MOdified DEroofing With Scar Excision (MODES Procedure) for the Surgical Treatment of Hidradenitis Suppurativa

November 21, 2022

This plain-language research summary was generated by AI, courtesy of HS Simplified.

AI Generated Content Verified By: So Yeon Paek, M.D. | Meridien Dermatology

MOdified DEroofing With Scar Excision (MODES Procedure) for the Surgical Treatment of Hidradenitis Suppurativa

In 2022, a new surgical technique called the MODES procedure, which stands for "Modified Deroofing with Scar Excision," was published to treat Hidradenitis Suppurativa (HS), a chronic skin condition marked by painful, inflamed lesions. By identifying and removing scar tissue from sinus tracts—under-skin channels—the procedure aims to improve recovery outcomes and reduce recurrence rates. This approach may offer an advanced solution for dermatologists managing this stubborn and often recurrent disease.

A New Way to Treat Hidradenitis Suppurativa: The MODES Procedure

Hidradenitis suppurativa (HS) is a long-lasting skin disease that causes painful bumps, tunnels, and scars, especially in places where skin rubs together, like the armpits or groin. These bumps can break open and leak fluid, and they sometimes form sinus tracts—small tunnels under the skin. HS can be hard to treat, especially when it keeps coming back even after medication.

Traditional Surgeries for HS

Doctors have used different surgeries to help patients with HS, such as:

• Deroofing: Opening up the tunnels without necessarily removing the tissue around them. It helps wounds heal faster, but the tunnel often comes back.

• Wide Local Excision: Taking out all the affected skin with extra tissue around it. This has a lower chance of HS coming back, but it takes a long time to heal and can be painful.

• STEEP: Removing tunnels and scars using a special electric tool. This procedure is more complicated and done in a hospital.

What is the MODES Procedure?

Paek and their team developed a new surgery called MODES—which stands for Modified Deroofing with Scar Excision. This procedure is done in the doctor’s office and can be used for all stages of HS, from mild to severe.

The MODES procedure works like this:

1. The doctor finds the sinus tracts and marks them on the skin.

2. They numb the area with medicine so the patient doesn’t feel pain.

3. A probe is used to find the tunnels under the skin, and a blade opens up the top of these tunnels.

4. Any connected tunnels are also opened.

5. Scar tissue around and at the base of the tunnels is cut out, removing the tissue that may cause the disease to come back.

6. The area is cleaned and any bleeding is stopped.

7. Instead of stitching the wound closed, it is left open to heal naturally while being covered with protective dressings.

How Does MODES Compare?

The MODES procedure has some advantages:

• Lower chance of HS coming back compared to regular deroofing (about 18%, and as low as 6% in some cases).

• Faster healing (about 5 weeks) than wide excision (which can take up to 14 weeks).

• It can be done in a clinic with numbing medicine, not needing full anesthesia or a hospital stay.

• Removes scar tissue that might hide more tunnels, lowering the risk of the disease returning.

Limitations and Important Notes

The MODES procedure may not work for everyone, and there can still be bleeding and a chance of infection, just like with other surgeries. Because the wound is left open, patients need to take care of it every day for several weeks. Also, this article did not provide detailed numbers or long-term results for all patients, so more research is needed to know how well it works over many years.

It’s important to know that Dr. Paek, one of the researchers, works with companies that make medicines for skin diseases, but the study did not receive any money from outside sources.

Why This Matters

HS can be very tough for patients, causing pain and embarrassment. The MODES procedure gives doctors another way to help people with HS, especially if other treatments haven't worked. By removing hidden scar tissue, it may help keep the disease from coming back as often, and it can be done without a hospital stay. This gives hope for better, faster healing for people struggling with HS.

Author(s)

Marcus Zaayman, Aaminah Azhar, Annika Silfvast-Kaiser, Charlotte Y Jeong, So Yeon Paek

Read Original Paper

https://journals.sagepub.com/doi/10.1177/12034754221138246