Dermatologic surgery
Deroofing: A tissue-saving surgical technique for the treatment of mild to moderate hidradenitis suppurativa lesions

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Background

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease, often refractory to treatment. Patients with HS and dermatologists are in need of an effective, fast surgical intervention technique. Deroofing is a tissue-saving technique, whereby the “roof” of an abscess, cyst, or sinus tract is electrosurgically removed. The use of a probe is mandatory to explore the full extent of a lesion.

Objective

We sought to evaluate the efficacy and patient satisfaction of the deroofing technique for recurrent Hurley I (mild) or II (moderate) graded HS lesions at fixed locations.

Methods

An open study consisted of 88 deroofed lesions in 44 consecutive patients with HS, treated by a single clinician with a follow-up time of up to 5 years.

Results

Fifteen of 88 (17%) treated lesions showed a recurrence after a median of 4.6 months. In all, 73 treated lesions (83%) did not show a recurrence after a median follow-up of 34 months. The median patient satisfaction with the procedure rated 8 on a scale from 0 to 10. Of the treated patients, 90% would recommend the deroofing technique to other patients with HS. One side effect occurred in the form of postoperative bleeding.

Limitations

Some patients were lost to follow-up.

Conclusions

The deroofing technique is an effective, simple, minimally invasive, tissue-saving surgical intervention for the treatment of mild to moderate HS lesions at fixed locations and it is suitable as an office procedure.

Section snippets

Methods

In all, 44 consecutive patients with HS were treated in an open trial with the deroofing technique in the outpatient Department of Dermatology, Deventer Hospital, The Netherlands, in the period 2003 to 2007. The criteria used to establish the diagnosis of HS were: presence of typical lesions (ie, deep-seated painful nodules, abscesses, draining sinuses, bridged scars, and “tombstone” open comedones in secondary lesions); typical topography (ie, axillae, groin, perineal and perianal region,

Results

In all, 44 patients with HS, 3 male and 41 female, with a total of 88 lesions underwent deroofing during the investigated period. No deroofed cases were excluded from the study. Patient characteristics are given in Table I. All patients had a history of active long-standing HS. The median age of disease onset was 28 years. The median age at time of deroofing was 35 years with a median body mass index of 26.8.

Lesion characteristics are given in Table II. Most of the deroofed lesions (41 [47%])

Discussion

The treatment repertoire for HS consists of medical (topical, systemic) and surgical interventions. Early intervention is considered mandatory to prevent disease activity from getting out of control with consequences such as fibrosis, scarring, and sinus tract formation causing therapy resistance and major quality-of-life impairment. Several surgical interventions have been described for HS often with considerable recurrence rates. The reported recurrence rates after incision with drainage are

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Funding sources: None.

Conflicts of interest: None declared.

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