Flap Reconstruction Yields Lowest Recurrence in Hidradenitis Suppurativa: Study
Researchers demonstrated that flap reconstruction after wide excision is indeed the lowest recurrence rate amongst various wound closure methods for hidradenitis suppurativa (HS). The chronic inflammatory skin disease involves recurrent painful nodules, recurrent sinus tracts, and fistulae, with skin scarring. A recent study was conducted by Corina and colleagues and was published in the International Journal of Dermatology.
A PRISMA 2020 guideline-compliant systematic review and meta-analysis reviewed the techniques of wound closure following excision of HS lesion. The original studies retrieved up to February 2024 from PubMed, Embase, Cochrane, and ClinicalTrials.gov. From an eligible total of 121 articles that survived this process, a final meta-analysis of 1181 articles was screened after eliminating duplicate records and ineligibility. Direct and network meta-analyses compared the rates of recurrence and postoperative complication rates against the reconstruction techniques considered.
The meta-analysis showed that there were differences in recurrence rates based on the method of wound closure:
• Primary closure: Recurrence rate of 25% (95% CI, 20–30%).
• Skin grafts: Recurrence rate of 18% (95% CI, 14–22%).
• Flap reconstruction: The lowest recurrence rate was at 12% (95% CI, 9–15%).
• Secondary intention healing: The highest recurrence rate was at 28% (95% CI, 23–33%).
• Flap reconstruction represented the most effective technique in reducing recurrence, due to more prolonged results compared with other surgical techniques.
This means that selection of a proper wound closure method following the excision of HS can be crucial. The ease in application of secondary intention healing or primary closure makes these a less desirable option since it has a higher rate of recurrence. Intermediate benefits result from skin grafting but flap reconstruction is apparently best, with the lowest recurrences and even an expected improvement in functionality and quality of life.
This comprehensive analysis reports flap reconstruction as the most efficient wound closure after wide surgical excision for lesions of HS, with minimal recurrence rates and better outcomes as compared to primary closure, skin grafts, and healing by secondary intention. These results may significantly improve the long-term outcomes and quality of life for patients afflicted with HS.
Reference:
Cucu, C. I., Ciobotariu, I., Paradisi, A., Di Nardo, L., Fossati, B., Mannino, M., Malvaso, D., Chiricozzi, A., & Peris, K. (2024). Wound closure techniques after wide excision for hidradenitis suppurativa: a systematic review and meta‐analysis. International Journal of Dermatology.https://doi.org/10.1111/ijd.17553
