Hidradenitis Suppurativa

Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that causes painful nodules, abscesses, drainage, and tunnels beneath the skin. It most commonly affects areas where skin rubs together, including the armpits, groin, buttocks, and genital or perineal region.

Because HS is a chronic condition that can affect multiple areas of the body, surgery does not cure the underlying disease. Instead, surgery is used to treat areas of persistent or advanced disease that are particularly painful, frequently draining, scarred, or limiting daily activities.

The goal is to reduce the burden of disease while preserving as much healthy tissue and function as possible.

Surgical Treatment

The appropriate operation depends on the severity and extent of the disease.

• Incision and Drainage: Used primarily for an acutely painful abscess when immediate drainage is needed. Although this can provide short-term relief, it does not remove the underlying HS and recurrence is common.
• Unroofing: A less extensive procedure used to open chronic HS tunnels and allow them to heal from the inside out. This can be effective for localized disease while preserving surrounding healthy tissue.
• Wide Excision: Used for areas of extensive or longstanding disease in which chronically inflamed, scarred, and interconnected tissue needs to be removed. Wide excision is often the most definitive surgical treatment for a severely affected area.

Reconstruction

After extensive HS is removed, reconstruction must be carefully planned to balance complete removal of diseased tissue with preservation of function and a manageable recovery.

Depending on the size and location of the defect, options may include:

• Primary closure, when the surrounding tissue can be brought together without excessive tension
• Healing by secondary intention, allowing the wound to heal gradually on its own
• Skin grafting, using a split-thickness skin graft to provide durable coverage
• Local or regional skin flaps, which move healthy, well-vascularized tissue into the area after disease has been removed
• Staged reconstruction, when a large or complex defect is best managed in multiple steps

Reconstruction of HS defects can be particularly challenging in the groin, genital, and perineal regions, where healing, mobility, hygiene, and sexual and urinary function all need to be considered.

Our approach is to remove the tissue that is causing the greatest disease burden while preserving as much healthy tissue as possible. When reconstruction is necessary, we select the simplest technique that provides durable coverage and a reliable recovery, reserving more complex flap or staged procedures for patients who truly need them.

Because HS can recur elsewhere even after successful surgery, long-term management often combines surgical treatment with medical therapy and attention to other areas of disease. The goal is to provide meaningful, durable improvement in the areas that are most significantly affecting the patient's quality of life.