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Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory disease that primarily affects the apocrine skin glands. Management options include risk factor modification, pharmacologic agents, and surgery. Many surgical management techniques exist, including incision and drainage, laser hair removal, deroofing, limited or wide local excision. Deroofing is an interesting alternative for simple superficial fistulas and potentially even for more complex lesions. Surgical treatment can be combined with drug treatment. The indication depends on a comprehensive and multidisciplinary assessment considering the severity and number of target lesions., Competing Interests: Michael Mühlstädt déclare participer à des « advisory boards » au sujet de l’hidradénite suppurée pour les laboratoires AbbVie, Sandoz et Novartis. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Objectives: The objective of this study was to compare the use of artificial dermal and perforator flap after radical surgery of severe axillary and perineal hidradenitis suppurativa disease., Patients and Methods: The data on postoperative outcomes, scar assessment (POSAS) and quality of life (DLQI, SF-36) were collected during consultation or by phone call. Forty-seven patients were included in our study between January 2015 and September 2017, including 27 patients in the artificial dermal group and 20 patients in the perforator flap group., Results: The quality of life assessment by the SF-36 questionnaire showed a significant increase in quality of life in both groups (P<0.05), higher in the perforating flap group (P<0.001). The DLQI questionnaire showed a decrease in the impact of MV on quality of life in both groups, which was greater in the perforator flap group (P<0.05). The scarring assessment by the POSAS patient and observer questionnaire showed a better overall opinion in the perforator flap group (P<0.001). In the perforator flap group, the total hospital stay and healing time was shorter (P<0.001) and the return to work was faster (P<0.001)., Conclusion: The artificial dermis and the perforator flaps are very useful coverage solutions after radical surgery of hidradenitis suppurativa. The use of perforator flaps, however, seems more interesting while simplifying the post-operative course., (Copyright © 2018. Published by Elsevier Masson SAS.)

Introduction: Hidradenitis suppurativa is a chronic inflammatory disease, particularly incapacitating. Wide surgical excision of the whole affected skin is the only radical and successful treatment that can be offered. Coverage of the defect is then generally obtained with a split-thickness skin graft after a period of granulation. We expose a single-stage procedure which reduces the number of surgical times and the period of recovery., Patients and Methods: We have documented a series of five patients who underwent uni- (three cases) or bilateral (two cases) axillary hidradenitis suppurativa, between December 2008 and December 2009. Surgical procedure included excision of the lesions and coverage with a split-thickness skin graft. The graft was meshed in a ratio of 1.5:1, and secured with a negative-pressure dressing. This dressing, which provided a continuous subatmospheric pressure of -75 mmHg, was removed after five days. Then, complete healing was obtained with conventional vaseline gauze dressings., Results: After removal of the negative-pressure dressings, the graft take was 90% on average (80-100%). Complete healing was obtained within an average of 34 days (20-43 days), with a good quality of scar tissue, no retraction and no limitation of arm's abduction., Conclusion: This technique, enabled by negative-pressure dressings, provides a quick and good quality healing, with only one surgical stage. It has many advantages: reduced morbidity, faster healing, higher level of patient's comfort, and lower costs., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Introduction: Hidradenitis suppurativa is a chronic disease, severe forms of which may be highly invalidating. Although wide surgery is usually considered the most effective curative therapy, few medical teams in France have extensive experience of this approach. Our aim was to evaluate the clinical history and the results of surgery in all patients operated with curative intent in an experienced centre., Patients and Methods: Medical records were reviewed for all patients operated between January 1985 and January 2007. In addition, the patients were contacted by telephone and/or letter and asked about their clinical history, the repercussions of their disease on their daily lives, postsurgical relapse and their overall satisfaction regarding surgery. Separate analyses were carried out for patients and for individual operated sites., Results: Of 93 patients followed-up for between one and 205 months (mean: 30 months), 209 anatomical sites were operated with curative intent, using either limited excision (i.e. including all visible lesions without margins) or wide excision (i.e. including all lesions with a significant margin). The disease had been present for an average of 7.6 years before surgical treatment, with onset seven years earlier in women. Most patients had previously received multiple and often unsuitable medical treatments. Patients' personal and professional lives were highly affected. Surgery required hospitalization for an average duration of 6.6 days, caused complications in 21% of cases and was often perceived as trying. Relapse in the operated areas occurred in 33% of cases and this was more frequent after limited excision. Nevertheless, 74% of patients were ultimately satisfied with their surgical treatment and most regarded surgery as the only really effective therapy., Discussion: Our study confirms the heavy repercussions of hidradenitis suppurativa on patients' day-life as well as the value of surgical management by experienced surgeons., Conclusion: Wide excision remains the mainstay of therapy in extensive forms of hidradenitis suppurativa. However, this chronic, disseminated and recurrent disease continues to be insufficiently understood and innovative medical approaches, including the development of clinical trials, are required.

Background: We report three patients (respectively 36, 52 and 52 years old) with a long history of hidradenitis suppurativa associated with pubic lymph oedema., Case Report: Dramatic pubic oedema was noted, with "rugby-ball and bag-like" tumefaction associated with nodules and fistula. There was no evidence of lymph node involvement or abdominal lymphatic blockade. One patient underwent surgical excision combined with split-thickness graft and complete healing ensued. Pathological examination of the excised tissue showed telangiectasia and fibrosis., Discussion: Chronic lymphedema affects patients with severe and long-lasting disease. The complication is caused by chronic and recurrent inflammation due to HS with subsequent blockade or destruction of local lymph drainage routes. Once this complication appears, no medical treatment is effective.

Hidradenitis suppurativa is a chronic, suppurative and scarring disease characterized by painful, inflamed lesions in the axillae, perineum, groin, scrotum and other parts of the body with apocrine-bearing skin including genital skin. Appropriate medical treatment alone appears to be insufficient for managing most patients with severe lesions. In the vast majority of cases, surgery consists in complete excision of the lesions with primary closure or healing by secondary intention. In severe cases, radical excision of all diseased apocrine-bearing skin is mandatory and the resulting defects are generally repaired by mesh skin grafts. In the most severe cases it may be necessary to realize loco-regional flaps. Generally we reconstruct the perineal region with bilateral fasciocutaneous thigh flaps. We report a case of hidradenitis suppurativa where the lesions were so extensive from penis to anus we had to imagine a tailor-made flap based on the abdominoplasty techniques.

Introduction: Verneuil's disease (hidradenitis suppurativa) is a chronic inflammatory, suppurating and fistulizing disease of apocrine sweat gland-bearing skin. The aim of this study was to describe the surgical treatment, conducted in 15 patients suffering from this disease., Patients and Methods: We retrospectively analyzed 15 observations (9 men, 6 women, mean age 38.6). The mean delay between beginning of the symptoms and diagnosis was 55.5 months. Surgery was conducted at the stage of abscesses, fistulization and keloids in all patients. The first surgical step was wide and deep excision of affected skin and subcutaneous fat. The second step was secondary intention healing, or ideal suture, Z plasty or dorsalis major flap., Results: Only four patients had complications: two axillary strictures, one anal margin stenosis and one hypertrophic scarring. Three relapses occurred, treated by excision under local anesthesia., Conclusion: Surgical treatment seems to be the only definitive treatment of Verneuil's disease.