title: Radical surgical resection combined with lymphadenectomy-directed antimicrobial therapy yielding cure of severe axillary hidradenitis.
abstract: BACKGROUND
  The current gold standard therapy for hidradenitis suppurativa (HS) is surgical resection. However, despite complete resection, the reoperation rate is reported as high as 54% due to wound infections and disease recurrences. Our hypothesis is that this high recurrence rate is related to retained disease and infected tissue not included in soft tissue resection, namely the lymph nodes. Therefore, performing a superficial lymphadenectomy with nodal microbacterial analysis would remove all infected tissue, eradicate the disease, and allow more specific targeted antibiotic therapy.
  
  
  METHODS
  From 2004 to 2009, 11 patients underwent 15 wide en bloc resections including superficial lymphadenectomy with flap reconstruction for axillary HS. A retrospective review was performed with the following outcomes assessed: culture results, hospital stay, and recurrences of HS.
  
  
  RESULTS
  Patients were followed up for an average of 4.3 years. During this time, there were no wound complications or disease recurrences. Positive bacterial cultures occurred in 12 of 14 nodes with results that differed from the soft tissue purulence. This led to a 75% change in antibiotic regimen. Superficial abscess cultures were uniformly covered, whereas only 3 of 12 nodal cultures where sensitive to our empiric antibiotic coverage. No patients developed lymphedema or any loss of function in the involved upper extremity.
  
  
  CONCLUSIONS
  Axillary HS has traditionally been a challenge due to the morbidity of care and high recurrence. Our data show that an en bloc resection with a superficial lymphadenectomy and subsequent antimicrobial therapy based on both the soft tissue and the lymph nodes can provide a definitive cure.
authors.affiliation: Division of Plastic Surgery, and †Department of Dermatology, University of Florida, Gainesville, FL, USA. rbnesmith@uams.edu
authors.forename: Richard B
authors.initials: RB
authors.lastname: Nesmith
authors.forename: Kim L
authors.initials: KL
authors.lastname: Merkel
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Mast
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001365:Axilla; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D017497:Hidradenitis Suppurativa / Q000382:microbiology / Q000628:therapy*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000382:microbiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013524:Surgical Flaps; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents