Excision Margins

The choice of the surgical borders for radical excision is important. Usually the excision reaches the deep subcutaneous fat or the fascia. Three types of excisional limits can be discussed (after Soldin et al. [63]):

1. Limited local excision. Only the obviously diseased tissue is excised. Usually this is within the area of the hair-bearing skin.

2. Hair-bearing skin excision - the area of axillary tissue containing terminal hair is excised. The excision is performed down to the fascia.

3. Wide local excision - all hair-bearing tissue and an additional 2-cm margin of surrounding skin are removed, down to the fascia (mainly for axillary disease).

The choice of margins is very much dependent on the extent and development of HS in the individual patient. Excision of inflammatory tissue including all occluded follicles and all fistulas is mandatory, otherwise immediate recurrence will follow surgery. In cases where the disease is limited, with fistulated processes separated by healthy skin (disease Stage II according to Hurley's classification), and when most of the region is spared, excision of the skin confined to the diseased tissues is satisfactory. In cases confined to a fistulating process, it is nec essary to avoid local recurrence. If any part of the fistula is left behind the inflammatory process will soon start again and often also dissect through the healthy scar and recur. In general small recurrences or new lesions seen can be excised as they occur. This will leave a lot of patients with a minor surgical scar and with fewer of the complications associated with major surgery. Even in cases where very wide excisions are performed, local recurrences or new lesions are seen and there is always a risk of new lesions in a new region. Local excision of more advanced HS (most of or the whole of a region is fistulated, Hurley Stage III) is often followed by recurrence and many authors agree that wide excision of affected skin is to be preferred. It is reasonable to excise at least all the hair-bearing skin in cases where a large area is affected. In these advanced cases most of the region is already involved by HS lesions and the aim is not to leave axillary skin that has a preponderance to develop HS lesions. Therefore, in the axilla, it is recommended to excise all of the hair-bearing skin. An extra margin of 2 cm is advocated by some authors [6, 55, 63]. In skin close to inflamed tissues an estimated free margin should be added. If radical surgery of the whole area cannot be done, the patient can still gain the relief of having a reduced disease burden following local excisions of the fistulating process. There are also cases that can be assessed as being somewhere between these two extremes. Other information about the patient's general health, surgical risks, surgical possibilities for closing specific defects and the patient's willingness to accept an unsightly scar must be balanced against the risk of recurrences. The consequences of a recurrence in the area are major surgery or a small excision.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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