title: The role of wide local excision for the treatment of severe hidradenitis suppurativa (Hurley grade III): Retrospective analysis of 74 patients.
abstract: BACKGROUND
  Effective medical treatment for patients with severe hidradenitis suppurativa (HS) is limited.
  
  
  OBJECTIVE
  We sought to measure the impact of wide local excision on quality of life in HS Hurley grade III patients and to examine the rate of postoperative complications, disease recurrences, and satisfaction with the cosmetic results.
  
  
  METHODS
  Seventy-four patients were enrolled. Outcome measures included Dermatology Life Quality Index responses, disease duration, recurrence, previous therapies, postoperative complications, and satisfaction with cosmetic results.
  
  
  RESULTS
  Most patients had inguinogenital/gluteal disease (68.9%, P < .001). Involvement of both the axillary and the inguinogenital/gluteal areas were pronounced in male patients (P = .018). None of the patients was treated with tumor necrosis factor-α inhibitors. Most patients (71.6%) had a disease history of >5 years at the time of presentation and multiple unsuccessful attempts with systemic and local therapeutic interventions. Wide local excision improved Dermatology Life Quality Index scores from initially 27.89 to 5.31 after surgery (P < .001), independent of localization (P = .195). Forty-seven percent of patients had postoperative complications, most frequently pain and scarring. The vast majority of patients (70.3%) were satisfied with the cosmetic results.
  
  
  CONCLUSIONS
  The retrospective nature of the study was a limitation.
  
  
  CONCLUSIONS
  Wide local excision significantly improves the quality of life of HS patients. Local recurrence rates are low, and satisfaction with the cosmetic results is high.
authors.affiliation: Department of Dermatology and Venerology, Rudolfstiftung Hospital, Vienna, Austria; School of Medicine, Sigmund Freud University, Vienna, Austria. Electronic address: Cposch81@gmail.com.
authors.forename: Christian
authors.initials: C
authors.lastname: Posch
authors.affiliation: Department of Dermatology and Venerology, Rudolfstiftung Hospital, Vienna, Austria.
authors.forename: Babak
authors.initials: B
authors.lastname: Monshi
authors.affiliation: Department of Dermatology and Venerology, Rudolfstiftung Hospital, Vienna, Austria.
authors.forename: Tamara
authors.initials: T
authors.lastname: Quint
authors.affiliation: Department of Dermatology and Venerology, Rudolfstiftung Hospital, Vienna, Austria; School of Medicine, Sigmund Freud University, Vienna, Austria.
authors.forename: Igor
authors.initials: I
authors.lastname: Vujic
authors.affiliation: Department of Dermatology and Venerology, Rudolfstiftung Hospital, Vienna, Austria.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Lilgenau
authors.affiliation: Department of Dermatology and Venerology, Rudolfstiftung Hospital, Vienna, Austria; School of Medicine, Sigmund Freud University, Vienna, Austria.
authors.forename: Klemens
authors.initials: K
authors.lastname: Rappersberger
mesh_terms: D000328:Adult; D062109:Dermatologic Surgical Procedures / Q000379:methods; D005260:Female; D017497:Hidradenitis Suppurativa / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: DLQI; TNF; acne inversa; inflammation; recurrence; satisfaction; surgery