Key points

■ The surgical method chosen in each case depends on several factors, including the region(s) involved, as well as the type and severity of hidradenitis suppurativa (HS)

■ Incision and drainage may sometimes lead to temporary control of symptoms but is best avoided since the abscesses almost inevitably recur

■ Simple excisions with primary closure or exteriorization, curettage and electrocoagulation of the sinus tracts may be sufficient in milder forms

■ Wide and radical excision, well beyond the clinical borders of activity, serves as the golden standard treatment, regardless of the localization of HS

■ Vaporization with carbon dioxide laser is a sufficient surgical method for early treatment in moderate forms

■ Healing by secondary intention is a convenient alternative to reconstruction using skin grafts or flaps

Contents

22.1 Introduction 161

22.2 Methods of Closure 164

22.3 Anatomical Regions Involved 165

22.3.1 Axillary HS 165

22.3.2 Inguinal Disease 165

22.3.3 Gluteal-Perianal-Perineal Disease 165

22.4 Excision Margins 166

22.5 Complications 166

22.5.1 Recurrent Disease After Surgery 167

22.6 Carbon Dioxide Laser Surgery in HS 167

22.6.1 Anesthesia 168

22.6.2 Postoperative Wound Care 168

22.6.3 Practical Hints and Comments 168

22.6.3.1 The Carbon Dioxide Laser Technique . .. 168

22.6.3.2 The Use of Scanners 169

22.6.3.3 How Radical Should the Therapy Be? ... 170

22.6.3.4 Concluding Remarks 171

References 171

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