Several Minor Surgeries Preferred in Some Dermatology Cases

WROCLAW, Poland — Several small surgeries to remove diseased skin related to hidradenitis suppurativa are easier for dermatologists than a single, more intensive procedure, and are also more palatable for patients, a small pilot study suggests.

“HS surgery is difficult from many points of view. My ultimate goal with this technique is to make HS surgery easier for dermatologists and to encourage them to do it more,” said Mariano Suppa, MD, from Erasme Hospital in Brussels.

“Plus, psychologically, almost none of my patients want a big intervention,” he told Medscape Medical News. “This is more livable for them and they can accept it more easily.”

Even after effective drug treatment, nodules and scarring from sinus tracts under the skin can be extensive in patients with severe disease, said Suppa.

He described the “step-by-step” surgical approach, which involves sequential procedures performed under local anesthesia over a period of months, here at the European Hidradenitis Suppurativa Foundation 2019.

Almost none of my patients want a big intervention.

This goes “against dogma, which is removing everything in one go,” Suppa acknowledged. “I don’t pretend this is a substitute for the classic, wide excision. It’s an alternative in the landscape of many surgical procedures.”

More radical procedures remove large swaths of skin — often under the arms or in the groin region — and require general anesthesia, longer recovery periods, and often skin grafts or flaps.

Of the 12 participants with moderate or severe hidradenitis suppurativa involved in the pilot study, eight underwent stepped procedures on the armpits and four underwent stepped procedures on the groin.

Investigators assessed the effectiveness of the approach with objective measures, such as recurrence rate, frequency of postsurgical scar contractures, and change of mobility in the shoulder joint, and with patient-reported measures, such as pain, satisfaction, quality of life, and how often patients recommended step-by-step surgery to other hidradenitis suppurativa patients.

Pilot Study

One of the 12 participants experienced a recurrence of hidradenitis suppurativa and two developed contracture of the postsurgical scar. Shoulder mobility improved in seven of the eight patients who underwent surgery under the armpit, but decreased in the remaining patient.

Pain, patient-satisfaction scores, patient recommendations, and quality-of-life assessments continued to improve over several months. No patients experienced problems with wound healing.

Audience members said they were receptive to the technique described by Suppa, and noted that it could prove useful in certain cases.

“The virtue of this method is that it’s less invasive in comparison to the big excision, and patients tolerate it better,” said Andrzej Bieniek, MD, PhD, DSc, from the Center for Plastic and Dermatologic Surgery in Wroclaw, Poland.

But the stepped approach does have drawbacks. “The patient can go back to his normal life faster, but the procedure has to be repeated multiple times,” Bieniek told Medscape Medical News. “So the total time of treatment is much longer. It makes sense, however, in some cases.”

Suppa and Bieniek disclosed no relevant financial relationships

Conference of the European Hidradenitis Suppurativa Foundation (EHSF) 2019: Abstract 043 OS09-01. Presented February 8, 2019.

Follow Medscape Dermatology on Twitter @MedscapeDerm and Maureen Salamon @maureensalamon

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