Two-stage Treatment Using Negative Pressure Wound Therapy with Instillation and Dwell Time (NPWTi-d) for Extensive Hidradenitis Suppurativa of the Buttocks

抄録

Introduction: Hidradenitis suppurativa is extremely difficult to treat. In the setting of a widespread infection, skin flaps and skin grafting are used to cover the wound after total excision of the infected region. If the treatment of the excised wound is inadequate and it is still infected, if the skin graft did not take, or if the bottom of the flap could not adhere, a recurrence of the infection might occur. We report the case of a patient with extensive hidradenitis suppurativa of the buttocks who was successfully treated with quick and efficient wound bed preparation using negative pressure wound therapy with instillation and dwell time (NPWTi-d).
Case: A 46-year-old man with a subcutaneous abscess on the buttocks presented to our department 3 years ago for the surgical treatment of extensive hidradenitis suppurativa.
Result: The patient underwent a wound resection under the superficial fascia, which included fistulas and inflammation. NPWTi-d was started the day after surgery. Wound granulation occurred very quickly using a graft bed, and 2 weeks later mesh split skin grafting was performed, without signs of infection.
Discussion: Extensive hidradenitis suppurativa infections require a wait time between the removal of the infection and the occurrence of granulation, making it difficult to predict when the second operation can be performed. In this case, NPWTi-d, which allowed for simultaneous wound irrigation and graft transplantation, was considered useful for the second-stage treatment of hidradenitis suppurativa.