title: Management of hidradenitis suppurativa wounds with an internal vacuum-assisted closure device.
abstract: BACKGROUND
  Hidradenitis suppurativa is a chronic, debilitating disease that is difficult to treat. Once medical management fails, wide local excision offers the best chance for cure. However, the resultant wound often proves too large or contaminated for immediate closure.
  
  
  METHODS
  The authors performed a retrospective chart review of hidradenitis cases managed surgically between 2005 and 2010. Data collected included patient characteristics, management method, and outcomes. Approximately half of the patients received internal vacuum-assisted closure therapy using the vacuum-assisted closure system and delayed closure and half of the patients received immediate primary closure at the time of their excision. Delayed closure consisted of closing the majority of the wound in a linear fashion following internal vacuum-assisted closure while accepting healing by means of secondary intention for small wound areas.
  
  
  RESULTS
  Patients managed with internal vacuum-assisted closure had wounds on average four times larger in area than patients managed without internal vacuum-assisted closure. In both groups, all wounds were eventually closed primarily. Healing times averaged 2.2 months with internal vacuum-assisted closure and 2.7 months without. At an average follow-up time of 2.3 months, all patients with internal vacuum-assisted closure had no recurrence of their local disease.
  
  
  CONCLUSIONS
  Severe hidradenitis presents a treatment challenge, as surgical excisions are often complicated by difficult closures and unsatisfactory recurrence rates. This study demonstrates that wide local excision with reasonable outcomes can be achieved using accelerated delayed primary closure. This method uses internal vacuum-assisted closure as a bridge between excision and delayed primary closure, facilitating closure without recurrence in large, heavily contaminated wounds.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Boston, Mass.; and Washington, D.C. From the Department of Medicine, Beth Israel Deaconess Medical Center; the Division of Plastic Surgery, Brigham and Women's Hospital; the Department of Plastic Surgery, Georgetown University Hospital; and the Department of Dermatology, Massachusetts General Hospital.
authors.forename: Y Erin
authors.initials: YE
authors.lastname: Chen
authors.forename: Theodore
authors.initials: T
authors.lastname: Gerstle
authors.forename: Kapil
authors.initials: K
authors.lastname: Verma
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Treiser
authors.forename: Alexandra B
authors.initials: AB
authors.lastname: Kimball
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Orgill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D017497:Hidradenitis Suppurativa / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D012189:Retrospective Studies; D014945:Wound Healing; D014947:Wounds and Injuries / Q000209:etiology / Q000601:surgery*; D055815:Young Adult