A novel technique for the surgical treatment of hidradenitis suppurativa (HS), termed smart wound closure (SWC), differs from the traditional secondary wound closure technique in that it addresses the latter technique’s deficiency of leaving large wounds without proper primary closure, like skin grafts or flaps. A description of this technique was recently published in Dermatologic Therapy.
The author describes SWC as a technique that involves pseudo primary wound closure that ultimately “self-evolves” into a secondary wound closure within 4 to 5 days. The technique starts with excision of all the scarring and inflammatory tissue, followed by careful hemostasis with dry cylindric absorbable gelatin sponges.
Stitches are then applied to constrict the wound and fix the hemostatic sponge. A purse string suture is recommended for wounds that features similar diameters in both axes, whereas a horizontal interrupted mattress suture is preferred for wound diameters that are unequal. The wound is then covered with surgical tape and gauzes for 4 to 5 days.
On the first few days after surgery, the sponge will absorb wound secretions, and the sutures will favor elastic distention in the skin, resulting in a smaller open wound. The sponge will progressively dissolve, which will lead to a partially healed secondary wound closure. This closure does not appear to impact most daily activities.
Symptoms of this closure technique include bleeding, infection, and possible nonpathological bad odor on day 4 or 5. On day 4 or 5, the dressing is removed, and the wound is then washed with a physiological saline solution. By this time, the hemostatic sponge has either partially or completely degraded. The sutures are then removed, and discrete wound enlargement occurs.
Patients are typically instructed to use self-care of the wound with daily soap washing and application of a flexible polyamide net coated with soft silicone, surgical tape, and gauzes. The patients are then scheduled for follow-up appointments every 2 to 4 weeks to monitor wound evolution.
Molina-Leyva A. Smart wound closure: A novel technique for the surgical treatment of hidradenitis suppurativa [published online May 16, 2020]. Dermatol Ther. doi: 10.1111/dth.13596