Evidence-Based Practice
The treatment of hidradenitis suppurativa (HS) follows three main pillars: patient education (hygiene, smoking cessation, weight loss, and dietary modifications), anti-inflammatory medications, and surgical therapy. Surgery is the only potentially curative measure for HS, but options are limited to punch debridement, radical excision, or deroofing (DR). However, DR often results in increased recurrence rates and post-operative challenges, with poor cosmetic results. Hence, alternative approaches to surgical intervention in HS are highly sought after. Recently, several minimally invasive technologies such as hydrosurgical debridement and low-frequency ultrasonic debridement (LFUD) have been developed to treat hard-to-heal wounds of various soft tissue diseases and we aim to broaden their application to the treatment of HS which we refer to as minimally invasive treatment for HS (MITHS). By combining the limitations of DR with our emerging understanding of MITHS in wound care, we have a novel opportunity to enhance care for HS patients.
Methods:
Data collection focused on three primary outcomes: lifestyle factors impacting HS, medication history, and patient experience with MITHS surgical intervention. Analysis of lifestyle factors and medications involved calculating the percentage of total patients that applied said lifestyle factor or medication. For patient experience qualitative categories were assessed, and percentages calculated.
Results:
Overall, most respondents (71.4%) had an HS recurrence with remissions ranging from 1 week to 34 months (mean of 39.4 weeks). 78.6% recommended MITHS. The greatest perceived benefits included improved flare control (85.7%), pain improvement (35.7%), and aesthetics (14.3%). Drawbacks included inadequate flare control (21.4%), post-operative pain (28.6%), and prolonged recovery time (7.1%). 21.4% of respondents preferred MITHS over DR while 14.3% indicated the opposite preference. 57.1% could not respond as they had only undergone MITHS.
Discussion:
HS is a chronic, multi-factorial disease, which often requires a combination of medical and surgical interventions for symptoms and flare management. Among these is the use of novel surgical technologies such as LFUD and hydrosurgical debridement to target disease flares, known as MITHS. These, in combination with lifestyle modifications and medications have shown great promise in reducing wound healing times, pain/discomfort, and most importantly increasing patient satisfaction rates as compared to traditional debridement techniques.