Pre-operative ultrasound planning in the surgical management of patients with hidradenitis suppurativa.

Ultrasonography can improve disease severity assessment in hidradenitis suppurativa (HS) patients. The use of pre-operative ultrasonography could improve surgical outcomes in HS patients.1) To assess changes in the projected skin excised area after the use of pre-operative ultrasonography, 2) To explore the clinical factors potentially associated with inaccurate clinical surgical delimitation, and 3) To compare recurrence rates after pre-operative ultrasound vs clinical surgical margin delimitation at week 24.

Cohort study. Patient candidates for surgical treatment by wide excision and healing by secondary intention with a clinical projected skin excised area equal to or larger than 15 cm² were included. The main variables of interest were the clinical and ultrasound projected skin excised area and surgical recurrence.

Pre-operative ultrasound surgical margin delimitation increased the mean excised area by 3.67 (SD 0.86) cm² , p=0.004. The Bland Altman plot showed that in 65% of surgical procedures the use of ultrasonography increased the projected skin excised area. Higher IHS4 scores, BMI, male sex and Hurley stage II vs III all increased the difference between clinical and ultrasound surgical delimitation. At week 24, the recurrence rate in the surgical clinical delimitation cohort was 30% compared to 10% in the cohort with preoperative ultrasonography (p=0.10).

Preoperative ultrasonography improves surgical margin delimitation and can lower recurrence rates at 24 weeks in HS patients. Potential risk factors for inaccurate clinical surgical delimitation are obesity, male sex, Hurley II stage and elevated IHS4 scores, so special attention should be given to these patients when ultrasonography is not available and surgical delimitation is based only on clinical examination.