Ge Shealinna, Orbay Hakan, Silverman Ronald P, Rasko Yvonne M
Plastic and Reconstructive Surgery, University of Maryland School of Medicine, Baltimore, USA.
Surgery, University of Maryland School of Medicine, Baltimore, USA.
Cureus. 2018 Sep 17;10(9):e3319. doi: 10.7759/cureus.3319.
Hidradenitis suppurativa (HS) is a physically debilitating disease that greatly impairs the quality of life of affected individuals. Advanced disease is often difficult to treat with topical and systemic therapies. Surgical resection of diseased skin has become paramount in HS management but proposes challenges of wound care and closure.
Four patients with a total of 12 complex wounds were treated over a three year period. All of the patients were males between the ages of 28 and 61 years. The lesions were located on the buttocks (n=5), chest (n=1), perianal (n=2), perineal (n=2), and axillary regions (n=2). A protocol of wide local excision, followed by negative pressure wound therapy with instillation and dwell time (NPWTi-d) to decrease bioburden and promote angiogenesis of the exposed base, and subsequent skin grafting was used. Patients remained hospitalized between procedures.
The original wound area ranged from 210-540 cm. Skin grafts of comparable sizes were taken from donor sites. The average duration of NPWTi-d placement was 3.5 days and the average time from excision to wound coverage was 4.3 days. The percent of graft uptake ranged from 70%-90%. All patients were resolved of their local disease with no complications.
Surgical management of HS can be complicated by difficult closures. This case series demonstrates that wide local excision followed by NPWTi-d and skin grafting is able to achieve local resolution of disease in HS patients who have failed multiple minimally invasive therapies.
化脓性汗腺炎（HS）是一种使人身体衰弱的疾病，严重损害患者的生活质量。晚期疾病通常难以通过局部和全身治疗来治愈。病变皮肤的手术切除已成为HS治疗的关键，但带来了伤口护理和闭合的挑战。
在三年期间对4例患者共12处复杂伤口进行了治疗。所有患者均为年龄在28至61岁之间的男性。病变位于臀部（n = 5）、胸部（n = 1）、肛周（n = 2）、会阴（n = 2）和腋窝区域（n = 2）。采用广泛局部切除，随后进行带灌洗和停留时间的负压伤口治疗（NPWTi-d）以减少生物负荷并促进暴露创面的血管生成，随后进行皮肤移植的方案。患者在两次手术之间住院。
原始伤口面积为210 - 540平方厘米。从供区获取了大小相当的皮肤移植物。NPWTi-d放置的平均持续时间为3.5天，从切除到伤口覆盖的平均时间为4.3天。移植物摄取率为70% - 90%。所有患者的局部疾病均得到治愈，无并发症发生。
HS的手术治疗可能因伤口闭合困难而复杂化。本病例系列表明，对于多种微创治疗失败的HS患者，广泛局部切除后进行NPWTi-d和皮肤移植能够实现疾病的局部治愈。
