Surgical management of hidradenitis suppurativa (acne inversa)
- Dennis P Orgill, MD, PhD
Dennis P Orgill, MD, PhD
- Associate Professor of Surgery
- Harvard Medical School
- Section Editors
- Marc G Jeschke, MD, PhD
Marc G Jeschke, MD, PhD
- Section Editor — Burn Surgery
- Director Ross Tilley Burn Centre
- Sunnybrook Health Sciences Centre
- Professor, Department of Surgery and Plastic Surgery
- University of Toronto
- Mark V Dahl, MD
Mark V Dahl, MD
- Section Editor — Acne and Rosacea
- Professor Emeritus
- Mayo Clinic College of Medicine
Hidradenitis suppurativa (HS), also known as acne inversa (AI), is a chronic, inflammatory skin disorder of the folliculopilosebaceous units characterized by the development of inflammatory nodules, pustules, sinus tracts (tunnels), and scars, primarily in intertriginous areas. Physical pain, odor, chronic drainage, and disfigurement are common features of this disorder.
The surgical management of hidradenitis suppurativa is reviewed here. The clinical features, diagnosis, and medical management are discussed separately. (See "Hidradenitis suppurativa (acne inversa): Pathogenesis, clinical features, and diagnosis" and "Hidradenitis suppurativa (acne inversa): Treatment".)
In the setting of refractory HS, surgery may be needed to remove active foci of disease and eliminate scarred tissue sequelae . Surgery should not be used in isolation; combining surgery with dietary restrictions and medical therapy provides the best chance for preventing the development of new lesions and controlling disease progress. As surgery is an invasive procedure that will result in additional scarring, prior to proceeding, the risks, benefits, and alternatives should be discussed with the patient.
Surgical procedures may be performed on individual inflammatory nodules, abscesses, or sinus tracts and in severe cases may be necessary to excise an entire affected area . The approach to treating lesions is individualized and becomes more aggressive with higher-stage HS, particularly if medical therapies have not been successful at controlling the disease. (See "Hidradenitis suppurativa (acne inversa): Treatment", section on 'Summary and recommendations'.)
Surgical techniques used to treat HS are listed and discussed in more detail below.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- GENERAL CONSIDERATIONS
- PERIOPERATIVE MEDICATION MANAGEMENT
- Preoperative treatment
- LOCAL PROCEDURES
- Punch debridement
- Unroofing (local or extensive)
- Role for I&D
- WIDE EXCISION AND RECONSTRUCTION
- Breasts and lower abdomen
- POSTOPERATIVE CARE AND FOLLOW-UP
- Negative pressure wound therapy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS