Surgical management of metastatic cutaneous Crohn’s disease: a case series from a tertiary centre in the United Kingdom

Background and aims Metastatic Crohn’s disease (MCD) is a rare extra-intestinal manifestation (EIM) of Crohn’s disease (CD), defined by granulomatous inflammation of skin non-contiguous to the gastrointestinal tract. This study describes the clinical features, surgical management and wound healing outcomes of the largest national surgical cohort of patients with severe MCD, a topic that remains poorly represented in the literature. Methods This retrospective single-centre case series included adults (> 18 years) undergoing surgical management for MCD from 2019 to 2024. Diagnosis was confirmed by expert clinical and histopathological assessment. We describe pre-operative optimisation, individualised surgical approaches and post-operative management delivered by a multi-disciplinary team led by consultant colorectal and plastic surgeons. Wound healing was assessed clinically in a specialist complex wounds clinic at 6 and 12 months and at final long-term follow-up. Results Eleven female patients (median age 37 years) underwent surgical intervention. At 6 and 12 months, 45.5% achieved complete healing, improving to 81.8% by final follow-up (median 36 months). Most underwent a combined medical and surgical approach with proctocolectomy and tailored perineal reconstruction. Persistent lesions and non-healing ulcers required additional adjuncts to treatment which included topical tacrolimus, hyperbaric oxygen therapy and surgical re-excision to improve healing outcomes. Conclusions MCD is a challenging condition requiring surgical treatment in refractory cases despite medical therapy. Our study highlights the need for multidisciplinary working alongside meticulous pre-operative optimisation and close post-operative follow-up to improve long-term wound healing outcomes for patients with this rare and complex disease.