Surgical management of advanced hidradenitis suppurativa via a one-stage procedure: A single-center experience

Hidradenitis suppurativa (HS) is a debilitating skin condition; in severe forms it requires excision and skin grafting for cure. This is commonly performed as a multi-stage procedure; we explored single-stage operation as a more efficient alternative. Retrospective review 2007–2018 evaluating outcomes of patients undergoing single-stage surgery. 139 one-stage procedures were performed: 35 excision and primary closure, 104 split-thickness skin grafting (STSG). Success rate was higher for STSG at 75% versus 60% with primary closure. Of failed primary closures, 57% required revision by grafting due to recurrence. Axilla procedures were most successful at 91% compared to 70%, 54%, and 50% for inguinal, gluteal, and perineal areas, respectively. Infection was the most common complication (17%), with 38% requiring readmission. Compared to prior literature on multi-stage HS treatment, one-stage operations are a feasible, cost-effective alternative. STSG should remain the procedure of choice, even when primary closure appears feasible. •Severe forms of hidradenitis suppurativa require excision and skin grafting.•We explored one-stage surgical treatment as an alternative for commonly performed multi-stage procedure.•Success rate was 71%; higher for skin graft at 75% vs. 60% with primary closure.•One-stage operations are a feasible, cost-effective alternative.