Surgery without postoperative adjuvant therapy for dissecting cellulitis of the scalp: a retrospective study of a selected cohort

Background Evidence regarding the efficacy of surgery without postoperative adjuvant therapy (SWPAT) for dissecting cellulitis of the scalp (DCS) remains limited, and objective biomarkers predicting postoperative outcomes are lacking.Objective To describe clinical outcomes after SWPAT in a selected retrospective cohort and to explore the association between baseline IHS4 and recurrence.Methods Fifty-eight DCS patients were analyzed. Receiver operating characteristic (ROC) analysis identified the optimal baseline IHS4 cutoff for recurrence prediction. Recurrence-free survival (RFS) was assessed by Kaplan-Meier analysis, and multivariable Cox proportional hazards models were constructed using a two-covariate-per-model strategy to mitigate overfitting.Results SWPAT significantly improved IHS4, VAS, and DLQI scores (all p < 0.001). Baseline IHS4 predicted recurrence with an AUC of 0.823, yielding an optimal cutoff of 11.5. Patients were stratified into a low-risk group (LRG, IHS4 ≤ 11, n = 30) and a high-risk group (HRG, IHS4 ≥ 12, n = 28). Surgical approaches were balanced between groups (p = 0.869). The HRG showed significantly shorter RFS (log-rank p < 0.001), and HRG classification remained an independent predictor of recurrence after adjustment for disease duration.Conclusions SWPAT delivers sustained benefits in this selected cohort. Baseline IHS4 ≥ 12 predicts postoperative recurrence in DCS, requiring prospective external validation and do not establish comparative efficacy.