Long-term results of wide surgical excision in 106 patients with hidradenitis suppurativa

BACKGROUND. Hidradenitis suppurativa (acne inversa) is a chronic recurrent disorder characterized by abscessing inflammation, fistulating sinus tracts , and scarring. Predilection sites are the intertriginal regions. The sever e course of the disease demands an early and curative treatment. OBJECTIVE. The aim of this study was to review the effect of radical surgic al excision concerning cure rate and potential complications within a large group of patients. METHODS. We analyzed data for 106 patients suffering from hidradenitis supp urativa treated during the period 1980-1998. The mean duration of the disea se was 7 years. In about 90% of the cases, two or more sites were affected. Inguinal (70.8%) and axillary regions (61.3%) were most commonly involved. All patients were treated by radical wide excision using intraoperative ma rking of sinus tracts with methylviolet solution. The method of reconstruct ion depended on the size and location of the defect. Median postoperative f ollow-up time was 36 months. RESULTS. The overall complication rate was 17.8%. Most of these were minor complications such as suture dehiscence, postoperative bleeding, and hemato ma. Wound infection occurred in only 3.7% of patients. The rate of recurren ce within the operated fields was 2.5%. There was no relation between the s urgical method of reconstruction and the rate of recurrence. Recurrence was related to the severity of the disorder. CONCLUSION. Our results confirm early radical excision as the treatment of choice for hidradenitis suppurativa. Using intraoperative color-marking of sinus tracts, the recurrence rate is minimal. The method of reconstruction has no influence on recurrence and should be chosen with respect to the siz e and location of the excised area.