What are the surgical options for hidradenitis suppurativa (HS)?

Updated: Aug 30, 2019
  • Author: Marina Jovanovic, MD, PhD; Chief Editor: William D James, MD  more...
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Answer

Surgery is most valuable in the chronic and recurrent stages of hidradenitis suppurativa. [5, 7] Wide surgical excision, with margins well beyond the clinical borders of activity, remains the most definitive surgical therapy. [5, 8, 9] However, although recurrence rates may be lower with aggressive surgery, recurrences often continue. [10, 11] After radical excision, the disease has been reported to recur in 33% of patients, [11] and it may be as high as 50% in the submammary region. [12]

More limited surgical intervention may include the following [13, 14, 15, 16] :

  • Drainage

  • Nd:YAG laser treatment of lesions

  • Exteriorization

  • Curettage

  • Electrocoagulation of the sinus tracts

  • Deroofing and skin-tissue-saving excision with electrosurgical peeling
  • Simple excision of the troublesome areas with direct closure

  • Reconstruction with skin grafting and negative-pressure wound healing therapy

  • Placement of local cutaneous flaps, musculocutaneous flaps, pedicled and free flaps, or skin grafts

  • Secondary-intention healing


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