Enhancing Healing in Hidradenitis Suppurativa With Tobacco Pouch Suture After CO2 Laser Excision Treatment

• DOI: 10.1111/ijd.17679
• Publication Date: 2025-02-07T11:53:27Z
• Authors: Martina Mussi; Michelangelo La P...; Valeria Gaspari; Antonio Russo; Davide Melandri; Bianca Maria Pira...; Corrado Zengarini
• Keywords: Hidradenitis Suppurativa; Wound dehiscence; Axilla

While medical therapies are the mainstay for early stages, treating advanced hidradenitis suppurativa (HS) poses challenges due to frequent recurrence of lesions, which often requires wider surgical excisions [1]. This can lead delayed wound healing, an increased risk complications and scarring, significant patient discomfort, creating a notable barrier management [2]. Carbon dioxide (CO2) laser treatment has proven be effective modality reducing improving outcomes compared traditional surgery [3]. However, further refinements in this technique still needed enhance its overall effectiveness, as well after intervention [4]. We propose use tobacco pouch suture following CO2 debulking margin approximation accelerate healing. involves placing continuous purse-string around wound's circumference, drawing edges inward, area, minimizing tension, lowers dehiscence (Figure 1). In our experience, method led faster granulation full re-epithelialization other treatments that did not incorporate specific technique, resulting minimal scarring significantly discomfort pain during recovery. As representative case, we present 35-year-old male suffering from HS since age 12, who progressed Hurley Stage III, International Hidradenitis Suppurativa Severity (IHS4)-score 13 [5], with left axilla refractory lesions unresponsive antibiotics, biologics, topical therapies. Treatment adalimumab was discontinued months administration development anti-TNF-alpha antibodies. Given lack response therapies, ablative pursued, excision performed under local anesthesia 2 suspension. Guerbet blue patent V staining previously injected into sinus tracts delineate their course depth accurately, guiding diseased tissue 1a,b). Both SmartPulse modes DEKA were utilized, power settings ranging 5 watts mode 30 45 W mode. Following debulking, wide defect created tension. To address this, employed 3-0 prolene, reduced tension promoted edge 1b,c). A collagen-based dressing applied, followed by sterile gauze bandage. Postoperatively, medicated every 48 hours betadine-based antiseptic gauzes bandages received only on-demand oral anti-inflammatory drugs. He exhibited rapid granulation, removed 1 week excellent progress 1d). At weeks, demonstrated re-epithelialization, at 3 months, complete healing observed 1e,f). The reported symptom relief marked improvement quality life, expressing great satisfaction outcome. is established management, particularly cases where risks large size. addition offers advantages such case. combined approach demonstrates potential better especially areas prone functional cosmetic impact. conclusion, integration proved highly severe axillary HS. facilitated closure, time, minimized underscoring value option complex cases. Further studies warranted validate establish standardized protocols application. Open access publishing Universita degli Studi di Bologna, part Wiley - CRUI-CARE agreement. patients manuscript have given written informed consent publication case details. authors declare no conflicts interest.