Surgical options in hidradenitis suppurativa

Abstract

Hidradenitis suppurativa is a chronic, debilitating disease managed by both medications and surgical therapies. The purpose of this study is to determine the indications for surgical therapies and compare the various surgical options for the treatment of hidradenitis suppurativa. A PubMed search found 32 articles on surgical therapies for hidradenitis. Search terms included hidradenitis suppurativa, cryoinsufflation, laser therapies, reconstructive surgery, and surgical therapies. About 88.9% of patients with Hurley Stage II/III are referred to surgery. Wide excision is superior to local excision based on consistently lower recurrence rates and high patient satisfaction. Healing by primary closure is inferior to skin graft and flap. Recurrence rate is most dependent on disease severity rather than the type of surgical procedure. Surgical options are offered alongside medical therapies as part of the treatment protocol. Procedures range from minimally invasive to aggressive therapies with variable recurrence rates. Minimally invasive surgeries produce better results in Hurley Stage I/II and aggressive options, such as wide excision, are superior to other options in patients with the more severe disease. Poor surgical candidates include those with comorbidities such type 2 diabetes mellitus which limits the use of more aggressive surgical interventions.

Keywords

• cryoinsufflation
• deroofing
• hidradenitis suppurativa
• laser
• local excision
• wide excision