Marchesi Andrea, Amendola Francesco, Garieri Pietro, Steinberger Zvi, Vaienti Luca
From the Plastic Surgery, Hand Surgery and Reconstructive Microsurgery Department, Ospedale San Gerardo, Monza.
Plastic and Reconstructive Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
Ann Plast Surg. 2021 Feb 1;86(2):201-205. doi: 10.1097/SAP.0000000000002482.
Hidradenitis suppurativa (HS) is a chronic skin pathology characterized by the occurrence of inflamed and swollen lesions, with a devastating impact of the disease on patient's quality of life. Wide local excision (WLE) of the affected tissue is the criterion-standard treatment, but there is no general consensus on the best reconstructive technique. The aim of this article is to evaluate the quality of life before and after WLE combined with pedicled perforator flap reconstruction, in patients suffering from HS.
We analyzed 26 consecutive patients suffering from Hurley stage III HS. Every patient underwent WLE, followed by reconstruction with pedicled perforator flap. Dermatology Quality of Life Index (DLQI) tests were administered to every patient preoperatively and 6 months after surgery, when the clinical condition was considered stable. Dermatology Quality of Life Index scores were compared in terms of means with Student t test. Linear regression studies were used to compare the changes in DLQI score with the surgical and clinical variables.
Axillary area involvement was found in 21 of 27 patients; 6 patients had more than 1 body region involved. Thirty-two pedicled perforator flaps were performed, and 22 were thoracodorsal artery perforator flaps. Mean DLQI test score before the first operation was 21.31 ± 4.79; the average DLQI score after the last follow-up was 5 ± 2.95 (P < 0.0001). Dermatology Quality of Life Index scores were not influenced by complications including reoperation. There were also no correlations found between DLQI score delta and number of reoperation (-0.18) or days of hospital stay (-0.13).
Wide local excision followed by pedicled perforator flap reconstruction allows a radical excision of HS areas with short postoperative healing periods. Dermatology Quality of Life Index scores confirmed high levels of patients' satisfaction. Disadvantages of this technique include difficult learning curve, long operating time, and a nonnegligible complications rate.
化脓性汗腺炎（HS）是一种慢性皮肤疾病，其特征为出现发炎和肿胀的病变，对患者的生活质量产生严重影响。受影响组织的广泛局部切除（WLE）是标准治疗方法，但对于最佳重建技术尚无普遍共识。本文的目的是评估HS患者在接受WLE联合带蒂穿支皮瓣重建前后的生活质量。
我们分析了26例连续的Hurley III期HS患者。每位患者均接受了WLE，随后进行带蒂穿支皮瓣重建。在术前及术后6个月（临床状况被认为稳定时）对每位患者进行皮肤病生活质量指数（DLQI）测试。采用Student t检验比较DLQI评分的均值。使用线性回归研究比较DLQI评分的变化与手术及临床变量。
27例患者中有21例腋窝区域受累；6例患者有多个身体区域受累。共进行了32例带蒂穿支皮瓣手术，其中22例为胸背动脉穿支皮瓣。首次手术前的平均DLQI测试评分为21.31±4.79；最后一次随访时的平均DLQI评分为5±2.95（P<0.0001）。DLQI评分不受包括再次手术在内的并发症影响。DLQI评分变化与再次手术次数（-0.18）或住院天数（-0.13）之间也未发现相关性。
广泛局部切除后行带蒂穿支皮瓣重建可彻底切除HS区域，术后愈合期短。DLQI评分证实患者满意度较高。该技术的缺点包括学习曲线困难、手术时间长和并发症发生率不可忽视。
