Trephine (“punch-debridement”) grattage: A definitive surgical approach for acute purulent inflammatory lesions of hidradenitis suppurativa

Summary: Background: Trephine (“punch-debridement”) grattage (TG) is an underutilized surgical procedure for treating purulent hidradenitis suppurativa (HS) lesions. While considered promising, the technique has not been standardized. Recurrence rates and aesthetic outcomes have not been studied (1). Objective: Investigating the value of TG for acute purulent lesions of HS. Methods: We performed TG on exudative inflammatory lesions. Under local anesthesia, a 6-8 mm trephine was used to enter the cavity; exudate manually drained; and, the cavity swabbed with a gauze-wrapped-probe. Once biofilm and blood clots were removed, the cavity walls/floor were scraped with a 5-6 mm curette to remove granulation tissue. A pressure dressing was applied for 36-48 hours. Nineteen patients underwent TG. Demographics, wound healing, complications, and recurrence rates were obtained from electronic medical records. All patients were surveyed with standardized questions addressing pre- and post-treatment mood, quality of life, pain, drainage, and measures of satisfaction. Results: Mean participant age was 35 years; 11 females/8 males; race/ethnic distribution: 8 Black, 6 Spanish/Hispanic /Latino, and 5 White. 15 patients were pain free one week after the procedure and the remaining four patients described minimal pain (1-2/10). 15 patients described complete healing in <2 weeks and the remaining patients healed within 2-4 weeks . Eighteen patients (95%) would undergo the procedure again. A majority of patients (14/19) rated their scar’s aesthetic outcome as 5/5.There were no complications or recurrences. Other highly positive outcome measures included quality of life, mood, drainage, and itch. Pain level pre- and post-TG showed statistically significant decreases. Discussion: Incision and drainage, the standard of care for purulent HS lesions, has high recurrence rates (2). Using TG we encountered no complications or recurrence, high rates of satisfaction, and excellent aesthetic outcomes. Aarthi Parvathaneni¹, Khyla Hill¹, Hansen Tai¹, Steven Cohen¹ 1. Dermatology, Weill Cornell Medicine, New York, NY, United States. Clinical Research: Interventional Research