Esterified Hyaluronic Acid Matrix* Treatment after Surgical Excision in Patients with Refractory Hidradenitis Suppurativa Promotes Healing and is Associated with Less Post-Operative Pain.

Introduction:Hidradenitis Suppurativa (HS) is a poorly understood disease that afflicts approximately 8.6 per 100,000 people a year in the US.1  Surgical excision of the infected skin and soft tissue remains the mainstay of treatment.2However, for the majority of patients the wounds remain open after surgery resulting in significant pain and delayed wound healing.
Objective: Evaluate an esterified hyaluronic acid matrix (eHAM)* to promote surgical wound healing and reduce post-operative pain for three cases.

Method: All patients had HS with a wound classification of 4: dirty/infected wounds. All procedures included pre-operative antibiotics followed by full thickness excision (FTE) of the infected wound area. Case 1: 53 yo male required FTE of 135 cm2area of the left buttock. Case 2: 40 yo female required FTE of 300 cm2 area of the right inner thigh and groin. Case 3: 21 yo male required FTE of 280 cm2area of the left axilla. For post-operative care, all cases received eHAM,* wound VAC, and opioid pain medications for pain as needed. Wound care transitioned to twice daily wet-to-dry dressing changes by home healthcare after wound VAC was removed.   

Results: Case 1: At one month, reported better pain control compared to prior HS surgery without eHAM.* Wound healing was at 82% closure compared to the prior HS surgery, which took five months to achieve similar closure. Case 2: At one week, reported less pain compared to prior HS surgeries without eHAM.* The wound defect had completely filled in and was flush with the skin at five weeks. Case 3: At two weeks, no opioids required for pain management. High-quality wound healing with good granulation.   

Conclusion:An eHAM* promoted wound healing and was associated with less post-operative pain of large area surgical excision wounds in patients with a history of refractory HS.

Trademarked Items (if applicable): *Hyalomatrix®, Medline Industries, Inc. Northfield, IL

References (if applicable): 1. Garg, A. et al. Incidence of Hidradenitis Suppurativa in the United States: A Sex- And Age-Adjusted Population Analysis. J Am Acad Dermatol. 2017 Jul;77(1):118-122.
2. Shanmugam, VK, et al. Longitudinal Observational Study of Hidradenitis Suppurativa: Impact of surgical intervention with adjunctive biologic therapy. Int J Dermatol. 2018 January ; 57(1): 62–69