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Axillary Hidradenitis: Risk Factors for Recurrence after Surgical Excision in 214 Patients

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Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the apocrine sweat glands. Although the mainstay of surgical treatment is excision, the disease has a high tendency to recur, for reasons that are not well understood. We sought to better characterize the natural history of this disease, focusing on patients who required operative intervention. Two hundred and fourteen patients with axillary HS underwent 293 surgical procedures. We divided the cohort into two groups based on recurrence and then compared them to identify the factors most associated with recurrent axillary HS. Mean age of onset of HS was 32.1 years. The patients were overwhelmingly female (84.1%), black (93%), and obese (average body mass index = 33.4). Of them, 35.5 per cent of the patients had bilateral axillary disease and 8.4 per cent had extra-axillary disease. Of the 214 patients, 22 (10.3%) had recurrent disease. The vast majority of interventions included excision of disease (median area = 78.6 cm2). Closure versus nonclosure was not associated with a proclivity toward recurrence. The patients with HS were overwhelmingly obese and female, and many of them smoked. Surgical excision was the most common intervention and closure was used in roughly half of the patients. Recurrence after excision was not associated with extra-axillary disease and did not seem to correlate with the manner in which the wounds were managed after excision. Weight loss and smoking cessation may play a more significant role in the prevention of recurrence of HS than surgical treatment alone.
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Document Type: Research Article

Affiliations: Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA

Publication date: March 1, 2018

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  • The Southeastern Surgical Congress owns and publishes The American Surgeon monthly. It is the official journal of the Congress and the Southern California Chapter of the American College of Surgeons, which all members receive each month. The journal brings up to date clinical advances in surgical knowledge in a popular reference format. In addition to publishing papers presented at the annual meetings of the associated organizations, the journal publishes selected unsolicited manuscripts. If you have a manuscript you'd like to see published in The American Surgeon select "Information for Authors" from the Related Information options below. A Copyright Release Form must accompany all manuscripts submitted.
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