Reconstructive options in severe cases of Hidradenitis suppurativa

Open Medicine ◽  
2010 ◽  
Vol 5 (6) ◽  
pp. 674-678 ◽  
Author(s):  
Birol Civelek ◽  
Kadir Aksoy ◽  
Esra Bilgen ◽  
Ibrahim İnal ◽  
Unal. Sahin ◽  
...  
Keyword(s):  
Hidradenitis Suppurativa ◽  
Skin Grafting ◽  
Surgical Removal ◽  
Apocrine Glands ◽  
Reconstruction Methods ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Topical Antibacterial ◽  
Systemic Antibiotics

AbstractHidradenitis suppurativa is a chronic, debilitating inflammatory disease of apocrine glands characterized with abscesses and nodular lesions. The treatment of Hidradenitis suppurativa consists of topical antibacterial or antiseptic solutions, systemic antibiotics, steroids, hormonal therapy, anti-tumor necrosis factor, and various surgical procedures. In this report, we present a series of 14 cases with severe Hidradenitis suppurativa. Surgical options are reviewed to show the best outcomes in the long term. A total of 14 patients (9 female, 5 male) were treated for advanced cases of Hidradenitis suppurativa. They underwent excision of the affected regions followed by reconstruction. The reconstruction methods consisted of split-thickness skin grafting and various cutaneous and myocutaneous flaps. There was no flap necrosis or dehiscence. One patient developed contracture in the axilla, for which he underwent release surgery. There were recurrences in 4 cases. There was no limitation of the arm movements in cases with flap reconstruction. In the long-term, they were satisfied with the results. In conclusion, incision and drainage should be avoided because it is of limited value. Surgical removal of the involved tissue should be the first treatment of choice. Depending on the defect following excision, local flaps should be preferred over the grafts for recurrence prevention.

Long Term Outcomes of Split-Thickness Skin Grafting to the Plantar Foot

2020 ◽  
Vol 59 (3) ◽  
pp. 498-501
Author(s):  
Elliot T. Walters ◽  
Mira Pandya ◽  
Neha Rajpal ◽  
Michel M. Abboud ◽  
Tammer Elmarsafi ◽  
...  
Keyword(s):  
Skin Grafting ◽  
Long Term Outcomes ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Efficacy of Wound Coverage Techniques in Extremity Necrotizing Soft Tissue Infections

2018 ◽  
Vol 84 (11) ◽  
pp. 1790-1795 ◽  
Author(s):  
Margaret H. Lauerman ◽  
Thomas M. Scalea ◽  
W. Andrew Eglseder ◽  
Raymond Pensy ◽  
Deborah M. Stein ◽  
...  
Keyword(s):  
Wound Closure ◽  
Skin Grafting ◽  
Wound Coverage ◽  
Secondary Intention ◽  
Primary Wound Closure ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Necrotizing Soft Tissue Infections ◽  
Flap Creation

Little data exist about management of wounds created by debridement in necrotizing soft tissue infections (NSTIs). Multiple wound coverage techniques exist, including complete primary wound closure, split-thickness skin grafting, secondary intention, and flap creation. We hypothesized that all wound coverage techniques would be associated with high rates of successful wound coverage and low crossover rates to other wound coverage techniques. NSTIs over a three-year period were retrospectively reviewed. Both the initial and secondary wound coverage techniques (if necessary) were recorded. The primary outcome was the ability to achieve complete wound coverage. Overall, 46 patients with NSTIs had long-term data available. Of the patients undergoing split-thickness skin grafting as the initial wound coverage technique, 8/8 (100%) achieved complete wound coverage; and of those undergoing flap creation, 1/1 (100%) achieved complete wound coverage; and of those undergoing complete primary wound closure, 4/4 (100%) achieved complete wound coverage. Of the patients undergoing secondary intention as the initial wound coverage technique, 5/33 (15.2%) achieved complete wound coverage and 28/33 (84.8%) required a secondary wound coverage technique with split-thickness skin grafting. All 46 patients achieved long-term successful wound coverage. Time to wound coverage did not vary with initial wound coverage technique ( P = 0.44). Split-thickness skin grafting, flap creation, complete primary wound closure, and secondary intention are all reasonable choices for initial wound coverage for NSTIs. Although secondary intention had a low success rate as an initial wound coverage technique, all patients ultimately achieved complete wound coverage without a significant increase in time to coverage.

scholarly journals Neonatal compartment syndrome

2016 ◽  
Vol 98 (7) ◽  
pp. e111-e113 ◽  
Author(s):  
B Martin ◽  
L Treharne
Keyword(s):  
Compartment Syndrome ◽  
Skin Grafting ◽  
Dermal Matrix ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Left Hand ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Contracture Release

A term neonate was born with a grossly swollen and discoloured left hand and forearm. He was transferred from the local hospital to the plastic surgical unit, where a diagnosis of compartment syndrome was made and he underwent emergency forearm fasciotomies at six hours of age. Following serial debridements of necrotic tissue, he underwent split-thickness skin grafting of the resultant defects of his forearm, hand and digits. At the clinic follow-up appointment two months after the procedure, he was found to have developed severe flexion contractures despite regular outpatient hand therapy and splintage. He has had further reconstruction with contracture release, use of artificial dermal matrix, and K-wire fixation of the thumb and wrist. Despite this, the long term outcome is likely to be an arm with poor function. The key learning point from this case is that despite prompt transfer, diagnosis and appropriate surgical management, the outcome for neonatal compartment syndrome may still be poor.

scholarly journals Multi-stage surgical treatment of extensive gluteal localized hidradenitis suppurativa combined with negativ pressure wound therapy

2021 ◽  
Vol 97 (1) ◽  
pp. 56-63
Author(s):  
Tímea Pálházy ◽  
◽  
Stephan Bennemann ◽  
András Fülöp ◽  
L. Hunor Gergely ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Skin Graft ◽  
Negative Pressure ◽  
Hidradenitis Suppurativa ◽  
Successful Outcome ◽  
Split Thickness Skin Graft ◽  
Wound Therapy ◽  
Apocrine Glands ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Hidradenitis suppurativa (HS) is a chronic, recurrent infammatory disease of the hair follicles in the skinfolds containing apocrine glands, which greatly impairs the quality of life of patients. The fnal solution in extensive cases is surgical treatment. There is no ideal treatment or uniform therapeutic template equally suitable for all patients. Treatment is personalized. In this paper, we present the case of a 53-year-old patient who underwent a two-stage surgical treatment for therapy-resistant HS, Hurley stage III, causing permanent complaints. During the frst surgery, the fstula openings were flled with methylene blue, then the skin and the scary subcutaneous tissue were excised, and after 10 days, in a second step, the surgical site was covered with split thickness skin graft from the back. After both surgeries, negative pressure wound therapy (NPWT) was initiated. After the applied treatment, 98-100% graft adhesion was observed, and the patient was emitted without complaints after 3 weeks. Our case illustrates that in cases where the prospects for fap replacement in HS are poor or the healing tendency of the faps is questionable (infective wound base, poor quality surrounding skin), split thickness skin grafting combined with negative pressure therapy may be less stressful and provides a successful outcome. The combined treatment (NPWT + split thickness skin graft) is excellent not only for clearing and stimulating the wound base, but also provides an excellent wound base and allows successful wound closure / coverage, signifcantly shortening the duration of the long and cumbersome open treatment has been used so far. In this case, NPWT treatment can also be considered as a “bridging” step.

scholarly journals Outcome of Split Thickness Skin Grafting and Multiple Z-Plasties in Postburn Contractures of Groin and Perineum: A 15-Year Experience

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Wani Sajad ◽  
Raashid Hamid
Keyword(s):  
Surgical Treatment ◽  
Skin Grafting ◽  
Cosmetic Outcome ◽  
Primary Concern ◽  
Secondary Surgery ◽  
Cosmetic Results ◽  
Cosmetic Appearance ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Background. Groin and perineal burn contracture is a rare postburn sequel. Such postburn contractures causes distressing symptoms to the patients and in the management of these contractures, both functional and cosmetic appearance should be the primary concern. Aims. To study the outcome of surgical treatment (STSG and multiple Z-plasties) in postburn contractures of groin and perineum. Material and Methods. We conducted a study of 49 patients, with postburn groin and perineal contractures. Release of contracture with split thickness skin grafting (STSG) was done in 44 (89.79%) patients and release of contracture and closure by multiple Z-plasties was done in 5 (10.21%) patients. Results. Satisfactory functional and cosmetic outcome was seen in 44 (89.79%) patients. Minor secondary contractures of the graft were seen in 3 (6.81%) patients who were managed by physiotherapy and partial recurrence of the contracture in 4 (8.16%) patients required secondary surgery. Conclusion. We conclude that postburn contractures of the groin and perineum can be successfully treated with release of contracture followed by STSG with satisfactory functional and cosmetic results. Long term measures like regular physiotherapy, use of pressure garments, and messaging with emollient creams should not be neglected and should be instituted postoperatively to prevent secondary contractures of the graft and recurrence of the contracture.

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