Hidradenitis Suppurativa; Effects of axillary disease on range of motion, should we excise and leave open or excise and close wounds

The paper is focused on Hidradenitis Suppurativa (HS) disease which is a debilitating disease of the skin. Primary areas it effects are the axilla and groin. The way this disease is usually treated is with medications initially. However, when medications fail and the disease progresses surigcal intervention is needed. 

The two train of thoughts are excise the lesions and leave the wound open to heal versus excise the lesions and close the wounds. In closing the wounds there is a higher risk of wound break down. However, when the wound does not break down we hypothesize that patients tend to do better overall. 

The first paragraph can be a short review of HS in general.  Definition, etiology, progression of disease, treatment options, psychosocial effects, etc. 

The second paragraph should speak about the debility of the condition especially around the axilla.  Quality of life scores used in the literature. Looking at the general surgery, plastic surgery or orthopedic surgery literature to find this. Looking at the the orthopedic literature on shoulder and axilla problems related to range of motion as well to correlate it to how significant HS disease is.  HS disease is very painful and patients tend to have decrease range of motion because of this, which improves after surgery

The third paragraph should focus on the point of the manuscript. Which is surgery in the axilla in the setting of  HS infection often involves picking one school of thought.  The options would be exciseand, leave open to heal in secondarily, skin graft at a later date or other school of thought suggesting close everything and hope that most of these heal.  If it does not heal the patient would then have an open wound, but less open than no closure at all. We are hypothesizing that closing is the better option. 

P.S. Attached is an article about how to write a manuscript. I need the introduction only for now. 

Below are also other articles about the HS disease for an idea. 

Garg
A, Kirby JS, Lavian J, Lin G, Strunk A. Sex- and age-adjusted population
analysis of prevalence estimates for Hidradenitis Suppurativa in the United
States. JAMA Dermatol. 2017;153:760–764. 

Fitzsimmons
JS, Guilbert PR. A family study of hidradenitis suppurativa. J Med Genet.
1985;22:367–373. 

Von Der Werth JM, Williams
HC, Raeburn JA. The clinical genetics of hidradenitis suppurativa revisited. Br
J Dermatol. 2000;142:947–953. 

 Brown TJ, Rosen T, Orengo
IF. Hidradenitis suppurativa. South Med J. 1998;91:1107–1114.) 

Matusiak
Ł, Bieniek A, Szepietowski JC. Hidradenitis suppurativa markedly decreases
quality of life and professional activity. J Am Acad Dermatol. 2010b;62:706–708. 

Dini
V., Oranges T., Rotella L., Romanelli M. Hidradenitis suppurativa and wound
management. Int. J. Low Extrem. Wounds. 2015;14:236–244. doi:
10.1177/1534734615598890.  

Van
Rappard D.C., Mooij J.E., Mekkes J.R. Mild to moderate hidradenitis suppurativa
treated with local excision and primary closure. J. Eur. Acad. Dermatol.
Venereol. 2012;26:898–902. doi: 10.1111/j.1468-3083.2011.04203.x 

  

Lin
C.-H., Chang K.-P., Huang S.-H. Deroofing: An effective method for treating
chronic diffuse hidradenitis suppurativa. Dermatol. Surg. 2016;42:273–275.
doi: 10.1097/DSS.0000000000000609.