A differentiated approach to radical surgical treatment of chronic suppurative hidradenitis

Background. Hidradenitis suppurativa (HS) is a severe chronic inflammatory disease affecting apocrine gland-bearing skin, characterized by a persistent relapsing course with abscess formation, sinus tracts, and scarring. The disease significantly impairs patients' quality of life and leads to substantial social disability. The lack of standardized treatment approaches necessitates the systematization of surgical experience. Objective. To evaluate the effectiveness of radical surgical treatment for extensive chronic hidradenitis suppurativa. Materials and methods. The study included 15 patients (14 males, 1 female) aged 20 to 60 years with a prolonged disease history and multiple previous surgical interventions. Disease severity was assessed using the H.J. Hurley classification (1989). All patients were diagnosed with Hurley stage II or III disease. The condition was predominantly multilocal: 47 affected sites were identified in 15 patients. Surgical treatment consisted of radical excision of pathologically altered tissues followed by wound irrigation and primary closure. When primary closure was not feasible, split-thickness skin grafting was performed. No more than two anatomical regions were operated on during a single hospitalization. Results. In stage II disease, primary wound healing was achieved in 100% of cases. In stage III, primary wound closure was possible in 50% of cases; the remaining cases required skin grafting. At long-term follow-up (12 months postoperatively), no disease recurrence was observed in any patient. Conclusion. Radical surgical excision of affected tissues is an effective treatment method for Hurley stage II–III hidradenitis suppurativa, ensuring no recurrence within one year of follow-up. In stage III disease, primary skin grafting is advisable for closure of extensive postoperative defects.