Assessing Surgical Complications in Management of Hidradenitis Suppurativa

Surgical complications are common in the management of hidradenitis suppurativa (HS), in which extensive resection, using skin flaps or skin grafts as a closure method, may increase risk of adverse events. Results were published in International Wound Journal.

In the management of HS, a chronic inflammatory disease that affects the apocrine glands in the axillary, groin, and breast regions, several surgical treatments (eg, incisions and drainage, roof removal, and local and extensive resection) have achieved varying degrees of success. However, there is a high recurrence rate even after an extensive surgical resection in HS, with challenging reconstruction also associated with the risk of postoperative complications.

“The healing options after extensive surgical resection include primary suture, secondary wound healing, skin flaps, and grafts. It is reported that surgical resection of affected skin tissue with a sufficiently wide margin can successfully prevent complications, especially in the late stage,” noted the study's researchers. “Various factors should be considered when choosing surgical resection method and healing pathway, including the size and location of the lesion and patient characteristics.”

They sought to further explore the incidence of complications to specific reconstruction surgeries in patients with HS. A comprehensive systematic review and meta-analysis of surgical treatment for HS outcomes was conducted from clinical studies derived from MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and clinical registries from their inception to May 1, 2022.

The meta-analysis was conducted on pooled complication sample studies and pooled recurrence sample studies. Patients with secondary healing intentions and studies evaluating complications after initial laser resection of abnormal HS tissue were excluded.

Thirteen studies comprising 535 patients with HS were included in the analysis, in which participants were compared on postoperative complications by surgery type (primary end point) and differences in recurrence rate of these complications (secondary end point).

Overall, the average estimated complication rate was 11.1% (95% CI, 6.4%-16.9%) and HS recurrence was 16.2% (95% CI, 9.1%-24.9%).

Subgroup analysis revealed that the highest complication rate among closure types was 18.9% (95% CI, 7.3%–34.3%) for skin graft, followed by multiple closures at 10.9% (95% CI, 4.9%-19.0%) and primary closure at 9.4% (95% CI, 2.2%-20.8%).

Differences were also observed in diverse excision methods, with the highest complication rate of 13.9% (95% CI, 2.2%-33.2%) associated with deroofing, followed by wide excision at 10.6% (95% CI, 5.2%-17.7%). Other moderators of complications of HS included multiple locations with 16.0% (95% CI, 6.8%-28.2%).

The researchers concluded that providers should consider carefully the use of extensive resection or using skin flaps or skin grafts as a closure method to minimize the risk of adverse events.

“Future research is recommended to assess the patient factors most closely associated with reduced HS complication incidence, as well as identifying effective ways to get patients involved in shared surgical decision-making,” they added.

Reference

Tang B, Huang Z, Yi Q, Zheng X. Complications of hidradenitis suppurativa after surgical management: A systematic review and meta-analysis. Int Wound J. Published online October 7, 2022. doi:10.1111/iwj.13945