Surgical Management of Hidradenitis Suppurativa

BACKGROUNDHidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by painful nodules, abscesses, and subcutaneous tunnels. HS often leads to intractable draining wounds and scarring. Complete regional excision (CRE) is highly effective; however, no consensus exists regarding closure approaches, including primary suture-closure (PSC), split-thickness skin grafting (STSG), flaps, or healing by secondary intention (CRE/SIH).

METHODSWe retrospectively analyzed records of 60 patients with advanced HS who underwent CRE/SIH or suture-closure between February 2009 and April 2025. All patients were treated by a single surgeon. The primary outcome was any postoperative complication. Associations between closure type and complications were estimated using generalized estimating equations to account for multiple surgical sites per patient. Recurrence was a secondary outcome.

RESULTSSixty patients underwent 122 CREs. Seventy-three wounds were managed by CRE/SIH and 49 by suture-closure (PSC, n = 22; STSG, n = 22; flap, n = 5). Suture-closure patients were older than CRE/SIH patients (mean [SD], 40.8 [12.6] vs. 33.2 [9.9] years; p = 0.012). Complication rates were highest for flaps (60%), followed by PSC (31.8%), STSG (22.7%), and CRE/SIH (12.3%). Primary suture-closure and flap complications were uniformly wound dehiscence; CRE/SIH complications predominantly involved bleeding. In adjusted analyses, suture-closure was associated with increased odds of complication compared with CRE/SIH (adjusted odds ratio [aOR] 4.82, 95% confidence interval [95% CI] 1.82-12.79; p = 0.002). One recurrence occurred after STSG.

CONCLUSIONSAmong patients undergoing CRE for advanced HS, CRE/SIH was associated with the lowest complication rate and low observed recurrence rates, supporting its use as an effective and potentially lower-risk reconstructive strategy.

Abstract from PubMed