Definition & Overview
Hidradenitis suppurative is a chronic skin condition that affects the follicular epithelium in the apocrine gland-bearing skin. The condition is progressive, and can result in immobility. It can be treated with the excision of the affected skin and subcutaneous tissue, followed by a simple or intermediate repair procedure to reduce scarring and to achieve a more normal-looking skin appearance.
Who Should Undergo and Expected Results
The procedure is for patients who suffer from hidradenitis axillary. Excising the damaged skin will allow the skin to begin its healing process and will also keep the condition from progressing further.
Hidradenitis axillary, also known as hidradenitis suppurative, is a skin condition that can affect a person in the long term. It causes the continuous growth and formation of keloids, scars, and contractures on the skin. It is known to be caused by the keratinous plugging of the hair follicle that leads to the follicle’s dilation and rupture. Studies show that obesity, hereditary factors, and smoking may play a causative or an exacerbating role in the disease.
The condition causes several other symptoms, which include:
- Comedolike follicular occlusion
- Chronic relapsing inflammation
- Mucopurulent discharge
- Progressive scarring
- Painful lesions
- Asymmetric pauciarticular arthritis
- Symmetric polyarthritis
Due to its wide range of possible symptoms, the condition is considered as a systemic disease. In the most severe cases, the procedure can also cause immobility; this is why it is also considered as a disabling disorder.
Mild cases of the disease can be managed through conservative treatment, such as proper hygiene, weight reduction in obese patients, warm compresses, laser hair removal, smoking cessation, anti-inflammatory and anti-androgen therapy, antibiotic therapy, and the use of antiseptic and antiperspirant agents. However, more severe cases call for more aggressive treatment such as the excision of the skin and subcutaneous tissue in the affected site.
Although effective in removing the damaged skin at the site of the disease, this procedure does not guarantee against recurrences.
How is the Procedure Performed?
The excision of skin and subcutaneous tissue is the primary surgical treatment option available for hidradenitis axillary. If the disease is caught early, it can be treated through a simple incision and drainage procedure. However, this is considered as a short-term solution, and some medical experts believe that repetitive but failed treatments can make the disease more widespread. Thus, they recommend the use of wide excisional therapy. The surgery involves removing the skin and subcutaneous tissue that has become damaged due to the condition. This is followed by a repair procedure to reconstruct or restore the appearance of the skin. The repair may be simple or intermediate depending on the size of the affected area.
The excision of skin and subcutaneous tissue is performed under local or general anaesthesia depending on the severity or the scope of the disease. All the damaged skin is removed, and the affected site is irrigated.
After the excision procedure, patients also undergo a simple or intermediate repair procedure in which the affected skin is reconstructed. The specific reconstruction technique used depends on the size of the affected site, but typically involves primary closure, skin grafting, and local/regional flaps.
Possible Risks and Complications
The procedure puts patients at risk of the following complications:
- Recurrence of the disease
- Allergic reaction to anaesthesia
Reaction to skin graft in the reconstruction stage
Alharbi Z, Kauczok J, Pallua N. “A review of wide surgical excision of hidradenitis suppurativa.” BMC Dermatology. 2012. 12:9. https://bmcdermatol.biomedcentral.com/articles/10.1186/1471-5945-12-9
Menderes A, Sunay O, Vayvada H, Yilmaz M. “Surgical management of hidradenitis suppurativa.” Int J Med Sci 2010; 7(4):240-247. http://www.medsci.org/v07p0240.htm