Skorochod Ron, Margulis Alexander, Adler Neta
Department of Plastic and Reconstructive Surgery, Hadassah Medical Center, Hebrew University School of Medicine, Jerusalem, Israel.
Plast Reconstr Surg Glob Open. 2023 Jan 18;11(1):e4752. doi: 10.1097/GOX.0000000000004752. eCollection 2023 Jan.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder. Treatment of HS remains challenging, and surgical procedures commonly follow attempts of conservative therapy. To date, a consensus regarding the optimal surgical technique has not been reached, and the implications of conservative therapy on future surgical outcomes have yet to be studied.
A retrospective cohort study of 65 patients surgically treated for HS at a tertiary care center was conducted. Patients' medical records were screened for demographical, clinical, and surgical characteristics. Statistical analysis was conducted to determine associations with postoperative complications and disease recurrence.
Fifty patients (75.8%) were treated with systemic antibiotics before opting for surgical resection. Previous treatment with systemic rifampicin was associated with higher rates of postoperative complications ( = 0.029); however, systemic cephalexin and topical clindamycin were associated with a lower rate of complications ( = 0.007 and 0.040, accordingly). Medical history of smoking and surgical management with split-thickness skin grafts were associated with higher rates of postoperative complications ( = 0.012 and 0.014, accordingly). Patients with a greater number of lesions, and those treated with split-thickness skin graft, had higher rates of disease recurrence ( = 0.0018 and 0.003, accordingly).In a multivariate analysis a greater number of lesions ( = 0.0498) and the use of autologous split-thickness skin graft ( = 0.022) were independently associated with higher rates of disease recurrence.
Previous conservative medical therapy bears the potential to modulate postoperative outcomes in HS patients, and should be taken into consideration. Despite reports of reliable results with split-thickness skin grafts, we found them to be associated with increased rates of diseases recurrence and postoperative complications.
化脓性汗腺炎(HS)是一种慢性炎症性皮肤病。HS的治疗仍然具有挑战性,通常在尝试保守治疗后进行外科手术。迄今为止,尚未就最佳手术技术达成共识,保守治疗对未来手术结果的影响也有待研究。
对一家三级医疗中心65例接受HS手术治疗的患者进行回顾性队列研究。筛查患者的病历以获取人口统计学、临床和手术特征。进行统计分析以确定与术后并发症和疾病复发的关联。
50例患者(75.8%)在选择手术切除前接受了全身抗生素治疗。先前使用全身利福平治疗与较高的术后并发症发生率相关(P = 0.029);然而,全身头孢氨苄和局部克林霉素与较低的并发症发生率相关(分别为P = 0.007和0.040)。吸烟病史和采用分层皮片移植的手术治疗与较高的术后并发症发生率相关(分别为P = 0.012和0.014)。病变数量较多的患者以及接受分层皮片移植治疗的患者疾病复发率较高(分别为P = 0.0018和0.003)。在多变量分析中,病变数量较多(P = 0.0498)和使用自体分层皮片移植(P = 0.022)与较高的疾病复发率独立相关。
先前的保守药物治疗有可能调节HS患者的术后结果,应予以考虑。尽管有报道称分层皮片移植结果可靠,但我们发现它们与疾病复发率和术后并发症的增加有关。