Surgical treatment of hidradenitis suppurativa: Comparing wide local excision with secondary intent healing versus definitive closure outcomes

Summary: <br /> Background: Hidradenitis suppurativa (HS) is a chronic follicular disorder affecting apocrine-rich areas, characterized by painful nodules, abscesses, and sinus tracts, leading to scarring and impaired quality of life. While surgical excision of lesions is a highly effective treatment modality, there is no standard approach. Objective: To compare various outcome measures associated with definitive closure (primary closure, split-thickness skin grafting (STSG), local tissue rearrangement (LTR)) versus wide local excision with secondary intent healing (WLE/SIH). Methods: A retrospective analysis of 45 HS patients with advanced disease undergoing WLE/SIH (n=29) or definitive closure (2009–2023) (n=44) were evaluated for healing time, complications, and recurrence rates. Results: A total of 45 patients underwent 73 surgical encounters for HS at a single institution. There were 44 sites treated by primary closure (n=18), STSG (n=21), or LTR (n=5); and 29 sites treated by WLE/SIH. There were no differences in comorbidities, mean body mass index, or length of hospital stay between cohorts (p>0.05). Healing time for WLE/SIH was similar to definitive closure techniques, ranging from 8-36 weeks (x=15.8 and 16.3 weeks, respectively). Primary closure had the highest complication rate (44.4%), followed by LTR (40%), STSG (8.3%), and WLE/SIH (20.7%). Recurrence was associated with 1 STSG procedure and 1 WLE/SIH procedure. While complete excision of affected tissue is the goal for HS patients, the most practical closure technique favors WLE/SIH because of the lower complication rate. Conclusion: Patients undergoing WLE/SIH demonstrated an equal healing time and recurrence rate with a lower overall complication rate. Based on these findings, WLE/SIH has become our institution's standard surgical technique for advanced HS. Owen B. Sedransk², Hansen Tai¹, Anmol Patel², Aarthi Parvathaneni¹, Khyla Hill¹, Brittany Lala², Peter Y. Ch'en², Evan Garfein², Steven Cohen¹ 1. Dermatology, Weill Cornell Medicine, New York, NY, United States. 2. Plastic Surgery, Montefiore Medical Center, New York, NY, United States. Clinical Research: Interventional Research