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. 2022 Jun 28:9:867487.
doi: 10.3389/fsurg.2022.867487. eCollection 2022.

The Value of Negative-Pressure Wound Therapy and Flap Surgery in Hidradenitis Suppurativa - A Single Center Analysis of Different Treatment Options

M C Stumpfe  1 , R E Horch  1 , A Arkudas  1 , A Cai  1 , W Müller-Seubert  1 , T Hauck  1 , I Ludolph  1
Affiliations

The Value of Negative-Pressure Wound Therapy and Flap Surgery in Hidradenitis Suppurativa - A Single Center Analysis of Different Treatment Options

M C Stumpfe et al. Front Surg. .

Abstract

Background: Hidradenitis suppurativa is manifested by painful abscesses and scarring of sweat glands. Axillary, inguinal and genital regions are mostly affected. Multiple options exist in the treatment of hidradenitis suppurativa. The aim of this retrospective, mono-center cohort study was to analyze the outcome of different treatment methods after radical excision of hidradenitis suppurativa.

Methods: We retrospectively evaluated the treatment strategy and recurrence rate of hidradenitis suppurativa. We included all eligible patients of legal age between February 2003 and October 2021, with the diagnosis of Hidradenitis suppurativa and the necessity for surgical treatment. All patients with surgical treatment and direct wound closure by suture were excluded. Bacterial load and flora were analyzed for primary and secondary reconstruction in combination with negative-pressure wound therapy. Patient data were analyzed for recurrence rate and remission time according to different reconstructive techniques.

Results: In 44 affected anatomical sites (n = 23 patients) we treated 15 patients with negative-pressure wound therapy. Bacterial load and flora were lower in the last wound swab of patients with multi-surgical procedures (22 localizations) compared to the first wound swab independent of the use of negative-pressure wound therapy.Wound closure, independent of a direct and multi-stage procedure was achieved by local fasciocutaneous flaps (n = 12), secondary intention healing (n = 7), secondary intention healing with buried chip skin grafts (n = 10), or split-thickness skin grafts (n = 15). Radical excision combined with split-thickness skin grafts showed the lowest recurrence rate in the follow-up (16%; n = 4).

Conclusion: Radical excision of hidradenitis suppurativa as gold standard for surgical treatment combined with negative-pressure wound therapy as multi-stage procedures ultimately reduced bacterial load and flora in our study. The use of split-thickness skin grafts showed the lowest recurrence rate.

Keywords: acne inversa; bacterial burden; flap surgery; hidradenitis suppurativa; negative-pressure wound therapy.

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Conflict of interest statement

R. E. H. has received third party funding for scientific research on NPWT from KCI—an Acelity company in the past and has served as a member of a Scientific Advisory Board of KCI-Acelity in the past. R. E. H. and A. A. served as speakers on scientific symposia of KCI-Acelity in the past. The authors have no other relevant affiliations or financial involvement with any organisation or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1
Figure 1
Flow chart with included patient numbers and reasons for exclusion and illustration of the subgroups primary vs. secondary reconstruction and reconstructive technique; SIH, secondary intention healing; SIHCS, secondary intention healing with buried chip skin grafts; STSG, split-thickness skin graft; FCF, fasciocutaneous flaps.
Figure 2
Figure 2
Graphical representation of the time until recurrence in months between reconstruction and recurrence (mean); SIH, secondary intention healing; SIHCS, secondary intention healing with buried chip skin grafts; STSG, split-thickness skin graft; FCF, fasciocutaneous flaps; PR, primary reconstruction; SR, secondary reconstruction.
Figure 3
Figure 3
Development of the bacterial flora (NDB) and load (AB) (before debridement (1. NDB/1. AB) and before reconstruction (2. NDB/2.AB); NPWT, negative pressure wound therapy; NPWTi-d, negative-pressure wound therapy with instillation and dwell time.
See this image and copyright information in PMC

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