Surgical Treatment of Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory skin disease that causes painful nodules, abscesses, and tunneling sinus tracts in areas rich is apocrine glands, such as armpits, groin, buttocks, and inner thighs. It disproportionately affects young adults and is significantly more common in women than men. The disease stems from follicular occlusion followed by rupture and secondary inflammation, though its precise cause is not fully understood. Because HS is chronic by nature, "management can often be unsatisfactory and challenging due to the chronic nature of the disease and its adverse impact on quality of life" (Shukla et al.). Treatment typically begins with medications but often requires surgical intervention when the disease advances or fails to respond to medical therapy alone. 

When conservative treatments prove insufficient, surgery becomes the primary option for managing HS. common surgical procedures include incision and drainage for acute abscess relief, deroofing to remove tunnels while preserving surrounding skin, and wide local excision to eliminate all affected tissue in severe cases. According to Mayo Clinic, "treatment with medicines, surgery or both can help control symptoms and prevent complications of hidradenitis suppurativa" (no author). The extent of surgery depends on the stage and spread of the disease, and no single procedure is considered universally superior. Recurrence rates vary by technique, with wide excision generally offering the lowest rates of disease return but requiring longer recovery.  

Recovery after surgery depends on the procedure performed and the extent of tissue removed. Wounds from wide excision are commonly left open to heal by secondary intention, a gradual process that can take several weeks. Patients must follow strict wound care routines, keep the area clean and dry, and monitor for signs of infection. Maintaining a healthy weight, avoiding smoking, and continuing any prescribed biologic or antibiotic therapy can all reduce the chance of recurrence. While surgery does not guarantee a permanent cure, it significantly reduces pain and disease burden, helping patients reclaim a better quality of life.

Written by Malak Ibrahim at Incisionary

References

Mayo Clinic. (2022, November 4). Hidradenitis suppurativa – Diagnosis and treatment.https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/diagnosis-treatment/drc-20352311

Shukla, V. V., et al. (2022). Awake spine surgery: An eye-opening movement. Surgical Neurology International, 12, 222. https://pmc.ncbi.nlm.nih.gov/articles/PMC9101712/

Taylor, E. M., Hamaguchi, R., Kramer, K. M., Kimball, A. B., & Orgill, D. P. (2021). Plastic surgical management of hidradenitis suppurativa. Plastic and Reconstructive Surgery, 147(3), 479–491. https://www.hs-foundation.org/plastic-surgical-management-of-hidradenitis-suppurativa