Login to Access Video or Poster Abstract: MP79-06
Sources of Funding: None

Introduction

Hidradenitis Supurativa (HS) is a recurrent inflammatory disease of the apocrine glands that causes painful lesions associated with sinus tracts, abscesses and skin fibrosis which can be debilitating. We report our experience with surgical management of genitoperineal HS with complete resection and reconstruction using local skin flaps and grafts in 23 patients, the largest series of which we are aware.

Methods

We completed a retrospective chart review from June 2004 to June 2016 of patients treated with complete resection of HS in the genital and perineal region. Patient demographics, previous treatment of HS, incidence/nature of recurrence and complications were analyzed.

Results

From 2004-2016 23 patients underwent hidradenitis excision. 96% were male, 74% were African American. The average age was 46 years old, with an average BMI of 31.5 (19.7-50.7). The most common comorbidities included tobacco use (69%), obesity (57%), HTN (39%) and DM (22%). Prior to definitive excision, 16 patients (76%) had at least one incision and drainage. STSG was required in 30% of patients, but the rest were covered with local thigh, scrotal or perineal flaps. Average length of hospital stay was 3.5 days (0-22 days). Follow-up interval was 13 months (0-45 mo). The 30-day complication rate was 48% (11/23 patients) for minor complications (Grade 1-2) which included wound infection and dehiscence. 3 patients (13%) had a Grade 3B complication with no grade 4 or 5 complications. Recurrence of HS outside of the borders of previous excision occurred 1-42 months after surgery in 8 (35%) patients, most requiring limited re-excision.

Conclusions

Genitoperineal HS can be a debilitating, painful and disfiguring disease. Conservative treatments or incision and drainage of lesions is ineffective in curing the root cause of the problem, and persistence or worsening is the rule over time. Complete surgical resection followed by local flap or skin graft closure is possible, curative and most often successful, at the cost of a unsurprisingly high number of self limited wound complications. Urologists should endeavor to fix instead of merely manage this difficult problem.

Funding

None