title: Recurrence of hidradenitis suppurativa after surgical management: A systematic review and meta-analysis.
abstract: BACKGROUND
  Hidradenitis suppurativa (HS) is a chronic inflammatory disease of apocrine-bearing skin. Treatment is challenging and long-standing. Surgery is one of the treatment options with varying reported success rates.
  
  
  OBJECTIVE
  This study provides a comprehensive systematic review of surgical approaches in the management of HS.
  
  
  METHODS
  A systematic literature search and meta-analysis of proportions were performed on the included studies.
  
  
  RESULTS
  Of a total of 1147 retrieved articles, 22 were included in the analysis. These were the estimated average recurrences: wide excision, 13.0% (95% confidence interval [CI], 5.0-22.0%); local incision, 22.0% (95% CI, 10.0-37.0%); and deroofing, 27.0% (95% CI, 23.0-31.0%). In the wide excision group, recurrence rates were as follows: 15% (95% CI, 0-72%) for primary closure, 8% (95% CI, 2.0-16.0%) for using flaps, and 6.0% (95% CI, 0.0-24.0%) for grafting. The secondary intention healing option was most commonly chosen after local excision and deroofing.
  
  
  CONCLUSIONS
  There was poor quality evidence and potential improper reporting of the results.
  
  
  CONCLUSIONS
  This systematic review found lower recurrence rates with wide excision, using skin flaps or skin grafts as the closure methods. The heterogeneity of the patient populations was high and statistically significant within and across all types of excisions.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ali
authors.initials: A
authors.lastname: Mehdizadeh
authors.affiliation: Case Western Reserve University, Cleveland, Ohio.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Hazen
authors.affiliation: Ruhr University Bochum, Germany.
authors.forename: Falk G
authors.initials: FG
authors.lastname: Bechara
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nora
authors.initials: N
authors.lastname: Zwingerman
authors.affiliation: Iranian Society of Dermatology, Tehran, Iran.
authors.forename: Marzyeh
authors.initials: M
authors.lastname: Moazenzadeh
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Morteza
authors.initials: M
authors.lastname: Bashash
authors.affiliation: Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada.
authors.forename: R Gary
authors.initials: RG
authors.lastname: Sibbald
authors.affiliation: Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada. Electronic address: afsaneh.alavi@mail.utoronto.ca.
authors.forename: Afsaneh
authors.initials: A
authors.lastname: Alavi
mesh_terms: D062109:Dermatologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D005260:Female; D006085:Graft Survival; D017497:Hidradenitis Suppurativa / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D016038:Skin Transplantation / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: hidradenitis suppurativa; recurrence; surgery; systematic review