Hidradenitis Suppurativa: Surgical Management

Hidradenitis suppurativa (HS) is a chronic, debilitating disease affecting between 1 and 4% of the global population. The exact etiology of HS remains unclear. More recent evidence suggests the continuous cycle of inflammation in HS is initiated by follicular plugging, or occlusion from hyperkeratosis and hyperplasia of the infundibular epithelium. Diagnosis of HS is clinical, relying heavily on a thorough history and physical exam. Lifestyle changes and medical management are the first-line treatments for a new diagnosis of HS. Surgical procedures are oftentimes reserved for those unresponsive to topical and system medical management, or have severe stage III, persistent disease. Wide excision of all neighboring affected areas is associated with some of the lowest recorded rates of recurrence. Defects following wide excision can be reconstructed with skin grafts depending on the location and depth of the defect. Fasciocutaneous and musculocutaneous flaps continue to gain popularity in recent years for their ability to cover large defects with superior aesthetic outcomes and overall improvement in quality of life.