Low, Yee-Cheng, MD

Miller, Nathan, MD

Murphy, Robert X, JR, MD, MS

Steele, Andrew, MD

Wallace, Sean J, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of SurgeryHidradenitis Suppurativa: A Comparison ofInstitutional Experience with the TrackingSean J. Wallace MDLehigh Valley Hospital, sean.wallace@lvhn.orgAndrew Steele MDLehigh Valley Health Network, Andrew.Steele2@lvhn.orgNathan Miller MDLehigh Valley Health Network, Nathan.Miller@lvhn.orgYee-Cheng Low MDLehigh Valley Health Network, YeeCheng.Low@lvhn.orgRobert X. Murphy JR, MD, MSLehigh Valley Health Network, Robert.Murphy@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/surgeryPart of the Plastic Surgery Commons, and the Surgery CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtWallace, S. J., Steele, A. Miller, N. Low, Y. Murphy, R.(2019, Sept 20-23). Hidradenitis Suppurativa: A Comparison of InstitutionalExperience with the Tracking. Poster Presented at: The American Society of Plastic Surgeons (ASPS).LVHN.org© 2019 Lehigh Valley Health NetworkHidradenitis Suppurativa: A Comparison of Institutional Experience with the Tracking Outcomes in Plastic Surgery (TOPS) RegistrySean J. Wallace, MD, Andrew Steele, MD, Nathan Miller, MD, Yee-Cheng Low, MD, Robert X. Murphy Jr., MDLehigh Valley Health Network, Allentown, Pa.DISCLOSURES:  ASPS Clinical Registries Steering Committee Members  R. Murphy, MD and N. Miller, MDHIDRADENITIS SUPPURATIVA• Reported prevalence of 0.3% to 4%.•  Painful nodules, abscesses, and sinus tracts.•  Inflammation and infection of the apocrine sweat glands. •  Severe disease usually requires surgical excision.METHODS INCLUDE:   Primary Closure   Secondary Intention   Skin Grafting   Local flaps   Fasciocutaneous or musculocutaneous flaps•  Reconstructive options determined by extent and depth of tissue resected.•  Insufficient data to compare complication rates by reconstructive method chosen. •  Surgical complication rate high.TRACKING OPERATIONS AND OUTCOMES FOR PLASTIC SURGEONS•  The American Society of Plastic Surgeons (ASPS) have maintained TOPS since 2002.•  Offered to all ASPS active members across the United States and Canada.•  Only database to capture both inpatient and ambulatory surgical cases.•  Data is self-reported•  TOPS tracks surgical procedures and 30-day outcomes.•  Designed to provide plastic surgeons with valid clinical/practice information.PURPOSE•  Evaluate complications based on location and reconstruction type within Lehigh Valley Health Network •  Reconcile institutional data versus TOPS•  Determine best practiceSTUDY DESIGN•  Retrospective review from  Jan. 2004–16•  ICD-9 code 705.83•  LVHN N = 381 operative sites•  TOPS N = 1,030 operative sites•  Complication rates for each type of reconstruction and location analyzed •  Results compared to TOPS database to compare institutional results to national benchmark dataRESULTS381 operative sites for 101 individuals Type of Closure Total Complication RateSimple 5 80%Intermediate 41 68.3%Complex 141 59.6%Adjacent Soft Tissue Rearrangement 190 69.5%Split-Thickness  Skin Graft 4 100%Location Total Complication  RateAxillary 127 61.6%Inguinal 99 71.4%Perineal 47 78.6%Gluteal 21 58.7%COMPARATIVE DATALocation Closure Method LVHN TOPSAxillary Complex 50.0% 31.9%Inguinal Complex 25.0% 38.7%Perineal Complex 50.0% 56.5%Any Adjacent tissue transfer 66.7% 53.8%Any STSG N/A* 6.7 % Inguinal 11.1 % AxillaryAny VAC N/A* 12.5%Any Muscle Flap N/A* 5.3%DISCUSSION•  HS is highly morbid •  Inguinal region has highest complication rate within LVHN data•  Adjacent-soft tissue rearrangement has highest complication rate within LVHN data and complex closure in TOPS data•  Statistically significant difference between adjacent-soft tissue rearrangement versus complex/intermediate closure for superficial wound dehiscence•  Potential under resection of primary disease CONCLUSIONS•  Potential need for more extensive surgical debridement  and excision•  More data needed to define best practices•  Similar trends in outcomes between institutional and TOPS data•  Type of reconstruction and different complications analyzed with Fischer T-test   Adjacent soft tissue rearrangement had highest occurrence of superficial surgical site dehiscence compared to intermediate and complex closure (p = 0.0132).   No significant difference between types of complications, complication rates, and type of reconstruction.Location Closure Method Wound Breakdown Complication RateAxillary Simple or Intermediate 58.9%Axillary Complex 31.9%Inguinal Simple or Intermediate 55.3%Inguinal Complex 38.7%Perineal Simple or Intermediate 40.0%Perineal Complex 56.5%Any Adjacent tissue transfer 53.8%Axillary STSG 11.1%Inguinal / Perineal STSG 6.7%Any VAC 12.5%Any Muscle Flap 5.3%

Hidradenitis Suppurativa: A Comparison of Institutional Experience with the Tracking

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=2509&context=surgery

Hidradenitis Suppurativa: A Comparison of Institutional Experience with the Tracking

Abstract

Similar works

Full text

Available Versions

Lehigh Valley Health Network: LVHN Scholarly Works