Hidradenitis Suppurativa: Radical Surgical Excisions with Staged Reconstructions: A Single-Surgeon Retrospective Review of 71 Patients.

Background: Hidradenitis suppurativa is a chronic, inflammatory disease involving the pilosebaceous unit of apocrine gland-bearing skin. Wide surgical excision, wherein margins extend beyond active lesions, is considered curative.

Objective: To evaluate the safety and efficacy of wide surgical excision in the treatment of hidradenitis suppurativa.

Methods: This single-surgeon, single-site analysis included all patients undergoing radical surgical excision of hidradenitis suppurativa between 2015 and 2019. Using paper case notes and electronic health records, researchers identified a total of 71 patients who underwent 262 surgeries.

Results: The mean number of surgeries per patient was 3.7, and the total number of sites addressed was 309. Wound dehiscence, infection, and flap necrosis were the most common complications. Disease recurrence in surgically treated areas was noted in two patients (3%).

Conclusions: For patients with failed medical management of hidradenitis suppurativa or who have otherwise developed severe disease, wide surgical excision remains a safe, effective treatment with comparatively low recurrence rates. Surgeons should consider staging surgeries, rather than performing a single-stage reconstruction, and anticipate complications.