Tumescent-Based Radical Excision Technique of Hidradenitis Suppurativa
Amy Hui, BS.
LSU School of Medicine - New Orleans, New Orleans, LA, USA.
Hidradenitis suppurativa (HS) is a debilitating disease that presents with chronic, recurrent infections of the skin and subcutaneous sweat glands, characterized by painful, fibrotic sinus tracts with purulent discharge. Patients are referred to plastic surgeons in the most advanced stages. Barriers to radical excision, the only potentially curative treatment, include bleeding, decreased visual planes, and difficult postoperative wound management. To overcome these barriers, we developed a tumescent-based radical excision technique (TRE).
An IRB-approved prospective cohort study of consecutive patients with StageIII HS was performed to demonstrate the safety and efficacy of TRE. Patient demographics, HS recurrence risk factors, intraoperative variables, and postoperative variables were recorded. Analyses were performed using Pearson correlation and linear regression.
Between April 2016 and September 2017, 31 patients underwent TRE of 81 anatomic sites. The average resection area was 101.5cm2. The average amount of tumescent used per surgery was 180mL, and the average reconstruction time was 16.7 minutes. The lesion size to tumescent fluid used was approximately 1.60mL/cm2 of disease. The average time to resect each area was 6.86 minutes. We identified no significant relationship between excision time and lesion size (R2=0.37). The mean follow up length was 82 days. There have been no local recurrences.
TRE is safe, fast, and effective. Intraoperative and postoperative complication rates were low (3.2% each). The average resection time was below 7 minutes. Efficacy, defined as no disease recurrence, was 100% at 3 months. The adoptions of TRE for HS will benefit patients and surgeons alike.
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