PMC8378912_01
Excision and grafting of the axillary area, with a favorable evolution after Hurley stage III suppurative hidradenitis.
JMDH-14-2205-g0002.jpg
PMC8378912_01_JMDH-14-2205-g0002.jpg
f0001
After limiting the infection, the bare areas were quite large and needed to be covered with right axillary advancement flaps and left axillary free skin graft, harvested from the region of the left thigh (Figure 1).
Hurley stage III suppurative hidradenitis, affecting the groin, scrotal, perineal, inner thighs.
JMDH-14-2205-g0003.jpg
PMC8378912_01_JMDH-14-2205-g0003.jpg
f0002
The general clinical examination at the second hospitalization found the presence of perineal and scrotal hidradenitis suppurativa in Hurley stage III or severe disease according to IHS4 staging (International HS Severity Score System): the presence of multiple abscesses in different stages of evolution, fistulous trajectories and scar tissue, following a local evolution of 2-3 years (Figure 2).
Favorable evolutionary fasciocutaneous flaps under VAC treatment and protection of the perineal area by colostomy. The post-fasciotomy scar is also observed on the right leg.
JMDH-14-2205-g0004.jpg
PMC8378912_01_JMDH-14-2205-g0004.jpg
f0003
The fasciocutaneous flaps show postoperative signs of vascular distress and the areas of skin necrosis are gradually excised, but the subsequent evolution is slowly favorable under VAC treatment and protection of the perineal area by colostomy (Figure 3).
PMC8378912_02
Hyperplasia of the epidermis and the presence of a fistulous tract lined with granulation tissue and hemorrhage (HE stain, x40).
JMDH-14-2205-g0005.jpg
PMC8378912_02_JMDH-14-2205-g0005.jpg
f0004
The pathological examination of the excised areas detects skin with reactionary hyperplasia of the epidermis and the presence of dermo-hypodermic fistulous tracts lined with granulation tissue with rich polymorphic inflammatory infiltrate represented by polymorphonuclear, lymphocytes, plasmocytes and multinucleous extracellular giant cells, fibrino-leukocyte on the surface and fibrosis on the wall (Figures 4-6).
Polymorphic inflammatory infiltrate with polymorphonuclear, lymphocytes, plasmocytes and multinucleous extracellular giant cells (HE stain, x200).
JMDH-14-2205-g0006.jpg
PMC8378912_02_JMDH-14-2205-g0006.jpg
f0005
The pathological examination of the excised areas detects skin with reactionary hyperplasia of the epidermis and the presence of dermo-hypodermic fistulous tracts lined with granulation tissue with rich polymorphic inflammatory infiltrate represented by polymorphonuclear, lymphocytes, plasmocytes and multinucleous extracellular giant cells, fibrino-leukocyte on the surface and fibrosis on the wall (Figures 4-6).
Hemato-fibrino-leukocyte exudate on the surface and fibrosis on the wall (HE stain, x40).
JMDH-14-2205-g0007.jpg
PMC8378912_02_JMDH-14-2205-g0007.jpg
f0006
The pathological examination of the excised areas detects skin with reactionary hyperplasia of the epidermis and the presence of dermo-hypodermic fistulous tracts lined with granulation tissue with rich polymorphic inflammatory infiltrate represented by polymorphonuclear, lymphocytes, plasmocytes and multinucleous extracellular giant cells, fibrino-leukocyte on the surface and fibrosis on the wall (Figures 4-6).
PMC8378912_03
Bilateral axillary hidradenitis, Hurley stage II.
JMDH-14-2205-g0008.jpg
PMC8378912_03_JMDH-14-2205-g0008.jpg
f0007
Male patient, CRT, 17 years old, passive smoker, normal weight, no family history, presents for bilateral axillary hidradenitis, persisting for 3-4 months, treated with clindamycin per os, incisions and drainage made in another hospital unit, but with local recurrences (Figure 7).
Suppurative hidradenitis in the groin and perineal.
JMDH-14-2205-g0009.jpg
PMC8378912_03_JMDH-14-2205-g0009.jpg
f0008
During clinical examinations at hospitalization, abscesses are also detected at the inguinal and perineal levels (Figure 8), and in addition, the patient associates acne, psoriasis, pectus excavatum, and dextroconvex dorsolumbar scoliosis (Figures 9 and 10).
Psoriasis lesions on the elbows and back.
JMDH-14-2205-g0010.jpg
PMC8378912_03_JMDH-14-2205-g0010.jpg
f0009
During clinical examinations at hospitalization, abscesses are also detected at the inguinal and perineal levels (Figure 8), and in addition, the patient associates acne, psoriasis, pectus excavatum, and dextroconvex dorsolumbar scoliosis (Figures 9 and 10).
Dextroconvex dorsolumbar scoliosis and L5 spondylolysis.
JMDH-14-2205-g0011.jpg
PMC8378912_03_JMDH-14-2205-g0011.jpg
f0010
During clinical examinations at hospitalization, abscesses are also detected at the inguinal and perineal levels (Figure 8), and in addition, the patient associates acne, psoriasis, pectus excavatum, and dextroconvex dorsolumbar scoliosis (Figures 9 and 10).
Thickened epidermis, edema, hemorrhagic exudate, inflammatory polymorphic infiltrate (HE stain, x40).
JMDH-14-2205-g0012.jpg
PMC8378912_03_JMDH-14-2205-g0012.jpg
f0011
The pathological examination of the excised lesions surprises the skin with thickened epidermis; areas with inflammatory polymorphic infiltrate with suppurative foci; relatively numerous eosinophils throughout the dermis; aspects of obliterative endarteritis and ducts with rich inflammatory infiltrate with intraepithelial polymorphonuclear (Figures 11 and 12).
Areas with inflammatory polymorphic infiltrate, with relatively numerous eosinophils throughout the dermis (HE stain, x100).
JMDH-14-2205-g0013.jpg
PMC8378912_03_JMDH-14-2205-g0013.jpg
f0012
The pathological examination of the excised lesions surprises the skin with thickened epidermis; areas with inflammatory polymorphic infiltrate with suppurative foci; relatively numerous eosinophils throughout the dermis; aspects of obliterative endarteritis and ducts with rich inflammatory infiltrate with intraepithelial polymorphonuclear (Figures 11 and 12).