Outcomes of surgical management of stage III vulvar hidradenitis suppurativa.

OBJECTIVE: To review prior experiences and outcomes of patients treated for stage III vulvar hidradenitis suppurativa (HS) and determine postoperative patient satisfaction. STUDY DESIGN: Patients managed surgically for stage III vulvar HS at University of Michigan Health Systems (January 2000 to December 2005) were identified. Retrospective record review was undertaken and data collected. Five met study criteria. All underwent radical vulvectomy to excise the HS. Most required extensive excision of the vulva, including mons, perianal area and buttock. One surgical defect was allowed to heal by secondary intention; all others underwent interval closure with split-thickness skin grafting (STSG). After debridement, all wounds were dressed with a vacuum assisted closure device. RESULTS: Of the 5 patients, 4 were satisfied with their outcome. The patient managed without STSG developed an introital stricture and was the only patient regretting undergoing surgical excision of the hidradenitis suppurativa. Some amount of depression was present in all patients postoperatively. Four were happy with the surgery; 3 said they would undergo surgery again. CONCLUSION: Patients with severe HS often require radical excision. Data conflict regarding optimal surgical management. Our experience supports good outcome in patients managed with radical excision and STSG.