Hospital MetroHealth Medical Center, Cleveland, OH
Reconstruction of a large soft-tissue defect to the left axilla, following failed conservative treatments of severe hidradenitis suppurativa.
NovoSorb® BTM was used for a staged soft tissue reconstruction in a 49-year-old male with severe bilateral axillary hidradenitis suppurativa. Surgical options were discussed with the patient after the failure of conservative treatments and NovoSorb BTM was selected to aid the soft-tissue reconstruction. The resulting outcome of the wound demonstrated soft, stable tissue without contracture and with full shoulder range of motion (ROM).
Figure 1: Post-op resection; initial presentation of soft-tissue loss.
Figure 2: Day 6 post NovoSorb BTM application; small areas of purulent fluid are expressed.
Figure 3: Day 2 7 post NovoSorb BTM application with exposed neodermis; appears well-vascularized and ready for final closure.
Figure 4: 1-year post grafting; full range of arm motion demonstrated.
A 49-year-old African American male with a two-year history of severe bilateral axillary hidradenitis suppurativa underwent treatment of his left axilla. Operative debridement and excision of all affected tissue resulted in a 20×15 cm soft-tissue defect (Fig. 1). The patient had no associated medical comorbidities prior to surgical treatment. After failure of conservative treatments, surgical options were discussed with the patient; because, he was experiencing increased pain affecting shoulder ROM and impacting his ability to work and perform daily activities. Traditional reconstructive options for a wound of this size would include resection, negative pressure wound therapy (NPWT) dressing for 5 to 7 days, followed by immediate or staged skin grafting. NovoSorb BTM was selected as an alternative treatment method for hidradenitis suppurativa reconstruction to minimize the risk of graft loss from persistent infection, limit contracture, and improve range of motion.
Aggressive surgical resection was performed on all affected skin and subcutaneous tissue, extending to the superficial axillary fascia. The wound was irrigated with normal saline and NovoSorb BTM was applied with staples. It was then dressed with NPWT bolster- type dressing.
The patient was discharged on postoperative day (POD) 0 with a five-day course of oral antibiotics. On day 6 post NovoSorb BTM application, a small collection of purulent fluid was noted in a few small areas under the NovoSorb BTM matrix and drained by a small incision to the sealing membrane (Fig. 2). NPWT was discontinued and the patient was transitioned to local wound care with antiseptic dressings. The patient was then referred to physical therapy to start formal ROM teaching and home exercises. Antiseptic dressings were discontinued at the subsequent clinic visit on POD 13 and redressed with gauze at that time.
At 27 days post NovoSorb BTM application, excellent revascularization was noted, the sealing membrane was removed, and the patient was scheduled for a skin graft on POD 33 (Fig. 3). A curette was used to gently refresh the neodermis and prepare the wound bed for a skin graft harvested at 12/1000th of an inch and meshed 1.5:1. Hemostasis was obtained with a temporary epinephrine-soaked dressing and NPWT was applied for 4 days until the next dressing change, at which time 90% graft take was noted. Daily dressing changes started with antibiotic ointment and petrolatum impregnated dressing.
On day 20 post grafting, the patient was lost to follow-up and returned on day 293 post grafting. At that time, complete take of the graft was visible, the patient had full active shoulder ROM, and the skin was noted to be soft and pliable.
At 1-year post skin grafting, soft-tissue reconstruction was successful with the use of NovoSorb BTM. The skin was soft and supple without surrounding scar contracture, and the patient demonstrated full shoulder ROM (Fig. 4). NovoSorb BTM provided a viable option for treating hidradenitis suppurativa and offered an improved long-term outcome for this patient.