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Surgical Treatment of Extensive Sacrococcygeal Hidradenitis Suppurativa With Triangular Closure Technique

Mutaf, Mehmet MD; Günal, Ertan MD; Berberoğlu, Ömer MD; Gökçe, Ayla MD

doi: 10.1097/SAP.0b013e3182840831
Reconstructive Surgery
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Background Recurrence of the sacrococcygeal hidradenitis suppurativa (HS) can significantly be reduced by invasive local excision of all the abscess, sinuses, and scars which often result in large defects on this region. Although a number of surgical procedures have been described, closure of large sacrococcygeal defects resulting from excision of extensive HS still remains a challenge.

Purpose Here, we present the use of triangular closure technique as a new alternative in surgical treatment of extensive HS of sacrococcygeal region.

Materials and Methods For more than 4 years, triangular closure technique has been used for skin coverage of the large sacrococcygeal defects resulting from excision of the HS in 16 patients (12 men and 4 women) aged between 18 and 52. The size of the defects range from 10 to 25 cm in the greatest dimension.

Results In all patients, a successful tension-free closure of the defect was obtained. Except for 2 patients who had tip necrosis, all patients healed uneventfully. There was no patient with infection and wound dehiscence. A mean follow-up for 36 months (6 months-5 years) revealed no recurrence and an aesthetically acceptable scar formation in all patients. No patient required additional surgery.

Conclusions Triangular closure technique enables the surgeon to achieve a tension-free defect closure of remarkably large sacrococcygeal defects resulting from surgical excision of extensive HS. Using 2 well-vascularized fasciocutaneous flaps, it provides a durable coverage and soft tissue padding over sacrococcygeal and gluteal region with good cosmesis. With these advantages, triangular closure technique seems to be a useful, 1-stage, and safe reconstructive alternative for the closure of these challenging defects.

From the Department of Plastic and Reconstructive Surgery, Gaziantep University School of Medicine, Gaziantep, Turkey.

Received January 5, 2012, and accepted for publication, after revision, December 18, 2012.

Presented at the 32nd Congress of Turkish Society of Plastic, Reconstructive and Aesthetic Surgery, September 14–17, 2011, Izmir, Turkey.

Conflicts of interest and sources of funding: none declared.

Reprints: Mehmet Mutaf, MD, Bahriye Ucok Bulvarı, Kultur Apt. A-Blok No: 8, Gaziantep, Turkey. E-mail: mutafgunal@gmail.com.

© 2014 by Lippincott Williams & Wilkins