Importance Hidradenitis suppurativa (HS) is relatively common, with the prevalence of 0.05% to 4.10%, yet many patients receive inadequate treatment. Objective To review the diagnosis, epidemiology, and treatment of HS with an emphasis on advances in the last 5 years. Evidence Review A literature search was conducted using PubMed, MEDLINE (Medical Subject Headings [MeSH]), and EMBASE to include recently published treatment studies (searched from September 1, 2011, to May 1, 2017). Reviews, guidelines, conference abstracts, and studies with less than 10 patients were excluded. Furthermore, internet searches for guidelines on hidradenitis suppurativa using Baidu, Bing, Google, and Qwant browsers were performed. Findings The diagnosis of HS is made by lesion morphology (nodules, abscesses, tunnels, and scars), location (axillae, inframammary folds, groin, perigenital, or perineal), and lesion progression (2 recurrences within 6 months or chronic or persistent lesions for ≥3 months). HS is more common than was previously thought based on epidemiological analysis (0.05%-4.10%). Disability from HS can be significant. Patients with HS may have significant comorbidities (eg, obesity, metabolic syndrome, diabetes, and arthritis) and increased all-cause mortality (incidence rate ratio, 1.35 [95% CI, 1.15-1.59]). Antibiotic treatment with combinations of clindamycin and rifampicin, or ertapenem followed by combination rifampicin, moxifloxacin, and metronidazole for 6 months is effective. Adalimumab is effective in a significant proportion of patients and treatment with IL-1 and IL-12 receptor subunit beta 1 (Rb1) antibodies may also be useful. Tissue-sparing surgical techniques and carbon dioxide laser treatments also are available, but the evidence on clinical outcomes with these approaches is limited. Conclusions and Relevance Hidradenitis suppurativa is more common than previously thought and may be treated by an array of pharmacological and surgical techniques. Hidradenitis suppurativa should be considered in the differential diagnosis of nodular lesions or sinus tracts present in the axillae, groin, perineal, and mammillary fold regions.

https://jamanetwork.com/journals/jama/articlepdf/2664466/jama_Saunte_2017_rv_170008.pdf

Hidradenitis Suppurativa: Advances in Diagnosis and Treatment

Objective: To describe nurses' recommendations for good patient safety practices in the operating room. Method: Quantitative, descriptive and exploratory research developed from an online survey of 220 operating room nurses from different regions of Brazil. The data processing for textual analysis was performed by the software IRAMUTEQ. Results: There were eight recommendations: (1) Involvement of the multiprofessional team and the managers of the institution; (2) Establishment of a patient safety culture; (3) Use of the safe surgery checklist; (4) Improvement of interpersonal communication; (5) Expansion of nurses' performance; (6) Adequate availability of physical, material and human resources; (7) Individual search for professional updating; and (8) Development of continuing education actions. Conclusion: These recommendations can be used as care management strategies by nurses for patient safety in the operating room.

/pdf/good-practices-for-patient-safety-in-the-operating-room-327gb2i6hd.pdf

Good practices for patient safety in the operating room: nurses' recommendations

Background As part of its mission to improve the quality of care for women with gynecological cancers across Europe, the European Society of Gynaecological Oncology (ESGO) first published in 2017 evidence-based guidelines for the management of patients with vulvar cancer. Objective To update the ESGO guidelines based on the new evidence addressing the management of vulvar cancer and to cover new topics in order to provide comprehensive guidelines on all relevant issues of diagnosis and treatment of vulvar cancer. Methods The ESGO Council nominated an international development group comprised of practicing clinicians who provide care to vulvar cancer patients and have demonstrated leadership through their expertize in clinical care and research, national and international engagement and profile as well as dedication to the topics addressed to serve on the expert panel (18 experts across Europe). To ensure that the statements were evidence-based, new data identified from a systematic search were reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Prior to publication, the guidelines were reviewed by 206 international practitioners in cancer care delivery and patient representatives. Results The updated guidelines cover comprehensively diagnosis and referral, staging, pathology, pre-operative investigations, surgical management (local treatment, groin treatment, sentinel lymph node procedure, reconstructive surgery), (chemo)radiotherapy, systemic treatment, treatment of recurrent disease (vulvar, inguinal, pelvic, and distant recurrences), and follow-up. Management algorithms are also defined.

https://ijgc.bmj.com/content/ijgc/early/2023/06/27/ijgc-2023-004486.full.pdf

European Society of Gynaecological Oncology Guidelines for the Management of Patients with Vulvar Cancer - Update 2023

Background:Reconstruction of the vulva, vagina, and buttocks following cancer ablation is challenging. Restoring the shape, volume, and function is the key to the best reconstruction for these regions. Perineal reconstruction with a free-style flap based on skin perforators from the internal pudenda

The internal pudendal artery perforator flap: free-style pedicle perforator flaps for vulva, vagina, and buttock reconstruction.

History of plastic surgery

Management of the perineal wound after abdominoperineal resection.

Summary Axillary hidradenitis suppurativa is a chronic and debilitating disease that primarily affects the axillae, perineum, and inframammary areas. Surgical removal of all the diseased skin constitutes the only efficient treatment. Covering an axillary fossa defect is challenging, due to the range of shoulder movement required. Indeed, shoulder movement may be compromised by scar contraction after inadequate surgery. The present study is the first to apply an inner arm perforator flap to the treatment of twelve axillary skin defects in 10 patients. The defect originated from extensive excision of recurrent hidradenitis suppurativa in the axilla. The technique used to cover the defect is a V-Y advancement flap or a propeller flap from the inner arm based on one to three perforators arising from the brachial artery or the superior ulnar collateral artery. The flap provides a tensionless wound closure and a generally unremarkable postoperative course in a short hospital stay. No major complications occurred. Two patients had minor delayed wound healing. Outcomes (including donor site morbidity, function and the cosmetic outcome) were very satisfactory in all cases. We consider that the inner arm perforator flap is a valuable new option for the reconstruction of axillary defects.

Application of the inner arm perforator flap in the management of axillary hidradenitis suppurativa.

WhatsApp: Improvement tool for surgical team communication

How to Save a Life From Macroscopic Fat Embolism: A Narrative Review of Treatment Options.

Classically, muscular or omental flaps are the gold standard in the management of thoracic defects following radionecrosis debridement. Their vascular supply and antibacterial property was supposed to enhance healing compared with cutaneous flaps. The evolution of reconstructive surgery allowed us to challenge this dogma. Therefore, we present five consecutive cases of thoracic radionecrosis reconstructed with cutaneous perforator flaps. In four patients, we performed a free deep inferior epigastric perforator (DIEP) flap and one patient had a thoracodorsal perforator (TDAP) flap. Median time healing was 22.6 days with satisfactory cutaneous covering and good aesthetic results. There were no flap necrosis, no donor site complications. We believe that perforator flaps are a new alternative, reliable and elegant option that questions the dogma of muscular flaps in the management of thoracic radionecrosis.

Change of paradigm in thoracic radionecrosis management

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