Burney Richard E
University of Michigan, TC 2124 University Hospital SPC 5343, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.
World J Surg. 2017 Nov;41(11):2723-2730. doi: 10.1007/s00268-017-4091-7.
Hidradenitis suppurativa is a painful and disfiguring chronic inflammatory condition affecting both men and women. Medical treatments, such as antibiotics and immunosuppressive agents, are often ineffective. Over time, patients can suffer from recurrent abscesses, chronic purulent drainage, scarring, and contractures that can only be corrected by surgical excision. There is no agreement, however, on the best way for the surgeon to manage this condition. The purpose of this review is to describe the results of surgical treatment of this condition in a large cohort of patients managed by local excision of hidradenitis, healing by secondary intention and reoperation as needed.
A retrospective review was conducted of all patients operated on by the author for hidradenitis over a 35-year period. Specific data abstracted included patient age, weight, admission, length of stay, wound size, type of wound care, number of post-op visits, time to heal, and recurrence. Most wounds healed by secondary intention and were managed using simple tap water-moistened plain gauze dressings changed three times a day.
From 1979 through 2014, 122 patients (56 men and 66 women), median age 38, underwent 245 operations for hidradenitis suppurativa. Patients underwent from 1 to 10 procedures; 61 patients (50%) underwent two or more procedures; and 26 (21%) underwent three or more. Wound sizes at operation ranged from quite small to over 1500 cm. Men were older (42 vs 34 years, p < 0.001) and had larger median wound size (98 vs 55 cm, p < 0.001). A total of 197 wounds healed by secondary intention: 83 of these (median size 159 cm) were left completely open at the time of surgery; 117 (median size 100 cm) were partially closed. A total of 30 wounds (median size 38 cm) were closed primarily; 15 (median size 196 cm) were closed by skin graft. Patients undergoing 139 procedures were admitted to the hospital for the initial wound care. Their median combined total wound size was 160 cm; length of stay was 5.5 days; and median time to heal was 60 days. In total, 106 procedures were ambulatory; median wound size was 30 cm; and median time to heal was 40 days. Recurrent or new disease was common, with some patients requiring multiple procedures over many years to maintain control of symptoms. Although wound healing can take up to several months, patients quickly learned how to care for themselves and were usually pain-free after the first two or three weeks.
Surgical treatment of hidradenitis suppurativa by wide local excision with healing by secondary intention using tap water-moistened plain gauze dressings changed 2-3 times per day is a simple, practical approach that has good results. Recurrence of disease is common and should not be thought of as a failure of surgical treatment, but rather as a feature of the disease that must be anticipated and managed.
化脓性汗腺炎是一种影响男性和女性的疼痛且毁容的慢性炎症性疾病。抗生素和免疫抑制剂等药物治疗往往无效。随着时间的推移，患者会反复出现脓肿、慢性脓性引流、瘢痕形成和挛缩，这些只能通过手术切除来纠正。然而，对于外科医生处理这种疾病的最佳方法尚无共识。本综述的目的是描述在一大群通过局部切除化脓性汗腺炎、二期愈合及必要时再次手术进行治疗的患者中，这种疾病的手术治疗结果。
对作者在35年期间为化脓性汗腺炎进行手术的所有患者进行回顾性研究。提取的具体数据包括患者年龄、体重、入院情况、住院时间、伤口大小、伤口护理类型、术后就诊次数、愈合时间和复发情况。大多数伤口通过二期愈合，使用简单的用自来水浸湿的普通纱布敷料，每天更换三次进行处理。
从1979年到2014年，122例患者（56例男性和66例女性），中位年龄38岁，接受了245次化脓性汗腺炎手术。患者接受了1至10次手术；61例患者（50%）接受了两次或更多次手术；26例（21%）接受了三次或更多次手术。手术时伤口大小从非常小到超过1500平方厘米不等。男性年龄较大（42岁对34岁，p<0.001），中位伤口大小较大（98平方厘米对55平方厘米，p<0.001）。共有197个伤口通过二期愈合：其中83个（中位大小159平方厘米）在手术时完全开放；117个（中位大小100平方厘米）部分闭合。共有30个伤口（中位大小38平方厘米）一期闭合；15个（中位大小196平方厘米）通过植皮闭合。接受139次手术的患者因初始伤口护理入院。他们的中位总伤口大小为160平方厘米；住院时间为5.5天；中位愈合时间为60天。总共106次手术为门诊手术；中位伤口大小为30平方厘米；中位愈合时间为40天。复发或新发病例很常见，一些患者需要在多年内进行多次手术以维持症状控制。尽管伤口愈合可能需要长达数月，但患者很快学会了如何自我护理，通常在最初的两到三周后就不再疼痛。
通过广泛局部切除、使用每天更换2 - 3次的自来水浸湿的普通纱布敷料进行二期愈合来治疗化脓性汗腺炎是一种简单、实用且效果良好的方法。疾病复发很常见，不应被视为手术治疗失败，而应被视为该疾病的一个特征，必须加以预期和处理。
