Stratégie chirurgicale et interventionnelle pour l'hidradénite suppurée ou maladie de Verneuil

Abstract

Surgery remains a key component in the management of advanced hidradenitis suppurativa (HS), particularly in Hurley stages 2 and 3. The recently updated European guidelines differentiate inactive vs active forms of the disease, wherein surgical intervention for residual fistulas is identified as the primary treatment approach.

However, the specific surgical techniques employed may vary. For extensive cases of HS, wide surgical excision beyond the scars and fistulas, followed by secondary intention healing and potentially utilizing split-skin grafts, is considered a gold standard. For more localized forms, deroofing is recommended. These surgical treatments not only enhance patients’ quality of life but also yield acceptable cosmetic outcomes. In instances of active disease, prior medical treatments may improve the quality of healing and reduce healing time. HS abscesses should be treated with intralesional corticosteroid injections and drainage incisions should be minimized whenever possible. For superficial fistulas located outside folds, phenolization or CO2 laser vaporization are preferred treatment options. Lastly, bariatric surgery may help to reduce the incidence of HS in cases of morbid obesity.