Turkey. Tel: +90 5055250343 e-mail: ozgur.sunayedu.tr ozgur2com

Citation:Int J Med Sci

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Relatively Minor Surgical Techniques

Numerous helpful and relatively minor surgical techniques include drainage exteriorization Nd:YAG laser treatment curettage electrocoagulation of the sinus tracts simple excision of the troublesome areas with direct closure placement of local cutaneous flaps, musculocutaneous flaps, pedicled and free flaps, or skin grafts and secondary-intention healing.

Local incision and drainage of purulent lesions are often required in the acute phase, and, although these procedures are helpful in providing short-term relief, recurrent inflammation is almost inevitable. Deroofing of sinus tracts and curettage of fistulous tracts have distinct roles as preliminary treatments before more definitive intervention, and are especially suited for recurrent hidradenitis suppurativa lesions at fixed locations in Hurley I or II stage, particularly in the acute phase of perianal disease. An alternative surgical approach may be used in so-called bridging lesions. These lesions have 2 distant cutaneous orifices connected by a subcutaneous fistula. Periorificial fusiform skin incisions are made parallel to the skin folds, followed by a viral blue dye injection for accurate visualization of the fistula tract, and the subcutaneous tubular fibrotic tissue is completely removed en bloc.

Submammary Hs: Options For Reconstruction

Dr. B C Shah general and laprascopic surgeon: Hidradenitis Suppurativa

There have been few case reports in the literature regarding surgical treatments of HS lesions in the submammary area. Moosa et al. reported aggressive treatment of HS by performing bilateral mastectomies. Although this is certainly a curative option, the breast contour is disturbed. In 2010, a successful treatment of a patient with HS of the submammary area based on the procedure typical for breast reduction was described. The overall cosmetic result was good with no recurrence and a high degree of patient comfort and satisfaction .

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Sure Closure: Skin Stretching System

This technique, described by Sharma et al.,38 uses the viscoelastic properties of the skin, so as to stretch the skin by exerting a controlled amount of tension along the wound margins. Known as the skin stretching system, this technique facilitates primary closure of a wound that would have otherwise required either graft or flap. Skin stretching allows closure of a larger wound than that can usually be primarily closed, and the bedside procedure can be performed under local anaesthetic. Although it does give a higher propensity for hypertrophic scar formation, infection of intradermal pin tracts and ischaemic necrosis of skin edges can occur if stretching is not done with caution.

Recurrences Of Hidradenitis Suppurativa After Radical Surgery

Dermatologic Surgery

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    Can Hs Cause Joint Pain

    If you have HS, arthritis may be causing your joint pain. In studies, researchers have found that HS increases your risk of developing some types of arthritis.

    Joint pain and morning stiffness are common symptoms of arthritis.

    Researchers continue to study this connection between HS and joint pain. We know that both cause inflammation. This fact may shed more light on what causes HS.

    To find out what researchers have learned so far about what causes of HS, go to, Hidradenitis suppurativa: Causes.

    ImagesImage 1: Property of the AADImage 2: Getty ImagesImages 3 – 6: Used with permission of DermNet NZImage 7: Image used with permission of the Journal of the American Academy of Dermatology. :144-4).Image 8: Images used with permission of the Journal of the American Academy of Dermatology. .

    ReferencesAlikhan A, Sayed C, et al. âNorth American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations Part I: Diagnosis, evaluation, and the use of complementary and procedural management.â J Am Acad Dermatol 2019 81:76-90.

    Garg A, Neuren E, et al. âEvaluating patientsâ unmet needs in hidradenitis suppurativa: Results from the Global Survey Of Impact and Healthcare Needs Project.â J Am Acad Dermatol 2020 82:366-76.

    Lee EY, Alhusayen R, et al. âWhat is hidradenitis suppurativa?â Can Fam Physician. 2017 Feb 63:114-120.

    You Are Not Alone With Hs

    Shining a light on living with hidradenitis suppurativa

    Dr. Richmond knows that life with HS can be difficult. Its painful, its really impactful to daily life and theres an embarrassing factor, she said. So some people are hesitant to talk about it. But, she emphasized, Youre not alone. Its a really common problem that I think people dont talk about.

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    This Article Is Part Of

  • Kurzen H, Kurokawa I, Jemec GB, Emtestam L, Sellheyer K, Giamarellos-Bourboulis EJ, Nagy I, Bechara FG, Sartorius K, Lapins J, Krahl D, Altmeyer P, Revuz J, Zouboulis CC: What causes hidradenitis suppurativa? Exp Dermatol 2008 17:455-472.External Resources
  • Naldi L: Epidemiology in Jemec G, Revuz J, Leyden JJ : Hidradenitis Suppurativa. Berlin, Springer, 2006, pp 58-64.
  • Revuz JE, Canoui-Poitrine F, Wolkenstein P, Viallette C, Gabison G, Pouget F, Poli F, Faye O, Roujeau JC, Bonnelye G, Grob JJ, Bastuji-Garin S: Prevalence and factors associated with hidradenitis suppurativa: results from two case-control studies. J Am Acad Dermatol 2008 59:596-601.External Resources
  • Yamauchi PS, Mau N: Hidradenitis suppurativa managed with adalimumab. J Drugs Dermatol 2009 8:181-183.External Resources
  • Sotiriou E, Goussi C, Lallas A, Chovarda E, Apalla Z, Lazaridou E, Ioannides D: A prospective open-label clinical trial of efficacy of the every week administration of adalimumab in the treatment of hidradenitis suppurativa. J Drugs Dermatol 2012 11:15-20.External Resources
  • Miller I, Lynggaard CD, Lophaven S, Zachariae C, Dufour DN, Jemec GB: A double-blind placebo-controlled randomized trial of adalimumab in the treatment of hidradenitis suppurativa. Br J Dermatol 2011 165:391-398.External Resources
  • How Is Wide Surgical Excision Performed

    Before surgery can occur, any infection or inflammation must first be treated, often through the use of antibiotics. During the procedure, the area affected by hidradenitis suppurativa is excised, or removed, along with a margin of unaffected tissue surrounding it. In some cases, the wound may be closed with stitches. However, since the area removed is often large and deep, it may require using healthy skin from other areas of the body to help cover the wound.

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    Why And Where It Develops

    Essentially, hidradenitis suppurativa starts in areas of the body where the skin tends to rub up against other skinor in areas where there are oil- and sweat-producing glands. The hair follicles become clogged with bacteria and other debris. Thats when pimples begin to form.

    The condition isnt contagious, and you cant give it to someone else. Its not the result of poor hygiene, either. However, no one really knows what causes it, although experts speculate it could be due to a combination of environmental and genetic factors. It is more common in people who are overweight, people who smoke, and people with a family history of hidradenitis suppurativa. Women are also far more likely to develop the condition. And the American Academy of Dermatology notes that its possible the immune system overreacts to the clogged follicle in people who have acne inversa.

    How Is Hidradenitis Suppurativa Diagnosed

    Hidradenitis Suppurativa Definition

    To diagnose hidradenitis suppurativa, a dermatologist will:

    • Ask you about your family history of skin problems.
    • Do a physical exam.
    • Closely study the appearance of your skin.
    • Note where the bumps are located.
    • Ask how long the bumps have been present and if they disappear and reappear.

    Blood tests can help confirm a diagnosis of hidradenitis suppurativa. If pus is present, your doctor may also take a biopsy of it to rule out other skin conditions.

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    Purpose Of Hidradenitis Suppurative Surgery

    Surgical options may be suggested for those who have severe hidradenitis suppurativa that has not responded to other treatments like medication. Surgery will remove the lesions associated with hidradenitis suppurativa.

    A doctor may recommend a surgery for those who have lesions that are extensive or persistent and causing considerable discomfort.

    Surgery for hidradenitis suppurative can result in large wounds because not only does a lesion need to be removed, but a wide margin of skin around the wound also needs to be removed. For this reason, surgery is only indicated for those with severe disease. Mild or moderate forms of the disease may be treated with medications and skincare.

    Hidradenitis Suppurativa Groin Surgery What To Expect

    Hidradenitis suppurativa frequently affects the skin in the groin causing pain, scarring, and recurring lesions that can be difficult to treat. When medication and lifestyle changes are not enough to improve HS, surgery may be needed to relieve symptoms.

    Dr. Christopher Sayed was interviewed by myHSteam to discuss what people need to know about groin surgery for HS. Dr. Sayed is an associate professor of dermatology at the University of North Carolina at Chapel Hill and a member of the board of directors for the Hidradenitis Suppurativa Foundation.

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    Getting Hs Under Control

    Before surgery, its important to reduce inflammation and get your HS flares under control with medication. If Im going to be excising a lesion entirely, said Dr. Richmond, I like to try to do it when its less inflamed so youre not having as much postoperative pain, reduce complications, and to minimize the size of surgery.

    In some cases, it may be better to delay surgery for HS to give medical therapies time to reduce inflammation. Keep the goal in mind: a surgery that achieves the best possible results.

    Are You A Candidate For Hidradenitis Suppurativa Surgery

    Deroofing of sinus tracts in Hidradenitis Suppurativa for Healthcare Professionals

    If you have been diagnosed with acne inversa, also known as hidradenitis suppurativa, youve likely been in search of relief from this chronic, sometimes painful and debilitating disease. In moderate-to-severe acne inversa, antibiotics and the injected biologic adalimumab have provided clinical benefit for some patients. Though no definitive cure has been found, surgery has also been shown to be an effective treatment for many individuals. Using what is known as a wide excision, the entire diseased area, as well as a border of healthy tissue surrounding it, is surgically removed. But how do you know if you are a candidate for this procedure?

    To answer this question, its important to address both how this disease physically manifests itself and how it affects your quality of life.

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    Are You Aware Of The Risk Of Recurrence

    All surgical patients must understand that although hidradenitis suppurativa shouldnt return to the area that was removed, it may reappear on other parts of the body. Risk factors such as obesity, smoking, chronic skin infection, and stress have also been linked to higher likelihood of recurrence. Those who are willing to make some lifestyle changes may be more likely to have a positive outcome after surgery.

    How Severe Is Your Case

    Hidradenitis suppurativa presents as inflamed pimple-like bumps or boils under the skin. It commonly occurs in areas that are prone to sweat or with skin-to-skin contact, such as the underarm, groin, and buttocks. These inflamed areas can become painful and may drain pus that often has an unpleasant smell. As the disease progresses, these may form deep abscesses and a connection of tunnel-like tracts, called sinus tracts, beneath the skin. Additionally, thick scars can develop, resulting in difficulty moving the affected area.

    The severity of hidradenitis suppurativa can range from person to person. Doctors will often use a system called the Hurley Criteria to classify patients.

    • Hurleys Stage I: There may be single or multiple affected areas that are widely separated, without scarring or sinus tract formation.

    • Hurleys Stage II: Recurrent affected areas are seen but are still widely separated. Sinus tracts and scars are formed.

    • Hurleys Stage III: Large areas are affected with multiple sinus tracts and scars.

    Mild cases, such as those in Stage I, will generally be managed medically. However, patients with recurrent and more severe disease in Stage II and III who have failed to respond to medical treatment may be considered candidates for surgery to remove the abscesses and the sinus tracts.

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    Reconstruction After Radical Wide Excision

    The choice of the reconstructive technique largely depends on the size and location of the defects. Reconstruction after radical wide excision is important to maintain function, reduce contracture, and provide good aesthetic outcomes. Nicoli et al. described an innovative treatment for severe HS using an innovative and alternative method with platelet-enriched plasma to promote neovascularization and a dermal substitute named Hyalomatrix , a delivery system for hyaluronic acid, to induce neodermis at the wound bed and to stimulate regeneration in a humid and protected environment. The procedure was well tolerated and achieved complete wound healing after 2 months. No recurrence was observed during the 1 year after the surgical procedure, as well as no wound dehiscence and no scar contractures occurred.

    What Are The Complications Of Hidradenitis Suppurativa

    Hidradenitis Suppurativa

    Hidradenitis suppurativa occurs in cycles throughout a patientâs lifetime, with periods of breakouts and healings. In some cases, the disease progresses and causes abscesses to form deep within skin tissue. Continued healing and scarring can cause that area of the skin to become thick and in extreme cases, the scarring makes the affected area firm and difficult to move. Continued healing and scarring can also cause fistulas to form inside the body. Fistulas are hollow passages that are painful and require surgery to repair.

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    Who Gets Hidradenitis Suppurativa

    Hidradenitis suppurativa affects between 1% to 4% of people in the U.S. It is more commonly seen in females than males. Hidradenitis suppurativa is typically seen in young people, starting at puberty up to about age 40. It is also more common people who are Black, have overweight or obesity and people who smoke.

    What Are The Symptoms Of Hidradenitis Suppurativa

    When it first develops, hidradenitis suppurativa can have symptoms that range from mild itching and discomfort to the appearance of a red, tender, and swollen areas. Pimple- and/or boil-like bumps appear and can grow, fill with pus, and then break open. The pus that drains sometimes has a foul odor due to the presence of bacteria. Healing of the bumps can cause scarring. Symptoms vary from person to person.

    In some patients, the breakouts can reoccur in the exact spot in others, breakouts occur in the same area but not in the exact same spot. Some people have constant breakouts on their skin in others, scars are the only sign present at that point in time.

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    What Are The Signs And Symptoms Of Hs

    If you have this skin disease, you may notice breakouts on your skin that look like pimples or boils. Often, these breakouts clear for a while. Later, you may see new breakouts develop in the same area. Sometimes, the breakouts develop in exactly the same spot.

    The following pictures show how HS develops and how it can worsen without treatment:

    Area of skin feels uncomfortable

    Before you notice a lump in your skin, you may feel some discomfort. The area where the lump will appear may swell. Some people say their skin burns, itches, or sweats excessively.

    Tender, deep nodule appears

    The first sign of HS is often a painful spot that looks like a deep pimple, acne cyst, or boil. This spot often appears on an armpit or in the groin area. Some people develop a spot on their buttocks or inner thigh.

    Nodules grow and start to join together

    As HS progresses, you see more lumps that may look like acne or boils. These lumps can grow and join together. As the lumps grow together, they fill up with fluid and become painful. These painful lumps are called abscesses.

    Large, painful abscess breaks open

    When an abscess breaks open, blood and pus spill out. This foul-smelling mixture can cause wet spots on your clothes. People often feel embarrassed by the odor.

    Blackhead-like spots

    In the advanced stages, some people see small black bumps that look like blackheads. These spots often appear in twos.

    Abscesses heal slowly and return scars form

    Treatment can prevent HS from progressing

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