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OUTCOME OF SPLIT-THICKNESS-SKIN GRAFT [STSG] FOR TREATMENT OF SEVERE HIDRADENITIS SUPPURATIVA OF THE AXILLA AT PLASTIC SURGERY DEPARTMENT NISHTAR HOSPITAL, MULTAN.

Dr Arif Baig Mirza, , Dr Ijaz Hussain Shah, Dr Muhammad Bilal Saeed, Assistant Professor, Dr Ahmad Ali, Dr Naheed Ahmed.

Background: Hidradenitis suppurativa [HS] is a pain full, chronic, inflammatory disease involving the apocrine glands of the axillary, groin and mammary regions with significant scarring, physical and psychosocial sequel. The lesions are usually painful and appear in regions where skin rubs together, such as armpits or groin HS prevalence ranges from 0.05 to 1%.[1] Severe axillary HS is associated with high rates of recurrence, scarring, infection, fistula formation, skin cancer [SCC] and it requires extensive surgical resection with challenging reconstruction associated with risk of post-operative complications[2] . The most effective method for reconstruction of the axilla after excision of HS is yet to be identified [3]. Surgical excision of the affected tissue and coverage is the gold standard treatment. When the process becomes chronic, wide surgical excision and coverage with split-thickness skin graft [ STSG] is a good option.[4] Methods: A descriptive case series study was conducted on 70 subjects with soft tissue defects created after the excision of H.S of the axilla and coverage was done with STSG over 3 years, we enrolled 70 consecutive patients with Hurley's Stage II and III HS of the axilla who underwent surgical excision with reconstruction using STSG [n=]. We evaluated and compared intraoperative and post-operative data, quality of life [dermatology life quality index questionnaire] and pain/discomfort [visual analogue scale] before and after surgery. Results: Seventy surgical procedures were done in which wide local excisions with 2-3 cm healthy margins followed by coverage with STSG was performed. Regarding post-operative complications, there was hematoma formation in 10 cases [13.13], infection occur in 05 [07.1] cases and no complication in 55 [78.60] cases. As for STSG, there was partial lost in 09 [12.8] cases, complete STSG lost in 02 [02.85]. The results show that successful treatment, without recurrence, was accomplished in 84.24% of the cases. The intervention was generally well tolerated Patients who underwent surgical excision and STSG reconstruction had significantly faster recovery. All patients reported an improved quality of life [QOL] after them. All patients reported a reduction in pain /discomfort. Conclusion: Conservative treatment methods for the control of this disease have little or no effects especially stage 2 and stage 3 on axillary hidradenitis suppurativa. The morbidity, skin changes and depression and risk of SCC associated with this disease is significant, and the only successful treatment is wide surgical excision and reconstruction/ coverage with STSG. Keywords: Hidradenitis Suppurativa [HS]; Split-Thickness Skin Graft [STSG], Improved Quality of Life [QOL].

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