Surgical approaches in the management of hidradenitis suppurativa: Techniques, risks, and clinical outcomes.

Background: Hidradenitis suppurativa (HS) is a chronic, progressive, inflammatory dermatologic condition that affects intertriginous areas with high concentrations of apocrine glands. Initial management is medical; however, surgical excision and wound reconstruction are indicated for severe or refractory disease. This study evaluated current surgical techniques for HS and analyzed their associated risks and reported outcomes. Methods: A review of the literature was conducted to assess surgical approaches, including incision and drainage, deroofing, local excision, wide excision, cryoinsufflation, and laser therapies. Reported complication and recurrence rates were analyzed. Results: Wide excision is favored over less extensive techniques for Hurley stage II and III HS, with lower recurrence and complication rates. The estimated overall complication rate for surgical treatment is 11.1% (95% confidence interval [CI], 6.4%-16.9%), and the estimated overall recurrence rate is 16.2% (95% CI, 9.1%-24.9%). Conclusion: These findings support a more aggressive surgical approach when minimizing recurrence is a primary goal. Procedure selection should be individualized based on patient lifestyle, comorbidities, disease location, and long-term efficacy. Further rigorous research into emerging multidisciplinary therapies and surgical innovations is needed to establish an improved standard of care for HS.