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Hidradenitis Süpürativada Cerrahi Tedavinin Başarısı: Geniş Ve Derin Cerrahi Eksizyon

Year 2018, Volume: 13 Issue: 1, 13 - 18, 25.03.2018
https://doi.org/10.17517/ksutfd.396944

Abstract

Amaç:
 Hidradenitis süpürativa apokrin ter
bezlerinde yerleşen ağrılı, akıntılı apse oluşumları, sinüs, fistül ve skarlar
ile çevre dokulara yayılan tekrarlayıcı bir hastalıktır. Etyolojisi kesin olarak bilinmemekle birlikte
genetik yatkınlık, hormonal faktörler, obezite ve sigara kullanımı suçlanan
faktörlerdir. Erken dönem lezyonlara medikal tedavi uygulanırken, kronik,
komplike olgularda tedavi cerrahidir. Bununla birlikte nüksler görülebilir ve
reeksizyon gerekebilir. Bu çalışmada farklı anatomik bölgelerde bulunan ve
klinik olarak farklı güvenlik sınırıyla eksizyon uygulanmış hidradenitis süpürativa
olgularındaki nüks ve diğer komplikasyon oranlarının araştırılması
amaçlanmıştır.



Gereç
Ve Yöntemler: Bu çalışmada Ocak 2000- Mart 2017 tarihleri arasında plastik
cerrahi polikliniğine müracat eden, medikal tedaviye dirençli, kronik,
rekürrens gösteren ve cerrahi tedavi uygulanan 45 hasta lezyonların yerleşim
yeri, uygulanan cerrahi yöntemler ve komplikasyonlar açısından retrospesifik
olarak değerlendirildi. Hastaların 25’i erkek, 20’si kadın ve yaş ortalaması 36,7
idi (15–78).  



Bulgular
: Hidradenitis süpürativalı hastaları tedaviye yönlendiren temel sebep yaşam
kalitesinin bozulması ve psikolojik sorunlara kadar uzanan sağlık problemlerine
sebep olmasıdır. Hidradenitis süpürativa’da tedavi hastalığın bulguları ve
derecesine göre belirlenir. Erken evre hastalara genellikle medikal tedaviler
uygulanırken ilerlemiş vakalarda geniş cerrahi eksizyon gerekmektedir.



Sonuç:
İntermammarial bölgede lezyonu olan 2 hastada ve perianal yerleşimli lezyonu
olan 3 hastada lezyon sınırında  yapılan
eksizyonlar sonrası nüks görüldü. Toplamda hastalarda nüks oranı %11,1 olarak
tespit edildi ve bu hastalara daha geniş cerrahi sınırla reeksizyon yapıldı. Bu
çalışmanın amacı hidradenitis süpürativa tedavisinde geniş ve derin cerrahi
eksizyonu önemini vurgulamaktır. 


References

  • 1- Werth JMVD, Williams HC, Raeburn JA. The clinical genetics of hidradenitis suppurativa revisited. Br J Dermatol 2000; 142(5): 947-953.
  • 2- Barth JH, Layton AM, Cunliffe WJ. Endocrine factors in pre and postmenopausal women with hidradenitis suppurativa. Br J Dermatol 1996;134(6):1057—9.
  • 3- Slade DEM, Powell BW, Mortimer PS. Hidradenitis suppurativa: pathogenesis and management. Br J Plast Surg 2003;56(5):451-61.
  • 4- Ko¨nig A, Lehman C, Rompel R, Happel R. Cigarette smoking as a triggering factor of hidradenitis suppurativa. Dermatology 1999;198(3):261–4.
  • 5- Camisa C, Sexton C, Friedman C. Treatment of hidradenirtis suppurativa with combination hypothalamic-pituitary-ovarian and adrenal supression: a case report . J Reprod Med 1989;34(8):543-6.
  • 6- Ather S, Chan DSY, Leaper DJ, Harding KD. Surgical treatment of hidradenitis suppurativa: case series and review of the literature. Int Wound J 2006;3(3):159–169.
  • 7- Mortimer PS, Lunniss PJ. Hidradenitis suppurativa. J R Soc Med. 2000;93(8):420-2.
  • 8- Anonymus. Calprotectin, zinc and abscess. Lancet 1991;338(8771): 855-6.
  • 9- Brocard A, Knol AC, Khammari A, Dreno B. Hidradenitis suppurativa and zinc: a new therapeutic approach. A pilot study. Dermatology 2007;214(4):325-7. 10- Akbaş H, Karacaoğlan N, Uysal A. [Hydradenitis Supurativa Case Report] J Exp Clin Med 1997; 14(1):69-72.
  • 11- Fitzsimmons JS, Guilbert PR. Evidence of genetic factors in hidradenitis suppurativa. Br J Dermatol 1985;113(1):1-8.
  • 12- Kırçuval D, Tüzün B, Korkut C. [A Case Of Follicular Occlusion Triad] Turkiye Klinikleri J Med Sci 2004, 24(3):291-4.
  • 13- Attanoos RL, Appleton MAC, Douglas-Jones AG. The pathogenesis of hidradenitis suppurativa: a closer look at apocrine and apo-eccrine glands. Br J Dermatol 1995;133(2):254–8.
  • 14- Pedraz J, Dauden E. Practical management of hidradenitis suppurativa. Actas Dermosifiliogr. 2008; 99(2): 101-10)
  • 15- Soldin MG, Tulley P, Kaplan H, Hudson DA,Grobbelaar AO. Chronic axillary hidradenitis–the efficacy of wide excision and flap coverage. Br J Plast Surg 2000;53(5):434–6.
  • 16- Rompel R, Petres J. Long-term results of widesurgical excision in 106 patients with hidradenitis suppurativa. Dermatol Surg 2000;26(7):638–4.
  • 17- Menderes A, Sunay O, Vayvada H,Yilmaz M. Surgical management of hidradenitis suppurativa. Int J Med Sci 2010;7(4): 240–247.
  • 18- Bieniek A, Matusiak L, Okulewicz-Gojlik D, Szepietowski JC. Surgical treatment of hidradenitis suppurativa: experiences and recommendations. Dermatol Surg 2010;36(2): 1998–2004.19- Bohn J. Svenson H. Surgical treatment of hidradenitis suppurtaiva. Scand J Plast Reconstr Surg Hand Surg 2001;35(3):305-9.
  • 20- Jemec GB. Effect of localized surgical excisions in hidradenitis suppurativa. J Am Acad Dermatol 1988;18(5 Pt 1):1103–7.
  • 21- Hurley HJ. Axillary hyperhidrosis, apocrine bromhidrosis, hidradenitis suppurative, and familial benign pemfigus: Surgical approach. In: Roenigk RK, Roenigk HHJ, editors. Dermatol Surg. Principles and practice.1st edt. New York: Marcel Dekker; 1989. p. 717–43.
  • 22- Wolkenstein P, Loundou A, Barrau K Auquier P, Revuz J. Quality of life impairment in hidradenitis suppurativa: a study of 61 cases. J Am Acad Dermatol 2007;56(4):621–623.
  • 23- Watson JD. Hidradenitis suppurativa—a clinical review. Br J Plast Surg 1985;38(4):567-9.
  • 24- Parks RW, Parks TG. Pathogenesis, clinical features and management of hidradenitis suppurativa. Ann R Coll Surg Engl 1997;79(2):83-9.
  • 25- Morgan WP, Harding KG, Hughes LE. A comparison of skin grafting and healing by granulation, following axillary excision for hidradenitis suppurativa. Ann R Coll Surg Engl 1983;65(4):235-6.
  • 26- Shah N. Hidradenitis suppurativa: a treatment challenge. Am Fam Physician 2005;72(8):1547–52.

Surgical Treatment Success In Hidradenitis Suppurativa: Deep And Wide Surgical Excision

Year 2018, Volume: 13 Issue: 1, 13 - 18, 25.03.2018
https://doi.org/10.17517/ksutfd.396944

Abstract

Abstract

Objective: Hidradenitis suppurativa is a recurrent disease that spreads to the surrounding tissues with painful, smooth abscess formation, sinus, fistula and scarring located in the apocrine sweat glands. Although etiology is not known precisely, genetic predisposition, hormonal factors, obesity and smoking are the accused factors. While medical treatment is applied to early lesions, it is the treatment surgeon in chronic, complicated cases. However, recurrences may occur and re-escision may be required. In this study, we aimed to investigate the recurrence and other complication rates of hydradenitis suppurativa in different anatomical regions with excision with clinically different safety margin.

Materials and Methods: In this study, 45 patients who were admitted to plastic surgery clinic between January 2000 and March 2017 with medical treatment resistant, chronic, recurrence and surgical treatment were evaluated retrospectively in terms of resection site, applied surgical methods and complications. Twenty-five of the patients were male, 20 were female and the mean age was 36,7 (15-78).

Results: The main reason why patients with Hidradenitis suppuratum leads to treatment is the deterioration of the quality of life and health problems leading to psychological problems. In hydradenitis suppurativa, treatment is based on the findings and the degree of the disease. Early stage disease is usually treated with medical treatments and extensive surgical excision is needed in advanced cases.

Conclusion: In 2 patients with intermammary lesions and 3 patients with perianal lesions, recurrences were observed after excision on the lesion border. In total, the recurrence rate was found to be 11.1% in patients and this disease was re-esced with wider surgical margin. The aim of this study is to emphasize the importance of extensive and profound surgical excision in the treatment of hydradenitis suppurativa. 

References

  • 1- Werth JMVD, Williams HC, Raeburn JA. The clinical genetics of hidradenitis suppurativa revisited. Br J Dermatol 2000; 142(5): 947-953.
  • 2- Barth JH, Layton AM, Cunliffe WJ. Endocrine factors in pre and postmenopausal women with hidradenitis suppurativa. Br J Dermatol 1996;134(6):1057—9.
  • 3- Slade DEM, Powell BW, Mortimer PS. Hidradenitis suppurativa: pathogenesis and management. Br J Plast Surg 2003;56(5):451-61.
  • 4- Ko¨nig A, Lehman C, Rompel R, Happel R. Cigarette smoking as a triggering factor of hidradenitis suppurativa. Dermatology 1999;198(3):261–4.
  • 5- Camisa C, Sexton C, Friedman C. Treatment of hidradenirtis suppurativa with combination hypothalamic-pituitary-ovarian and adrenal supression: a case report . J Reprod Med 1989;34(8):543-6.
  • 6- Ather S, Chan DSY, Leaper DJ, Harding KD. Surgical treatment of hidradenitis suppurativa: case series and review of the literature. Int Wound J 2006;3(3):159–169.
  • 7- Mortimer PS, Lunniss PJ. Hidradenitis suppurativa. J R Soc Med. 2000;93(8):420-2.
  • 8- Anonymus. Calprotectin, zinc and abscess. Lancet 1991;338(8771): 855-6.
  • 9- Brocard A, Knol AC, Khammari A, Dreno B. Hidradenitis suppurativa and zinc: a new therapeutic approach. A pilot study. Dermatology 2007;214(4):325-7. 10- Akbaş H, Karacaoğlan N, Uysal A. [Hydradenitis Supurativa Case Report] J Exp Clin Med 1997; 14(1):69-72.
  • 11- Fitzsimmons JS, Guilbert PR. Evidence of genetic factors in hidradenitis suppurativa. Br J Dermatol 1985;113(1):1-8.
  • 12- Kırçuval D, Tüzün B, Korkut C. [A Case Of Follicular Occlusion Triad] Turkiye Klinikleri J Med Sci 2004, 24(3):291-4.
  • 13- Attanoos RL, Appleton MAC, Douglas-Jones AG. The pathogenesis of hidradenitis suppurativa: a closer look at apocrine and apo-eccrine glands. Br J Dermatol 1995;133(2):254–8.
  • 14- Pedraz J, Dauden E. Practical management of hidradenitis suppurativa. Actas Dermosifiliogr. 2008; 99(2): 101-10)
  • 15- Soldin MG, Tulley P, Kaplan H, Hudson DA,Grobbelaar AO. Chronic axillary hidradenitis–the efficacy of wide excision and flap coverage. Br J Plast Surg 2000;53(5):434–6.
  • 16- Rompel R, Petres J. Long-term results of widesurgical excision in 106 patients with hidradenitis suppurativa. Dermatol Surg 2000;26(7):638–4.
  • 17- Menderes A, Sunay O, Vayvada H,Yilmaz M. Surgical management of hidradenitis suppurativa. Int J Med Sci 2010;7(4): 240–247.
  • 18- Bieniek A, Matusiak L, Okulewicz-Gojlik D, Szepietowski JC. Surgical treatment of hidradenitis suppurativa: experiences and recommendations. Dermatol Surg 2010;36(2): 1998–2004.19- Bohn J. Svenson H. Surgical treatment of hidradenitis suppurtaiva. Scand J Plast Reconstr Surg Hand Surg 2001;35(3):305-9.
  • 20- Jemec GB. Effect of localized surgical excisions in hidradenitis suppurativa. J Am Acad Dermatol 1988;18(5 Pt 1):1103–7.
  • 21- Hurley HJ. Axillary hyperhidrosis, apocrine bromhidrosis, hidradenitis suppurative, and familial benign pemfigus: Surgical approach. In: Roenigk RK, Roenigk HHJ, editors. Dermatol Surg. Principles and practice.1st edt. New York: Marcel Dekker; 1989. p. 717–43.
  • 22- Wolkenstein P, Loundou A, Barrau K Auquier P, Revuz J. Quality of life impairment in hidradenitis suppurativa: a study of 61 cases. J Am Acad Dermatol 2007;56(4):621–623.
  • 23- Watson JD. Hidradenitis suppurativa—a clinical review. Br J Plast Surg 1985;38(4):567-9.
  • 24- Parks RW, Parks TG. Pathogenesis, clinical features and management of hidradenitis suppurativa. Ann R Coll Surg Engl 1997;79(2):83-9.
  • 25- Morgan WP, Harding KG, Hughes LE. A comparison of skin grafting and healing by granulation, following axillary excision for hidradenitis suppurativa. Ann R Coll Surg Engl 1983;65(4):235-6.
  • 26- Shah N. Hidradenitis suppurativa: a treatment challenge. Am Fam Physician 2005;72(8):1547–52.
There are 24 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Makaleler
Authors

Fatma Bilgen

Alper Ural This is me

Mehmet Bekerecioğlu This is me

Publication Date March 25, 2018
Submission Date February 20, 2018
Acceptance Date March 9, 2018
Published in Issue Year 2018 Volume: 13 Issue: 1

Cite

AMA Bilgen F, Ural A, Bekerecioğlu M. Hidradenitis Süpürativada Cerrahi Tedavinin Başarısı: Geniş Ve Derin Cerrahi Eksizyon. KSU Medical Journal. March 2018;13(1):13-18. doi:10.17517/ksutfd.396944