Adjunctive Hyperbaric Oxygen Therapy in the Multimodal Management of Refractory Gluteal Hidradenitis Suppurativa: A Case Report

Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disorder characterized by recurrent nodules, abscesses, and sinus tracts, frequently leading to significant morbidity. Severe cases often require surgical intervention, and multimodal approaches are increasingly being explored to optimize outcomes. Case Presentation: We report the case of a 49-year-old male with long-standing, treatment-refractory Hurley III HS affecting the gluteal and proximal thigh regions. Despite lifestyle modifications and pharmacologic therapies, including antibiotics, methotrexate, and biologic treatment with adalimumab, there was no sustained clinical improvement. The patient subsequently underwent wide local excision followed by perioperative adjunctive hyperbaric oxygen therapy (HBOT) and reconstructive skin grafting as part of a multimodal salvage strategy. First, a wide local excision of the affected regions was performed, targeting areas with the most extensive disease activity. In the second stage, HBOT was administered to enhance granulation, reduce edema, and promote wound bed preparation. Finally, the patient underwent plastic reconstruction with split-thickness skin grafts and a tie-over dressing. Postoperative recovery was uneventful, with excellent graft integration and significant improvement in local inflammation, pain, and functional status. The patient was discharged ambulating and resumed daily activities without significant limitations. Conclusion: This case highlights the potential role of HBOT as a perioperative adjunct in refractory gluteal HS after failure of anti-TNF therapy with adalimumab. In this setting, the combination of wide surgical excision, adjunctive HBOT, and reconstructive skin grafting resulted in satisfactory healing and functional recovery.