Hidradenitis Suppurativa: A Team Based Systematic Approach

Introduction: Patients with advanced stage hidradenitis suppurativa often experience high morbidity and multifocal disease which presents a significant challenge to their quality of life. There is a need for better solutions for these patients. We present a limited case series of three patients who have been successfully managed with a multidisciplinary, coordinated treatment algorithm including varied plastic surgical reconstructive techniques.Methods:Three patients were identified through retrospective review who initially presented with Hurley Grade 3 hidradenitis suppurativa to an academic hospital between September 2023 and April 2024. All three were managed with an integrated, multidisciplinary approach that involved medical management, multistage surgical repair, and post-operative wound care in dedicated wound care clinics with telehealth capabilities for post-op coordination with the surgery team. Outcomes were assessed by post-operative care at a wound care center based on recurrence of disease and healing of wound sites.Results:Three patients underwent a combined 13 surgical procedures between August 2023 and April 2024. Patient A underwent a treatment course of 6 procedures over 7 months. Patient B underwent 2 procedures over a 5-month span. Patient C underwent 5 procedures over 10 months. Two of the three required salvage split thickness skin grafting, and all were admitted to the hospital at least once. Patients followed up weekly or bi-weekly in the wound care clinic with in-person or telehealth visits with the primary surgeon when applicable. All patients are at present disease free and continue in multidisciplinary follow up care.Discussion: This case series discusses the timing and interdisciplinary care of wound management specialists and staged surgical intervention for these patients. Our goal was to help delineate this complex problem and define appropriate multidisciplinary protocols to coordinate long term care. We underscore the potential for effective surgical management with basic plastic reconstructive principles: to excise all advanced disease and follow the reconstructive ladder for wound closure. This algorithm reduced disease burden and restored quality of life in this frequently despondent population. The utilization of a multidisciplinary team and a staged approach to advanced hidradenitis surgical management improves the chances of a successful operation.References: