title: Outcomes After Combined Radical Resection and Targeted Biologic Therapy for the Management of Recalcitrant Hidradenitis Suppurativa.
abstract: BACKGROUND
  Trials demonstrating the efficacy of biologic therapy for moderate to severe hidradenitis suppurativa (HS) have inspired new multidisciplinary treatment strategies. We present our experience with combined biologic and surgical therapy for recalcitrant HS.
  
  
  METHODS
  Between 2011 and 2014, 21 patients (57 cases) with Hurley Stage III HS underwent radical resection with delayed primary closure alone, or in combination with adjuvant biologic therapy. Demographic data, treatment regimen, outcomes, and complications were retrospectively reviewed for all cases.
  
  
  RESULTS
  Eleven patients underwent combined surgical and biologic therapy, whereas radical resection alone was performed in 10 patients. The average soft tissue deficit, before closure, for the combined and surgery-only patients was 56 cm and 48.5 cm, respectively (P = 0.66). Biologic agents including infliximab (n = 8) and ustekinumab (n = 3) were initiated 2 to 3 weeks after closure and were continued for an average of 10.5 months. Recurrence was noted in 19% (4/29) and 38.5% (10/26) of previously treated sites for combined and surgery-only patients (P < 0.01). For the combined cohort, the disease-free interval was approximately 1 year longer on average (P < 0.001); however, this difference was reduced to 4.5 months when considering time to recurrence after cessation of biologic therapy (P = 0.09). New disease developed in 18% (2/11) and 50% (5/10) of combined and surgery-only patients, respectively (P < 001). No adverse events were noted among patients who received biologic therapy.
  
  
  CONCLUSIONS
  Lower rates of recurrence and disease progression, as well as a longer disease-free interval may be achieved with the use of adjuvant biologic therapy after radical resection for recalcitrant HS.
authors.affiliation: From the *Department of Plastic Surgery, Center for Wound Healing, Medstar Georgetown University Hospital; and †Division of Rheumatology, Department of Medicine, The George Washington University Hospital, Washington, DC.
authors.forename: Michael V
authors.initials: MV
authors.lastname: DeFazio
authors.forename: James M
authors.initials: JM
authors.lastname: Economides
authors.forename: Kathryn S
authors.initials: KS
authors.lastname: King
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Han
authors.forename: Victoria K
authors.initials: VK
authors.lastname: Shanmugam
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Attinger
authors.forename: Karen K
authors.initials: KK
authors.lastname: Evans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003879:Dermatologic Agents / Q000627:therapeutic use*; D062109:Dermatologic Surgical Procedures; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D017497:Hidradenitis Suppurativa / Q000628:therapy*; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D000069549:Ustekinumab / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D000069285:Infliximab; D000069549:Ustekinumab