BACKGROUND: Hidradenitis suppurativa is a chronic and often refractory skin disease that can require radical excision of the full layer of fatty tissue under the lesion. Closure using a split-thickness skin graft often results in depression deformity and lack of tissue flexibility. We have developed a two-stage procedure to preserve fatty tissue during radical excision and apply an artificial dermis graft, and we have performed this procedure in 18 patients (33 lesions). OBJECTIVE: To describe our two-stage procedure and report results of the procedure in our patient series. METHODS: In the first step, all diseased skin including the superficial subcutaneous fatty tissue is excised; normal deep subcutaneous fatty tissue is preserved. Artificial dermis is then grafted to the preserved fatty tissue. Two weeks later, split-thickness skin grafts are applied to the skin defects. We evaluated graft success, any recurrence, and postoperative appearance in our patients, who were followed up for 8 to 36 months. RESULTS: All 32 skin grafts were successful. There was only one recurrence, which was treated using reoperation, and postoperative appearances were good. CONCLUSIONS: Our new procedure incorporating artificial dermis appears to be a good treatment option for advanced hidradenitis suppurativa.
BACKGROUND:Hidradenitis suppurativa is a chronic and often refractory skin disease that can require radical excision of the full layer of fatty tissue under the lesion. Closure using a split-thickness skin graft often results in depression deformity and lack of tissue flexibility. We have developed a two-stage procedure to preserve fatty tissue during radical excision and apply an artificial dermis graft, and we have performed this procedure in 18 patients (33 lesions). OBJECTIVE: To describe our two-stage procedure and report results of the procedure in our patient series. METHODS: In the first step, all diseased skin including the superficial subcutaneous fatty tissue is excised; normal deep subcutaneous fatty tissue is preserved. Artificial dermis is then grafted to the preserved fatty tissue. Two weeks later, split-thickness skin grafts are applied to the skin defects. We evaluated graft success, any recurrence, and postoperative appearance in our patients, who were followed up for 8 to 36 months. RESULTS: All 32 skin grafts were successful. There was only one recurrence, which was treated using reoperation, and postoperative appearances were good. CONCLUSIONS: Our new procedure incorporating artificial dermis appears to be a good treatment option for advanced hidradenitis suppurativa.
Authors: Ali Alikhan; Christopher Sayed; Afsaneh Alavi; Raed Alhusayen; Alain Brassard; Craig Burkhart; Karen Crowell; Daniel B Eisen; Alice B Gottlieb; Iltefat Hamzavi; Paul G Hazen; Tara Jaleel; Alexa B Kimball; Joslyn Kirby; Michelle A Lowes; Robert Micheletti; Angela Miller; Haley B Naik; Dennis Orgill; Yves Poulin Journal: J Am Acad Dermatol Date: 2019-03-11 Impact factor: 15.487