Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disorder that involves the infundibular terminal follicles in areas rich of apocrine glands and associated with formation of abscesses and fistulating sinus [1-5]. The pathogenesis of the disease is not fully understood, although it was reported that HS is androgen dependent that can be associated with endocrine abnormalities [6]. Bacterial infection is considered as a secondary event in the pathogenesis. Furthermore, smoking and obesity are both known as risk factors and may increase the severity of the disease [1, 6].
Clinical manifestations include painful nodules, abscesses, sinus tracts, and ropelike hypertrophic scars in the apocrine gland-bearing areas [7]. Consequently, the abscesses extend deeper into the subcutaneous tissue and then intercommunicating sinus tracts develop, resulting in irregular hypertrophic scars [8]. Hidradenitis suppurativa was initially classified by using Hurley’s Staging System (Table 1) [9].
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Likewise, Sartorius et al. have suggested that the Hurley system is not enough to assess the efficacy of the treatment. Therefore, they described the Sartorius Staging System. Points are accumulated in each category to assess the treatment of HS in an accurate way [11]. The Sartorius Staging System [12] accumulates points according to:
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· Anatomic regions involved
· Number and types of lesions involved (abscesses, nodules, fistulas, scars, points for lesions of all regions involved)
· The distance between lesions, in particular the longest distance between two relevant lesions (i.e. nodules and fistulas in each region or size if only one lesion present)
· The presence of normal skin in between lesions
It is indeed a challenging aspect and requires a proper treatment plan that may involve different specialties. Hidradenitis suppurativa is commonly misdiagnosed and sometimes even referred to many subspecialties [13]. In general, treatment includes the use of topical or systemic antibiotics, topical antiseptics and intralesional corticosteroids. Furthermore, systemic retinoids, antiandrogen therapy, immunotherapy (TNF alfa inhibitors) and oral immunosuppressive agents have also shown a positive effect on disease progression [10, 12]. However, for most cases of advanced hidradenitis suppurativa, radical surgery can be the only curative treatment option [14]. It is also reported that early wide surgical excision is important and effective in order to prevent complications and the recurrence of hidradenitis suppurativa and to improve the quality of life [15].
This article focuses on the surgical treatment of hidradenitis suppurativa with special regard to the methods of reconstruction for resulted defects after wide surgical excision in the axilla, inguinal region, gluteal region, trunk, perineal and perianal area. The rate of recurrence will be also reviewed. Furthermore, a review of the literature regarding surgical treatment of hidradenitis suppurativa is provided.
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