Can a patient with hidradenitis suppurativa (HS) undergo surgery?

From the Guidelines

Yes, a patient with hidradenitis suppurativa (HS) can undergo surgery, and it is often a crucial treatment option for moderate to severe cases. Surgery may be recommended when other treatments like antibiotics (such as clindamycin, doxycycline, or rifampin), anti-inflammatory medications, or biologics (like adalimumab) have not adequately controlled symptoms 1. The type of surgery depends on the severity and location of HS lesions, ranging from incision and drainage of individual abscesses to wide excision of affected areas with skin grafting or flap reconstruction for extensive disease.

Key Considerations

• Before surgery, controlling active inflammation with medications is crucial, and patients should be advised to stop smoking as it worsens HS and can impair healing 1.
• Surgery aims to remove affected tissue containing the abnormal hair follicles and sweat glands that cause recurrent inflammation, potentially providing long-term relief.
• Even with surgery, HS can recur in other areas, and continued medical management is often necessary as part of a comprehensive treatment approach 1.

Treatment Approach

• The decision for surgical intervention should be based on an assessment of the type and extent of scarring, and an evidence-based surgical approach should be implemented 1.
• A holistic approach to treatment, including adjuvant therapy for pain management, weight loss, tobacco cessation, treatment of superinfections, and application of appropriate dressings, is recommended 1.
• Patient-reported outcomes, including quality of life assessments (DLQI) and pain evaluation (Visual Analogue Scale), are important for monitoring treatment effectiveness 1.

Evidence-Based Guidelines

• Recent guidelines from the United States and Canadian Hidradenitis Suppurativa Foundations provide a framework for the diagnosis, evaluation, and management of HS, including surgical and medical treatments 1.
• These guidelines emphasize the importance of individualized care, considering factors unique to each patient, and highlight the need for ongoing medical management even after surgical intervention 1.

From the Research

Surgical Options for Hidradenitis Suppurativa

• Patients with hidradenitis suppurativa (HS) can undergo surgery, especially in cases where the disease is severe or refractory to other treatments 2, 3, 4, 5, 6.
• Surgical options for HS include simple excision, complete local excision followed by skin graft, incision and drainage, debridement, skin graft, and flap reconstruction 2, 3, 4, 5.
• The choice of surgical procedure depends on the severity and location of the disease, as well as the patient's overall health and comorbidities 3, 4.

Efficacy and Safety of Surgical Procedures

• Studies have shown that surgical excision and reconstruction can be effective in managing HS, with high patient satisfaction rates and minimal complications 4, 5, 6.
• However, surgical procedures for HS can also be associated with risks and complications, such as bleeding, infection, and wound dehiscence 3, 4.
• The use of advanced surgical techniques, such as carbon dioxide laser excision and platelet-rich plasma gel, may improve outcomes and reduce complications 5, 6.

Factors Affecting Surgical Outcomes

• Patient characteristics, such as comorbidities and overall health, can affect surgical outcomes and increase the risk of complications 3, 4.
• The choice of surgical specialty and expertise can also impact outcomes, with plastic surgeons potentially achieving better results than general surgeons in certain cases 3.
• The use of multidisciplinary approaches and best-practice guidelines can help optimize surgical outcomes and improve patient care 4.