Category Archives: J Eur Acad Dermatol Venereol

Surgical outcomes and the impact of major surgery on quality of life, activity impairment and sexual health in hidradenitis suppurativa patients: a prospective single centre study.

J Eur Acad Dermatol Venereol. 2019 May 27;:

Authors: Prens LM, Huizinga J, Janse IC, Horváth B

Abstract
BACKGROUND: Hidradenitis suppurativa (HS) is a chronic debilitating skin disease, frequently located in the groin and anogenital area, leading to a substantial impact on quality of life and sexual health in HS patients. Skin-tissue-sparing excision with electrosurgical peeling (STEEP) is a procedure with known low recurrence rates and high patient satisfaction in retrospective series. However, a prospective study to investigate the impact of any major surgery on specific aspects of the quality of life has not yet been performed.
OBJECTIVE: To assess surgical outcomes and the effect of major surgery on the general quality of life, sexual health and activity impairment in HS patients.
MATERIALS AND METHODS: A single centre prospective survey study was conducted among 40 patients undergoing major surgery. Surveys were completed prior to surgery and 2, 6, 12 and 26 weeks after surgery. Besides the objective parameters (time to wound closure and surface of the wound), patient reported outcomes were reported.
RESULTS: Thirty-nine patients with a total of 171 survey responses were included for analysis.. Patients with Hurley stage I or II had a shorter time to wound closure (TTWC) compared to patients with Hurley stage III (p=0.005). TTWC was significantly prolonged in patients treated with biologics (p<0.001). Smoking did not significantly influence TTWC. For patient reported outcomes, DLQI and ASEX scores did not significantly improve during the study period of six months. However, activity and overall work impairment showed considerable improvement after surgery.
CONCLUSION: Time to wound closure is significantly prolonged by, higher Hurley stage and treatment with biologics, contrastingly not by smoking. Major surgery improved the overall work and daily activity impairment. This article is protected by copyright. All rights reserved.

PMID: 31132177 [PubMed – as supplied by publisher]

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Surgery under general anaesthesia in severe hidradenitis suppurativa: a study of 363 primary operations in 113 patients.

J Eur Acad Dermatol Venereol. 2015 Jan 15;

Authors: Blok JL, Boersma M, Terra JB, Spoo JR, Leeman FW, van den Heuvel ER, Huizinga J, Jonkman MF, Horváth B

Abstract
BACKGROUND: Treatment of hidradenitis suppurativa (HS) is a difficult undertaking, especially as there is no consensus on what surgical technique is preferred. At our centre severe HS (Hurley II/III) is operated under general anaesthesia, mostly with the STEEP procedure.
OBJECTIVES: To investigate characteristics, surgical outcomes and patient satisfaction of HS patients who underwent deroofing or STEEP under general anaesthesia.
METHODS: A clinical records-based retrospective analysis was conducted of all patients who had surgery under general anaesthesia between 1999 and 2013. Patient satisfaction was retrospectively investigated with questionnaires.
RESULTS: A total of 482 operations (363 primary operations and 119 re-operations) were performed during the study period. The proportion of women in the included population was 68%. The median diagnostic delay (patient’s and doctor’s delay) was 6.5 years. Relapses occurred after 29.2% of primary operations. Women had higher relapse rates than men [odds ratio 2.85 (1.07;7.61)]. Hypergranulation of the wound was the most common complication and occurred in 7% of all operations. The median score patients attributed to the medical effect of surgery was eight of 10 (zero corresponding to very dissatisfied and 10 to very satisfied).
CONCLUSION: The diagnostic delay in HS is long due to a lack of knowledge in both patients and health care professionals, indicating that there is a need for education. Deroofing and the STEEP are effective surgical procedures in severe cases of HS and lead to a relatively high patient satisfaction. The postoperative relapse risk is higher in women. Prospective studies are required for the development of clear guidelines on the appropriate choice of surgery.

PMID: 25589154 [PubMed – as supplied by publisher]

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Skin-Tissue-sparing Excision with Electrosurgical Peeling (STEEP): a surgical treatment option for severe hidradenitis suppurativa Hurley stage II/III.

J Eur Acad Dermatol Venereol. 2014 Jan 25;

Authors: Blok JL, Spoo JR, Leeman FW, Jonkman MF, Horváth B

Abstract
BACKGROUND: Surgery is the only curative treatment for removal of the persistent sinus tracts in the skin that are characteristic of severe hidradenitis suppurativa (HS). Complete resection of the affected tissue by wide excision is currently regarded as the preferred surgical technique in these cases. However, relatively large amounts of healthy tissue are removed with this method and suitable skin-tissue-saving techniques aiming at creating less-extensive surgical defects are therefore needed in severe HS.
METHOD: We describe a skin-tissue-saving surgical technique for HS Hurley stage II-III disease: the Skin-Tissue-sparing Excision with Electrosurgical Peeling (STEEP) procedure.
DISCUSSION: In contrast to wide excisions that generally reach into the deep subcutaneous fat, the fat is maximally spared with the STEEP procedure by performing successive tangential excisions of lesional tissue until the epithelialized bottom of the sinus tracts has been reached. From here, secondary intention healing can occur. In addition, fibrotic tissue is completely removed in the same manner as this also serves as a source of recurrence. This tissue-sparing technique results in low recurrence rates, high patient satisfaction with relatively short healing times and favourable cosmetic outcomes without contractures.

PMID: 24460855 [PubMed – as supplied by publisher]

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