Surgical Management of Hidradenitis Suppurativa: A 14-Year Retrospective Review of 98 Consecutive Patients.

Hidradenitis suppurativa (HS) is a debilitating suppurative disease of the apocrine/follicular glands. Medical treatment has some efficacy in early-stage disease but is costly and requires frequent physician visits. Advanced disease usually requires surgical intervention. This treatment has not been well described in the literature. We sought to review our experience with HS treatment in a large surgical cohort. A retrospective review of 98 consecutive HS patients from 2000 to 2014 was performed. A two-stage operative approach was used. The first stage involved the removal of all the hair-bearing skin in the affected areas down to healthy tissue followed by the application of split-thickness skin grafts 48 to 72 hours later. Descriptive statistics were performed to describe the population and assess outcomes. The study population was young (36 ± 12 years) and predominately female (65, 66%). The patients were obese (body mass index, 36 ± 8.3 kg/m) and smokers (73, 73.7%). The majority presented with axillary disease (73%). There were 144 debridement procedures and 146 grafting procedures performed with a mean area grafted being 416 ± 500 cm (90-3400 cm). Only nine (9%) required regrafting, with the mean area regrafted being 140 ± 93 cm. Graft failure of less than 30% did not require regrafting. At 30 days after the initial procedure, 94.7% of all wounds were fully grafted and closed. Advanced stages of HS require ablation of the infected distorted glands for control of recurrent infections. Ablative excision of HS-affected skin and wound closure with split-thickness skin grafts is a safe, reliable, and effective therapy.