ririРаны и раневые инфекции. Журнал имени проф. Б.М. КостючёнкаWounds and wound infections. The prof. B.M. Kostyuchenok journal2408-96132500-0594Regional non-governmental organization “Surgical society - Wounds and wound infections”10.25199/2408-9613-2024-11-1-22-27riri-316Research ArticleОБЗОРЫ, ЛЕКЦИИ, ИСТОРИЯ РАН И РАНЕВЫХ ИНФЕКЦИЙREVIEWS, LECTURES, HISTORY OF WOUNDS AND WOUND INFECTIONSХирургическое лечение гнойного гидраденита (обзор литературы)Surgical treatment of hidradenitis suppurativa (a literature review)https://orcid.org/0000-0003-0017-621XБуроваС. А.BurovaS. A.

Бурова София Алексеевна – доктор медицинских наук, профессор, вице-президент

123104, Москва, ул. М. Бронная, д. 20, стр. 1

Sofia A. Burova – MD, Dr Sc. (Med.), Professor, Vice-President

20/1 M. Bronnaya Str., Moscow, 123104

doctorburova@mail.ruНациональная академия микологииРоссияNational Academy of MycologyRussian Federation2024120820241112227Copyright © Бурова С.А., 20242024Бурова С.А.Burova S.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.riri.su/jour/article/view/316

Особое внимание уделено наиболее эффективному хирургическому методу, а именно радикальному иссечению воспалительных очагов гидраденита. Сделан акцент на борьбе с коморбидностью и необходимости многокомпонентной, тщательной предоперационной подготовки с использованием современных медикаментозных средств.

The review presents information on various methods of surgical treatment of hidradenitis suppurativa depending on its stage, severity, inflammatory process extension, and disease duration. The author describes specific features of lesion opening, drainage, curettage, excision, deroofing as well as of CO2 and laser therapy, cryosurgery, physiotherapy, and electrosurgery. Particular attention is paid to the most effective surgical technique, namely: radical excision of inflammatory foci of hidradenitis. The emphasis is made at the management of comorbidities, at the adequate and thorough preoperative preparation using modern medications.

гнойный гидраденитосложненные инфекции кожи и мягких тканейгнойная ранагнойно-некротический очагхирургическая инфекциядиагностикадифференциальная диагностикахирургическое лечениепредоперационная подготовкаhidradenitis suppurativacomplicated infectionsskin and soft tissuespurulent woundpurulent and necrotic focisurgical infectiondiagnosisdifferential diagnosissurgical treatmentpreoperative preparationReferencesOcker L., Abu Rached N., Seifert C., et al. Current Medical and Surgical Treatment of Hidradenitis Suppurativa-A Comprehensive Review. J Clin Med. 2022; 11 (23): 7240.Ocker L., Abu Rached N., Seifert C., et al. Current Medical and Surgical Treatment of Hidradenitis Suppurativa-A Comprehensive Review. J Clin Med. 2022; 11 (23): 7240.Yeroushalmi S., Ildardashty A., Elhage K. G., et al. Hidradenitis suppurativa and sleep: a systematic review. Arch Dermatol Res. 2023; 315 (5): 1409–1415.Yeroushalmi S., Ildardashty A., Elhage K. G., et al. Hidradenitis suppurativa and sleep: a systematic review. Arch Dermatol Res. 2023; 315 (5): 1409–1415.Zouboulis C. C., Desai N., Emtestam L., et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015; 29 (4): 619–644.Zouboulis C. C., Desai N., Emtestam L., et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015; 29 (4): 619–644.Alavi A., Lynde C., Alhusayen R., et al. Approach to the Management of Patients With Hidradenitis Suppurativa: A Consensus Document. J Cutan Med Surg. 2017; 21 (6): 513–524.Alavi A., Lynde C., Alhusayen R., et al. Approach to the Management of Patients With Hidradenitis Suppurativa: A Consensus Document. J Cutan Med Surg. 2017; 21 (6): 513–524.Scuderi N., Monfrecola A., Dessy L. A., et al. Medical and Surgical Treatment of Hidradenitis Suppurativa: A Review. Skin Appendage Disord. 2017; 3 (2): 95–110.Scuderi N., Monfrecola A., Dessy L. A., et al. Medical and Surgical Treatment of Hidradenitis Suppurativa: A Review. Skin Appendage Disord. 2017; 3 (2): 95–110.Chawla S., Toale C., Мorris М., et al. Surgical Management of Hidradenitis Suppurativa: A Narrative Review. J Clin Aesthet Dermatol. 2022; 15 (1): 35–41.Chawla S., Toale C., Мorris М., et al. Surgical Management of Hidradenitis Suppurativa: A Narrative Review. J Clin Aesthet Dermatol. 2022; 15 (1): 35–41.Бурова С. А., Бородулина К. С. Гнойный гидраденит: вопросы патогенеза, оценочные шкалы, лечение (часть 2). Клиническая дерматология и венерология. 2019; 18 (3): 265–269.Burova S. A., Borodulina K. S. Hidradenitis suppurativa: issues of pathogenesis, rating scales, treatment (part 2) = Burova S. A., Borodulina K. S. Gnoynyy gidradenit: voprosy patogeneza, otsenochnyye shkaly, lecheniye (chast’ 2). Klinicheskaya dermatologiya i venerologiya. 2019; 18 (3): 265–269. (In Russ.)Cuenca-Barrales C., Montero-Vilchez T., Sanchez-Diaz M., et al.Patterns of Surgical Recurrence in Patients with Hidradenitis Suppurativa. Dermatology. 2023; 239 (2): 255–261.Cuenca-Barrales C., Montero-Vilchez T., Sanchez-Diaz M., et al.Patterns of Surgical Recurrence in Patients with Hidradenitis Suppurativa. Dermatology. 2023; 239 (2): 255–261.Vellaichamy G., Braunberger T., Nahhas A., et al. Surgical Procedures for Hidradenitis Suppurativa. Cutis. 2018; 102 (1): 13–16.Vellaichamy G., Braunberger T., Nahhas A., et al. Surgical Procedures for Hidradenitis Suppurativa. Cutis. 2018; 102 (1): 13–16.Ingram J., Woo P., Chua S., et al. Interventions for hidradenitis suppurativa: a Cochrane systematic review incorporating GRADE assessment of evidence quality. Br J Dermatol. 2016; 174 (5): 970–978.Ingram J., Woo P., Chua S., et al. Interventions for hidradenitis suppurativa: a Cochrane systematic review incorporating GRADE assessment of evidence quality. Br J Dermatol. 2016; 174 (5): 970–978.van der Zee H. H., Prens E. P., Boer J. Deroofing: a tissue-saving surgical technique for the treatment of mild to moderate hidradenitis suppurativa lesions. J Am Acad Dermatol. 2010; 63: 475–480.van der Zee H. H., Prens E. P., Boer J. Deroofing: a tissue-saving surgical technique for the treatment of mild to moderate hidradenitis suppurativa lesions. J Am Acad Dermatol. 2010; 63: 475–480.van Hattem S., Spoo J. R., Horvath B. et al. Surgical treatment of sinuses by deroofing in hidradenitis suppurativa. Dermatol Surg. 2012; 38 (3): 494–497.van Hattem S., Spoo J. R., Horvath B. et al. Surgical treatment of sinuses by deroofing in hidradenitis suppurativa. Dermatol Surg. 2012; 38 (3): 494–497.Zaayman M., Azhar A., Silfvast-Kaiser A., et al. MOdifiedDEroofing With Scar Excision (MODES Procedure) for the Surgical Treatment of Hidradenitis Suppurativa. J Cutan Med Surg. 2023; 27 (1): 69–71.Zaayman M., Azhar A., Silfvast-Kaiser A., et al. MOdifiedDEroofing With Scar Excision (MODES Procedure) for the Surgical Treatment of Hidradenitis Suppurativa. J Cutan Med Surg. 2023; 27 (1): 69–71.Shavit E., Pawliwec A., Alavi A., et al. The surgeon’s perspective: a retrospective study of wide local excisions taken to healthy subcutaneous fat in the management of advanced hidradenitis suppurativa. Can J Surg. 2020; 63(2): E94–E99.Shavit E., Pawliwec A., Alavi A., et al. The surgeon’s perspective: a retrospective study of wide local excisions taken to healthy subcutaneous fat in the management of advanced hidradenitis suppurativa. Can J Surg. 2020; 63(2): E94–E99.Корейба К. А., Доброквашин С. В., Демьянов С. Л. Хирургическое лечение хронических свищевых формгидраденита подмышечных областей. Казанский медицинский журнал. 2010; 91 (4): 545–546.Koreyba K. A., Dobrokvashin S. V., Demyanov S. L. Surgical treatment of chronic fistulous forms of hidradenitis of the axillary regions = Koreyba K. A., Dobrokvashin S. V., Dem’yanov S. L. Khirurgicheskoye lecheniye khronicheskikh svishchevykh formgidradenita podmyshechnykh oblastey. Kazanskiy meditsinskiy zhurnal. 2010; 91 (4): 545–546. (In Russ.)Бурова С. А. Принципиальные подходы к радикальному лечению актиномикоза и других гнойно- воспалительных заболеваний абдоминальной и параректальной локализаций. В сб.: Успехи медицинской микологии. 2017. Т. 17. с. 244–245.Burova S. A. Principled approaches to the radical treatment of actinomycosis and other purulent-inflammatory diseases of the abdominal and pararectal localizations = Burova S. A. Printsipial’nyye podkhody k radikal’nomu lecheniyu aktinomikoza i drugikh gnoyno-vospalitel’nykh zabolevaniy abdominal’noy i pararektal’noy lokalizatsiy. V sb.: Uspekhi meditsinskoy mikologii. 2017. T. 17. S. 244–245. (In Russ.)Manfredini M., Garbarino F., Bigi L., et al. Surgical and postsurgical wound care in hidradenitis suppurativa. Dermatol Ther. 2020; 33(3): e13282.Manfredini M., Garbarino F., Bigi L., et al. Surgical and postsurgical wound care in hidradenitis suppurativa. Dermatol Ther. 2020; 33(3): e13282.Wormald J., Balzano A., Clibbon J., et al. Surgical treatment of severe hidradenitis suppurativa of the axilla: Thoracodorsal artery perforator (TDAP) ap versus split skin graft. J PlastReconstrAesthet Surg. 2014; 67 (8): 1118–1124.Wormald J., Balzano A., Clibbon J., et al. Surgical treatment of severe hidradenitis suppurativa of the axilla: Thoracodorsal artery perforator (TDAP) ap versus split skin graft. J PlastReconstrAesthet Surg. 2014; 67 (8): 1118–1124.Elgohary H., Nawar A., Zidan A., et al. Outcome of Pedicled Thoracodorsal Artery Perforator Flap in the Surgical Treatment of Stage II and III Hidradenitis Suppurativa of Axilla. Ann Plast Surg. 2018; 81 (6): 688- 693.Elgohary H., Nawar A., Zidan A., et al. Outcome of Pedicled Thoracodorsal Artery Perforator Flap in the Surgical Treatment of Stage II and III Hidradenitis Suppurativa of Axilla. Ann Plast Surg. 2018; 81 (6): 688- 693.Ge S., Ngaage L., Orbay H., et al. Surgical Management of Pediatric Hidradenitis Suppurativa. Ann Plast Surg. 2020; 84 (5): 570–574.Ge S., Ngaage L., Orbay H., et al. Surgical Management of Pediatric Hidradenitis Suppurativa. Ann Plast Surg. 2020; 84 (5): 570–574.Ruan Q., Chen A., Singhal D., et al. Surgical management of hidradenitis suppurativa: procedural trends and risk factors. J Surg Res. 2018; 229 (1): 200–207.Ruan Q., Chen A., Singhal D., et al. Surgical management of hidradenitis suppurativa: procedural trends and risk factors. J Surg Res. 2018; 229 (1): 200–207.Balik E., Eren T., Bulut T., et al. Surgical Approach to Extensive Hidradenitis Suppurativa in the Perineal/Perianal and Gluteal Regions. World J Surg. 2008; 33 (3): 81–487.Balik E., Eren T., Bulut T., et al. Surgical Approach to Extensive Hidradenitis Suppurativa in the Perineal/Perianal and Gluteal Regions. World J Surg. 2008; 33 (3): 81–487.Rambhatla P. V., Lim H. W., Hamzavi I. A Systematic Review of Treatments for Hidradenitis Suppurativa. Arch Dermatol. 2012; 148 (4): 439–446.Rambhatla P. V., Lim H. W., Hamzavi I. A Systematic Review of Treatments for Hidradenitis Suppurativa. Arch Dermatol. 2012; 148 (4): 439–446.Posch C., Monshi B., Quint T., et al. The role of wide local excision for the treatment of severe hidradenitis suppurativa (Hurley grade III): Retrospective analysis of 74 patients. J Am Acad Dermatol. 2017; 77 (1): 123–129.Posch C., Monshi B., Quint T., et al. The role of wide local excision for the treatment of severe hidradenitis suppurativa (Hurley grade III): Retrospective analysis of 74 patients. J Am Acad Dermatol. 2017; 77 (1): 123–129.Burney R. 35-Year Experience with Surgical Treatment of Hidradenitis Suppurativa. World J Surg. 2017; 41 (11): 2723–2730.Burney R. 35-Year Experience with Surgical Treatment of Hidradenitis Suppurativa. World J Surg. 2017; 41 (11): 2723–2730.Finley E. M., Ratz J. L. Treatment of hidradenitis suppurativa with carbon dioxide laser excision and second-intention healing. J Am Acad Dermatol. 1996; 34 (3): 465–469.Finley E. M., Ratz J. L. Treatment of hidradenitis suppurativa with carbon dioxide laser excision and second-intention healing. J Am Acad Dermatol. 1996; 34 (3): 465–469.Dalrymple J. C., Monaghan J. M. Treatment of hidradenitis suppurativa with the carbon dioxide laser. Br J Surg. 1987; 74 (5): 420.Dalrymple J. C., Monaghan J. M. Treatment of hidradenitis suppurativa with the carbon dioxide laser. Br J Surg. 1987; 74 (5): 420.Sherman A. I., Reid R. CO2 laser for suppurative hidradenitis of the vulva. J Reprod Med. 1991; 36: 113– 117.Sherman A. I., Reid R. CO2 laser for suppurative hidradenitis of the vulva. J Reprod Med. 1991; 36: 113– 117.Lapins J., Marcusson J. A., Emtestam L. Surgical treatment of chronic hidradenitis suppurativa: CO2 laser stripping-secondary intention technique. Br J Dermatol. 1994; 131 (4): 551–556.Lapins J., Marcusson J. A., Emtestam L. Surgical treatment of chronic hidradenitis suppurativa: CO2 laser stripping-secondary intention technique. Br J Dermatol. 1994; 131 (4): 551–556.Madan V., Hindle E., Hussain W., et al. Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser. Br J Dermatol. 2008; 159 (6): 1309–1314.Madan V., Hindle E., Hussain W., et al. Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser. Br J Dermatol. 2008; 159 (6): 1309–1314.Hazen P. G., Hazen B. P. Hidradenitis suppurativa: successful treatment using carbon dioxide laser excision and marsupialization. Dermatol Surg. 2010; 36 (2): 208–213.Hazen P. G., Hazen B. P. Hidradenitis suppurativa: successful treatment using carbon dioxide laser excision and marsupialization. Dermatol Surg. 2010; 36 (2): 208–213.Danby F., Hazen P., Boer J. New and traditional surgical approaches to hidradenitis suppurativa. J Am Acad Dermatol. 2015; 73 (5): 62–65.Danby F., Hazen P., Boer J. New and traditional surgical approaches to hidradenitis suppurativa. J Am Acad Dermatol. 2015; 73 (5): 62–65.Tierney E., Mahmoud B. H., Hexsel C., et al. Randomized control trial for the treatment of hidradenitis suppurativa with a neodymiumdoped yttrium aluminium garnet laser. Dermatol Surg. 2009; 35 (8): 1188–1198.Tierney E., Mahmoud B. H., Hexsel C., et al. Randomized control trial for the treatment of hidradenitis suppurativa with a neodymiumdoped yttrium aluminium garnet laser. Dermatol Surg. 2009; 35 (8): 1188–1198.Mahmoud B. H., Tierney E., Hexsel C. L., et al. Prospective controlled clinical and histopathologic study of hidradenitis suppurativa treated with the long-pulsed neodymium:yttrium-aluminium-garnet laser. J Am Acad Dermatol. 2010; 62 (4): 637–645.Mahmoud B. H., Tierney E., Hexsel C. L., et al. Prospective controlled clinical and histopathologic study of hidradenitis suppurativa treated with the long-pulsed neodymium:yttrium-aluminium-garnet laser. J Am Acad Dermatol. 2010; 62 (4): 637–645.Highton L., Chan W. Y., Khwaja N., et al. Treatment of hidradenitis suppurativa with intense pulsed light: a prospective study. Plast Reconstr Surg. 2011; 128(2): 459–465.Highton L., Chan W. Y., Khwaja N., et al. Treatment of hidradenitis suppurativa with intense pulsed light: a prospective study. Plast Reconstr Surg. 2011; 128(2): 459–465.Strauss R. M., Pollock B., Stables G. I., et al. Photodynamic therapy usingaminolaevulinic acid does not lead to clinical improvement in hidradenitis suppurativa. Br J Dermatol. 2005; 152 (4): 803–804.Strauss R. M., Pollock B., Stables G. I., et al. Photodynamic therapy usingaminolaevulinic acid does not lead to clinical improvement in hidradenitis suppurativa. Br J Dermatol. 2005; 152 (4): 803–804.Sotiriou E., Apalla Z., Maliamani F., et al. Treatment of recalcitrant hidradenitis suppurativa with photodynamic therapy: report of five cases. Clin Exp Dermatol. 2009; 34 (7): e235–e236.Sotiriou E., Apalla Z., Maliamani F., et al. Treatment of recalcitrant hidradenitis suppurativa with photodynamic therapy: report of five cases. Clin Exp Dermatol. 2009; 34 (7): e235–e236.Schweiger E. S., Riddle C. C., Aires D. J. Treatment of hidradenitis suppurativa by photodynamic therapy with aminolevulinic acid: preliminary results. J Drugs Dermatol. 2011; 10 (4): 381–386.Schweiger E. S., Riddle C. C., Aires D. J. Treatment of hidradenitis suppurativa by photodynamic therapy with aminolevulinic acid: preliminary results. J Drugs Dermatol. 2011; 10 (4): 381–386.Blok J., Spoo J., Leeman F., et al. SkinTissue-sparing Excision with Electrosurgical Peeling (STEEP): a surgical treatment option for severe hidradenitis suppurativa Hurley stage II/ III. J Eur Acad Dermatol Venereol. 2014; 29 (2): 379–382.Blok J., Spoo J., Leeman F., et al. SkinTissue-sparing Excision with Electrosurgical Peeling (STEEP): a surgical treatment option for severe hidradenitis suppurativa Hurley stage II/ III. J Eur Acad Dermatol Venereol. 2014; 29 (2): 379–382.

The authors declare that there are no conflicts of interest present.