A Modified Tissue-Saving Technique with Silver Nitrate to Obliterate Tunnels for Hidradenitis Suppurativa.

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis characterized by recurrent nodules, abscesses, draining sinus tracts, and scar formation, predominantly affecting intertriginous areas. The associated pain, drainage, and scarring significantly diminish the quality of life of affected individuals. Surgical interventions for HS lesions include excision, traditional deroofing techniques, and a simpler mini-deroofing method (punch debridement). Here we present a further modification to mini-deroofing: the application of silver nitrate into the tunnel to achieve tunnel obliteration and expedite healing. A 41-year-old woman with Hurley stage 2 HS, despite multiple rounds of antibiotics and steroid injections, developed a nodule that progressed to form a tunnel, causing considerable discomfort. A mini-deroofing technique followed by silver nitrate application into the tunnel was performed with complete resolution of the tunnel at the 3-week follow-up. The application of silver nitrate offers several advantages over traditional deroofing methods, including reduced procedure time and faster healing due to a minimized wound surface area. Silver nitrate facilitates chemical debridement, promoting an expedited and less painful recovery. Moreover, this in-clinic procedure does not require a dedicated visit, making it a convenient and effective option for managing HS, particularly in patients with early-stage disease.