Department of Dermatology, University of Pisa, Pisa, Italy.
Interdisciplinary Center of Health Science, Sant'Anna School of Advanced Studies of Pisa, Pisa, Italy.
J Wound Care. 2024 Aug 2;33(Sup8):S10-S16. doi: 10.12968/jowc.2023.0224.
Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the hair follicle. Its treatment often requires a surgical approach. The aim of our study was to evaluate the occurrence of post-surgical complications following a new standard of surgical management. This included presurgical lesion mapping by ultra-high frequency ultrasound (UHFUS) with a 70MHz probe. Postoperative management was based on the principles of HS-TIME (time, inflammation/infection, moisture, edges).
A single-centre, retrospective study was conducted by the Department of Dermatology of the University of Pisa. Patients with moderate and severe HS, refractory to previous medical and surgical therapies, were enrolled. All of the patients were treated with wide surgical excision of lesions, previously explored through a UHFUS evaluation with VEVO MD (Fujifilm VisualSonics, Inc., Canada) using a 48MHz and a 70MHz ultrasound probe. Following surgery, all patients were treated with secondary intention healing following the principles of HS-TIME. For each patient, we assessed the occurrence of post-surgical complications at follow-up visit six months after surgery. For each patient we assessed the occurrence of early post-surgical complications at every follow-up visit after surgery until complete wound healing. The occurrence of delayed complications was then assessed in all patients with an observation time after complete healing of >3 months (n=23).
A total of 26 patients were enrolled in the study. There were no reported cases of post-surgical bleeding or haematoma occurrence, while three (11.5%) patients developed minor surgical site infection. The average severity of pain decreased from a numerical rating scale of 5.3 immediately after surgery to 1.3 after four weeks. The average healing time was 33.3±16.8 days, and only five (19.2%) patients reported a complete wound healing time of >6 weeks. Focusing on delayed complications: 1/23 (4.3%) patient had hypertrophic scarring; 2/23 (8.7%) patients reported dysaesthesia; and 2/23 (8.7%) cases of clinical relapse were reported. No cases of limited mobility at the surgery site were registered.
The findings of the study demonstrated the efficacy of a novel surgical protocol, including a preoperative ultrasound evaluation and appropriate postoperative wound management. Further prospective studies are needed to validate the observed results; however, we conclude that the low recurrence rates and post-surgical complications confirmed that our proposed protocol would represent an effective strategy for the management of patients with HS eligible for surgical therapy.
化脓性汗腺炎（HS）是一种毛囊的慢性炎症性疾病。其治疗通常需要手术方法。我们的研究目的是评估新的手术管理标准后手术后并发症的发生情况。这包括通过 70MHz 探头的超高频超声（UHFUS）进行术前病变定位。术后管理基于 HS-TIME（时间、炎症/感染、水分、边缘）的原则。
皮萨大学皮肤病系进行了一项单中心回顾性研究。招募了对以前的医学和手术治疗有抗药性的中重度 HS 患者。所有患者均接受广泛的病变切除术，术前通过使用 48MHz 和 70MHz 超声探头的 VEVO MD（富士胶片视觉超声公司，加拿大）进行 UHFUS 评估进行了探查。手术后，所有患者均按照 HS-TIME 的原则进行二期愈合治疗。对于每位患者，我们在手术后 6 个月的随访中评估术后并发症的发生情况。对于每位患者，我们在手术后的每次随访中评估早期术后并发症的发生情况，直到完全愈合。然后，在所有完全愈合后观察时间>3 个月的患者（n=23）中评估迟发性并发症的发生情况。
共有 26 名患者入组研究。未报告术后出血或血肿发生的病例，而 3 例（11.5%）患者发生轻微手术部位感染。疼痛的严重程度平均从手术后即刻的数字评分量表 5.3 降至 4 周时的 1.3。平均愈合时间为 33.3±16.8 天，只有 5 例（19.2%）患者报告完全愈合时间>6 周。关注迟发性并发症：23 例患者中 1 例（4.3%）有肥厚性瘢痕形成；23 例患者中有 2 例（8.7%）报告感觉异常；23 例中有 2 例（8.7%）报告临床复发。未记录到手术部位活动受限的病例。
研究结果表明，包括术前超声评估和适当的术后伤口管理在内的新手术方案是有效的。需要进一步的前瞻性研究来验证观察到的结果；然而，我们得出结论，低复发率和术后并发症证实，我们提出的方案将成为适合手术治疗的 HS 患者管理的有效策略。
