Using Business Tools to Establish a Multidisciplinary Care System (MCS) and Multidisciplinary Surgical Care Plan (MSCP) for Patients with Wounds from Hidradenitis Suppurativa

Wounds from Hidradenitis suppurativa (HS) are a lifelong debilitating affliction. They are difficult to treat, affect 1-4% of the population, and despite being relatively common, no definitive treatment strategies exist. Patients go from one flare-up to the next, with several medical/hospital visits.

To address this, we performed a needs assessment in the community and then designed and implemented a strategic treatment plan. First, we internally aligned potential care providers based on frequency of HS patient encounters. This data revealed potential referral sources and care providers, that then were grouped into a multidisciplinary care system (MCS) comprised of emergency departments (ER), wound centers (WC), and specialties including dermatology (DM), dermato-immunology (DI), acute-care surgery (ACS), general surgery (GS), plastic surgery (PS), infectious disease (ID) and rehabilitation medicine (RM). Ancillary care teams included social workers (SWs), case managers (CMs), and registered nurses (RNs). Then, a multidisciplinary surgical care plan (MSCP) for HS patients with Hurley Stage II or III was designed based on acuity, site, stage of HS, and previous treatment history. This included acute surgical care (abscess drainage) by ACS and intermediate antibiotic coverage by ID, followed by definitive extirpative surgery by GS and reconstruction by PS.

Extirpative surgery involved en-bloc resection of the entire affected area and the surrounding hair-bearing skin if possible (to reduce recurrence rates), followed by reconstruction using fasciocutaneous perforator or local flap reconstruction by PS. Intraoperative cultures guided the postoperative selection of antibiotics by ID. Postoperative management included in-hospital RNs, CMs, and SWs, as most patients needed help arranging home health care. Using the MSCP, patients with HS in axillae, perineal areas, groin, inframammary crease, and pannus were treated successfully. Most patients were able to fully resume their preoperative work within 12–15 weeks of surgery. Complication and recurrence rates were low. Overall patient satisfaction with the MSCP was high.

In summary, a multidisciplinary surgical care plan can provide a safe, effective, and permanent treatment option for patients suffering from Hidradenitis suppurativa.