Surgery without postoperative adjuvant therapy for dissecting cellulitis of the scalp: a retrospective study of a selected cohort.

Abstract

Background: Evidence regarding the efficacy of surgery without postoperative adjuvant therapy (SWPAT) for dissecting cellulitis of the scalp (DCS) remains limited, and objective biomarkers predicting postoperative outcomes are lacking.

Objective: To describe clinical outcomes after SWPAT in a selected retrospective cohort and to explore the association between baseline IHS4 and recurrence.

Methods: Fifty-eight DCS patients were analyzed. Receiver operating characteristic (ROC) analysis identified the optimal baseline IHS4 cutoff for recurrence prediction. Recurrence-free survival (RFS) was assessed by Kaplan-Meier analysis, and multivariable Cox proportional hazards models were constructed using a two-covariate-per-model strategy to mitigate overfitting.

Results: SWPAT significantly improved IHS4, VAS, and DLQI scores (all p < 0.001). Baseline IHS4 predicted recurrence with an AUC of 0.823, yielding an optimal cutoff of 11.5. Patients were stratified into a low-risk group (LRG, IHS4 ≤ 11, n = 30) and a high-risk group (HRG, IHS4 ≥ 12, n = 28). Surgical approaches were balanced between groups (p = 0.869). The HRG showed significantly shorter RFS (log-rank p < 0.001), and HRG classification remained an independent predictor of recurrence after adjustment for disease duration.

Conclusions: SWPAT delivers sustained benefits in this selected cohort. Baseline IHS4 ≥ 12 predicts postoperative recurrence in DCS, requiring prospective external validation and do not establish comparative efficacy.