The Use of Negative-pressure Wound Therapy with Instillation Before and After Grafting in the Surgical Management of Hidradenitis Suppurativa

Abstract

Aim:Hidradenitis suppurativa (HS) is a chronic infection of apocrine sweat glands. HS related morbidities such as chronic infection, and carcinoma development reduce the life quality of the patients. Non-surgical management cannot provide complete recovery. The aim of the surgical treatment of HS is full control of the illness and prevention of recurrence.Method:From January 2014 to May 2018, ten male patients underwent treatment of HS in the gluteal and sacral area. A protocol of wide excision, followed by negative pressure wound therapy with instillation (NPWTi) to decrease bioburden and promote angiogenesis of defect area and a splitthickness skin graft was used. The mean age was 40 years. Patients are examined for granulation tissue formation, graft condition, hospitalization time, and recurrence.Results:The period for granulation tissue formation was 5.4 (4-8) days. NPWTi was put off on the fifth day after surgical excision and graft were observed three more days with wound dressing. Patients were discharged on the 10th postoperative day. The mean hospitalization time was 14.3 (range=12-16) days. There was no graft loss in nine patients. Approximately 20% of graft loss was observed in one patient. Secondary healing was obtained with local wound care measures in this patient. The patients had neither contour irregularity nor contracture. There was no recurrence after a median of 23.4 (range=12-36) months follow-up time.Conclusion:NPWTi can be used in the surgical management of HS either at graft preparation period or after grafting for better graft survival rate and shorter hospitalization duration.

Keywords

• hidradenitis suppurativa
• negative pressure wound therapy with instillation
• skin grafting