Surgical Management of Hidradenitis Suppurativa: A Two-Center Retrospective Study.

BACKGROUND: Hidradenitis suppurativa is a chronic inflammatory condition that presents a challenging reconstructive problem for plastic surgeons. METHODS: The authors performed a retrospective chart review of hidradenitis suppurativa patients managed with surgical excision between 2005 and 2020 at Brigham and Women's Hospital and Tulane University Medical Center. Operative cases associated with the same hospitalization were organized into treatment episodes and assessed for patient demographics, operative techniques, and outcomes. RESULTS: A total of 181 patients, 435 cases and 316 treatment episodes (Brigham and Women's Hospital, n = 269; Tulane University Medical Center, n = 47), were identified across two diverse institutions. Their respective series showed comparable patient demographics, and 94 percent of the combined episodes achieved wound closure and healing during the study period. Several techniques of closure were identified, including immediate closure and site-specific methods, such as an expedited staged closure using internal negative-pressure wound therapy as a temporary bridge, "recycled" skin grafting, and repurposing iodoform wicks as an adjunct wound healing therapy to immediate closure. CONCLUSIONS: This large multi-institutional retrospective chart review on the plastic surgical management of hidradenitis suppurativa demonstrates that surgery is an effective therapy for hidradenitis suppurativa and captures a diversity of site-specific techniques that may serve as a foundation for future prospective studies and evidence-based guidelines for the use of various techniques to optimize patients' surgical outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Plastic Surgical Management of Hidradenitis Suppurativa.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe the pathogenesis of hidradenitis suppurativa. 2. Discuss perioperative multimodal therapy of hidradenitis suppurativa, including medical optimization. 3. Determine an appropriate surgical plan with excision and reconstruction based on hidradenitis suppurativa severity, size, and anatomical location. SUMMARY: Successful treatment of hidradenitis suppurativa requires a multidisciplinary team approach and multimodal therapy.

Tumour exosome integrins determine organotropic metastasis.

Ever since Stephen Paget's 1889 hypothesis, metastatic organotropism has remained one of cancer's greatest mysteries. Here we demonstrate that exosomes from mouse and human lung-, liver- and brain-tropic tumour cells fuse preferentially with resident cells at their predicted destination, namely lung fibroblasts and epithelial cells, liver Kupffer cells and brain endothelial cells. We show that tumour-derived exosomes uptaken by organ-specific cells prepare the pre-metastatic niche. Treatment with exosomes from lung-tropic models redirected the metastasis of bone-tropic tumour cells. Exosome proteomics revealed distinct integrin expression patterns, in which the exosomal integrins α6ß4 and α6ß1 were associated with lung metastasis, while exosomal integrin αvß5 was linked to liver metastasis. Targeting the integrins α6ß4 and αvß5 decreased exosome uptake, as well as lung and liver metastasis, respectively. We demonstrate that exosome integrin uptake by resident cells activates Src phosphorylation and pro-inflammatory S100 gene expression. Finally, our clinical data indicate that exosomal integrins could be used to predict organ-specific metastasis.