外科医生的观点：一项回顾性研究，探讨了在治疗严重化脓性汗腺炎时，广泛切除至健康皮下脂肪的方法。
The surgeon’s perspective: a retrospective study of wide local excisions taken to healthy subcutaneous fat in the management of advanced hidradenitis suppurativa.
机构信息
From the Department of Medicine, Women’s College Hospital, and the Department of Surgery, CIBC Breast Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ont.
出版信息
Can J Surg. 2020 Feb 28;63(2):E94-E99. doi: 10.1503/cjs.003119.
BACKGROUND
Hidradenitis suppurativa (HS) is a chronic debilitating folliculopilosebaceous disease that affects the skin most commonly in the axilla, groin, inframammary, genital and buttock areas. Surgical intervention may be an appropriate option in selected cases, but there is a risk of recurrence. The purpose of this study was to assess the results of wide local excision (WLE) to healthy subcutaneous fat with secondary intention healing in patients with HS who were under concurrent surgical and dermatologic care.
METHODS
We conducted a retrospective review of 192 consecutive HS consultations to a general surgical service, identifying patients treated with WLE. Cases involving minor procedures (deroofing, incision and drainage) were excluded. Data on patient demographics, surgical site, method of closure, complications and recurrence were extracted from patient charts. We also conducted a literature review of surgical procedures in the management of HS.
RESULTS
A total of 66 patients underwent 133 WLE to healthy subcutaneous fat. All patients were under concurrent medical care directed by a dermatologist. No medical therapies, including biological treatments, were interrupted or withheld for surgery. One hundred procedures were closed primarily with rotation or advancement flaps and 33 by secondary intention healing. Local recurrence occurred in 18% of primary closures and 18% of secondary intention closures (p = 0.98, χ2 test, no difference between groups). One patient with secondary intention healing returned to the emergency department for bleeding; 34% of patients with primary closure experienced some dehiscence (23% major, 11% minor separation). Two patients with axillary disease had restrictions in their ability to raise their arm that required physiotherapy. Median follow-up was 14.5 (range 1–55) months.
CONCLUSION
Resection to healthy subcutaneous fat during WLE provides disease control comparable to that with deeper resections, simplifying care.
背景
化脓性汗腺炎（HS）是一种慢性衰弱性毛囊皮脂腺疾病，最常见于腋窝、腹股沟、乳晕下、生殖器和臀部区域。在某些情况下，手术干预可能是一种合适的选择，但存在复发的风险。本研究旨在评估在接受外科和皮肤科联合治疗的 HS 患者中，广泛局部切除（WLE）至健康皮下脂肪并二期愈合的结果。
方法
我们对一个普通外科服务中心的 192 例连续 HS 咨询进行了回顾性分析，确定了接受 WLE 治疗的患者。排除了涉及小手术（除顶、切开引流）的病例。从患者病历中提取了患者人口统计学、手术部位、闭合方法、并发症和复发的数据。我们还对 HS 管理中手术程序的文献进行了综述。
结果
共有 66 例患者接受了 133 次 WLE 至健康皮下脂肪。所有患者均同时接受皮肤科医生的医疗护理。手术期间未中断或停止任何医疗治疗，包括生物治疗。100 例手术采用旋转或推进皮瓣一期缝合，33 例采用二期愈合。一期缝合的局部复发率为 18%，二期愈合的局部复发率为 18%（p = 0.98，X2 检验，两组间无差异）。1 例二期愈合患者因出血返回急诊室；34%的一期缝合患者出现部分裂开（23%为大裂开，11%为小分离）。2 例腋窝疾病患者手臂上举受限，需要物理治疗。中位随访时间为 14.5（范围 1-55）个月。
结论
在 WLE 中切除至健康皮下脂肪可提供与深部切除相当的疾病控制，简化了治疗。
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