Study Highlights Wound Closure Techniques Following Wide Excision for HS

Secondary closure techniques may allow for superior outcomes in managing hidradenitis suppurativa (HS) versus primary closure methods, according to recent findings, with local/distant flap and split skin graft techniques leadinging to HS recurrence risk reductions of 55% and 45%, respectively.¹

These data resulted from a new systematic review and meta-analysis conducted to identify the most efficient methods of wound closure after wide excision of HS lesions, specifically in terms of functionality, recurrence, and life quality. Corina Ioana Cucu, from Carol Davila University of Medicine and Pharmacy in Romania, worked alongside a team of investigators in this analysis.

The investigators highlighted that while recurrence of lesions is a primary outcome measure, several analyses have stressed the issues with providing a standardized definition.²

“We conducted a systematic review and meta-analysis of the existing literature to evaluate the most effective wound closure technique after wide excision for HS,” Cucu and colleagues wrote. “We compared the wound closure methods in terms of recurrence, outcome, and the patient's quality of life.”¹

Background and Design

The investigators conducted their systematic review of available literature, using the PubMed (MEDLINE) and Embase (Scopus) databases to identify original research on methods of wound closure in wide excisions for individuals with HS. These analyses would cover the period from 1965 - 2024.

The research team also reviewed additional sources such as ClinicalTrials.gov, the Cochrane Register, and the first 10 pages of Google Scholar. Some of the key information they would draw from each eligible trial included the country, Dermatology Life Quality Index (DLQI), author, study design, publication year, patient demographics such as sex and Hurley stage, the number of body sites treated surgically, surgical closure methods, average lesion duration before surgery, rates of recurrence, reports of postoperative complications, pain visual analog scale (VAS), and duration of follow-up interactions.

The team’s main focus of their review was recurrence rates, calculated by them as the number of recorded events divided by the number of interventions. In terms of secondary outcomes they assessed, the investigators looked at postoperative complications, including infection, wound bleeding, dehiscence, and issues with movement.

The investigative team’s search was last updated in February 2024. Reference lists from relevant articles were assessed for further data. Some of the search terms implemented included “wide excision,” “hidradenitis suppurativa,” and different types of wound closure techniques.

The team also only included English-language articles in their analysis, and automated tools from PubMed and Scopus assisted in refining the results. The provision of full-text access and a focus on relevant original research was also required.

Main Findings

The investigative team’s search led to 1,181 records, and after duplicates were removed and articles failing to meet their criteria for inclusion were excluded, a total of 121 analyses were included in the meta-analysis.

The team noted that rates of HS recurrence varied by the surgical reconstruction method. Primary closure was shown to have a rate of recurrence of 25% (95% CI: 20–30%).

The investigators also reported that skin grafts had a rate of 18% (95% CI: 14–22%), and flaps had a rate of 12% (95% CI: 9–15%). In terms of secondary intention healing, the research team noted the highest recurrence rate had been 28% (95% CI: 23–33%).

Overall, among the set of techniques that the team set out to evaluate, flaps was shown to have the lowest rate of disease recurrence.

“Our study has some limitations,” they wrote. “Most of the included studies were retrospective, which may introduce bias and affect the reliability of the results. The heterogeneity in study designs, patient populations, and follow-up periods across studies may also impact our findings.”¹

References

1. ^{Cucu, C.I., Ciobotariu, I., Paradisi, A., Di Nardo, L., Fossati, B., Mannino, M., Malvaso, D., Chiricozzi, A. and Peris, K. (2024), Wound closure techniques after wide excision for hidradenitis suppurativa: a systematic review and meta-analysis. Int J Dermatol. https://doi.org/10.1111/ijd.17553.}
2. ^{Bui H, Bechara FG, George R, Goldberg S, Hamzavi I, Kirby JS, et al. Surgical procedural definitions for hidradenitis suppurativa developed by expert delphi consensus. JAMA Dermatol. 2023; 159(4): 441–447. https://doi.org/10.1001/jamadermatol.2022.626.}