What is the goal of surgery 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

The goal of surgery is to achieve complete removal of lesional tissue, but it is important to spare as much healthy tissue as possible to prevent the formation of serious contractures. In order to gain both goals the Skin-Tissue sparing Excision with Electrosurgical Peeling (STEEP) procedure was developed. Wide excisions reach into the healthy deep subcutaneous fat, but the STEEP procedure with its successive tangential transsections leaves the epithelialized bottoms of the sinus tracts and a large extent of the subcutaneous fat intact, leading to more superficial and smaller defects. STEEP is done with the patient under general anesthesia. For the performance of the multiple transversal sections, electrosurgery has some important advantages over the carbon dioxide laser, since transversal electrosection is more easily controlled and adjusted by the surgeon. This leaves the epithelialized sinus bottom intact and allows deep excision of fibrotic and inflammatory tissue at the same time, while a carbon dioxide laser removes a continuous horizontal plane of one depth, making it less precise and less tissue sparing. [9]


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