Two-stage surgery for hidradenitis suppurativa: staged artificial dermis and skin grafting.

BACKGROUND

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).

OBJECTIVE

To describe our two-stage procedure and report results of the procedure in our patient series.

METHODS

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 36 months.

RESULTS

All 32 skin grafts were successful. There was only one recurrence, which was treated using reoperation, and postoperative appearances were good.

CONCLUSIONS

Our new procedure incorporating artificial dermis appears to be a good treatment option for advanced hidradenitis suppurativa.