Trephine Grattage: Optimizing the Surgical Approach for Acute Abscesses in Hidradenitis Suppurativa

Trephine grattage (TG) (also known as "punch-debridement") is an underutilized surgical procedure for acute abscesses in hidradenitis suppurativa (HS). While previously described, the technique has neither been standardized nor studied for recurrence rates and other outcomes.

The aim of this study was to retrospectively investigate TG for the treatment of HS abscesses.

We performed 30 cases of TG on 26 patients receiving care at the Weill Cornell Dermatology Center for HS. Demographics and wound healing parameters were retrieved from electronic medical records. Patient satisfaction was evaluated post-treatment using a standardized questionnaire.

Characterization of our cohort included: age: $\overline{x}$  = 33.7 years; gender: 16 females/10 males; ethnicity/race: 9 Black, 9 White, 8 Spanish/Hispanic/Latino. All participants reported minimal or no pain 1 week postoperatively; wound healing was complete in less than 4 weeks in all cases. Other than 4 (13%) transient, focal recurrences, no complications were observed. Highly positive outcome measures included quality-of-life, mood, drainage, and itch. In 29 of 30 procedure-specific questionnaires (97%), patients reported they would undergo TG again, and in all 30 procedure-specific questionnaires (100%), patients reported that they would recommend TG to a friend. A majority rated aesthetic outcomes as desirable.

While incision and drainage is the standard of care for HS abscesses, recurrences are frequent. Using TG, we encountered no complications, a recurrence rate of 13%, high levels of patient satisfaction, and excellent aesthetic outcomes. These findings warrant further study.