Ali Mehdizadeh1, Paul G Hazen2, Falk G Bechara3, Nora Zwingerman1, Marzyeh Moazenzadeh4, Morteza Bashash1, R Gary Sibbald5, Afsaneh Alavi6. 1. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 2. Case Western Reserve University, Cleveland, Ohio. 3. Ruhr University Bochum, Germany. 4. Iranian Society of Dermatology, Tehran, Iran. 5. Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada. 6. Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada. Electronic address: afsaneh.alavi@mail.utoronto.ca.
Abstract
BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of apocrine-bearing skin. Treatment is challenging and long-standing. Surgery is one of the treatment options with varying reported success rates. OBJECTIVE: This study provides a comprehensive systematic review of surgical approaches in the management of HS. METHODS: A systematic literature search and meta-analysis of proportions were performed on the included studies. RESULTS: Of a total of 1147 retrieved articles, 22 were included in the analysis. These were the estimated average recurrences: wide excision, 13.0% (95% confidence interval [CI], 5.0-22.0%); local incision, 22.0% (95% CI, 10.0-37.0%); and deroofing, 27.0% (95% CI, 23.0-31.0%). In the wide excision group, recurrence rates were as follows: 15% (95% CI, 0-72%) for primary closure, 8% (95% CI, 2.0-16.0%) for using flaps, and 6.0% (95% CI, 0.0-24.0%) for grafting. The secondary intention healing option was most commonly chosen after local excision and deroofing. LIMITATIONS: There was poor quality evidence and potential improper reporting of the results. CONCLUSION: This systematic review found lower recurrence rates with wide excision, using skin flaps or skin grafts as the closure methods. The heterogeneity of the patient populations was high and statistically significant within and across all types of excisions.
BACKGROUND:Hidradenitis suppurativa (HS) is a chronic inflammatory disease of apocrine-bearing skin. Treatment is challenging and long-standing. Surgery is one of the treatment options with varying reported success rates. OBJECTIVE: This study provides a comprehensive systematic review of surgical approaches in the management of HS. METHODS: A systematic literature search and meta-analysis of proportions were performed on the included studies. RESULTS: Of a total of 1147 retrieved articles, 22 were included in the analysis. These were the estimated average recurrences: wide excision, 13.0% (95% confidence interval [CI], 5.0-22.0%); local incision, 22.0% (95% CI, 10.0-37.0%); and deroofing, 27.0% (95% CI, 23.0-31.0%). In the wide excision group, recurrence rates were as follows: 15% (95% CI, 0-72%) for primary closure, 8% (95% CI, 2.0-16.0%) for using flaps, and 6.0% (95% CI, 0.0-24.0%) for grafting. The secondary intention healing option was most commonly chosen after local excision and deroofing. LIMITATIONS: There was poor quality evidence and potential improper reporting of the results. CONCLUSION: This systematic review found lower recurrence rates with wide excision, using skin flaps or skin grafts as the closure methods. The heterogeneity of the patient populations was high and statistically significant within and across all types of excisions.
Authors: Victoria K Shanmugam; Shaunak Mulani; Sean McNish; Sarah Harris; Teresa Buescher; Richard Amdur Journal: Int J Dermatol Date: 2017-11-11 Impact factor: 2.736
Authors: Ledibabari M Ngaage; Yinglun Wu; Shealinna Ge; Selim Gebran; Fan Liang; Erin M Rada; Arthur J Nam; Ronald P Silverman; Yvonne M Rasko Journal: Int Wound J Date: 2019-11-03 Impact factor: 3.315