title: Surgical Management of Hidradenitis Suppurativa: Outcomes of 590 Consecutive Patients.
abstract: BACKGROUND
  Hidradenitis suppurativa is a progressive, recurrent inflammatory disease. Surgical management is potentially curative with limited efficacy data.
  
  
  OBJECTIVE
  To evaluate hidradenitis surgical patients.
  
  
  METHODS
  Retrospective review of outcomes of 590 consecutive surgically treated patients.
  
  
  RESULTS
  Most patients were white (91.0% [435/478]), men (337 [57.1%]), smokers (57.7% [297/515]) with Hurley Stage III disease (476 [80.7%]). Procedure types were excision (405 [68.6%]), unroofing (168 [28.5%]), and drainage (17 [2.9%]) treating disease of perianal/perineum (294 [49.8%]), axilla (124 [21.0%]), gluteal cleft (76 [12.9%]), inframammary (12 [2.0%]), and multiple surgical sites (84 [14.2%]). Postoperative complications occurred in 15 patients (2.5%) and one-fourth (144 [24.4%]) suffered postoperative recurrence, which necessitated reoperation in one-tenth (69 [11.7%]) of patients. Recurrence risk was increased by younger age (hazard ratio [HR], 0.8; 95% confidence interval [CI], 0.7-0.9), multiple surgical sites (HR, 1.6; 95% CI, 1.1-2.5), and drainage-type procedures (HR, 3.5; 95% CI, 1.2-10.7). Operative location, disease severity, gender, and operative extent did not influence recurrence rate.
  
  
  CONCLUSIONS
  Excision and unroofing procedures were effective treatments with infrequent complications and low recurrence rates. Well-planned surgical treatment aiming to remove or unroof the area of intractable hidradenitis suppurativa was highly effective in the management of this challenging disease.
authors.affiliation: *Department of Dermatology, Mayo Clinic, Rochester, Minnesota; †Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota; ‡Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota; §Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota; ‖Department of Plastic Surgery and Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: John J
authors.initials: JJ
authors.lastname: Kohorst
authors.forename: Christian L
authors.initials: CL
authors.lastname: Baum
authors.forename: Clark C
authors.initials: CC
authors.lastname: Otley
authors.forename: Randall K
authors.initials: RK
authors.lastname: Roenigk
authors.forename: Louis A
authors.initials: LA
authors.lastname: Schenck
authors.forename: John H
authors.initials: JH
authors.lastname: Pemberton
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dozois
authors.forename: Nho V
authors.initials: NV
authors.lastname: Tran
authors.forename: Alex
authors.initials: A
authors.lastname: Senchenkov
authors.forename: Mark D P
authors.initials: MD
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000601:surgery; D001940:Breast / Q000601:surgery; D002081:Buttocks / Q000601:surgery; D004322:Drainage; D005260:Female; D017497:Hidradenitis Suppurativa / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult