A Plastic Surgeon’s Perspective on the Management of Complicated Cases of Hidradenitis Suppurativa

Hidradenitis suppurativa is a chronic inflammatory and recurrent cutaneous disorder that involves the apocrine glands. Axilla and inguinal regions are rich in these glands. Wide excision that involves surgical margins beyond the clinical extent of disease is recommended in Hurley stages II and III, in order to completely eliminate the disease and to prevent recurrence. After excision, these areas must be reconstructed with flaps. The various flaps that are possible for axilla resurfacing are parascapular, lateral thoracic artery perforator, thoracodorsal artery perforator, medial arm, posterior arm, and flaps. The various flaps that are possible for resurfacing of inguinal and anogenital region are anterolateral thigh, tensor fascia lata, rectus femoris, rectus abdominis, gracilis, and medial thigh flaps. In recent times, dermal templates are gaining popularity because of their versatility and ease of use. The planning of these flaps, advantages, and limitations is highlighted in this chapter.