A Multicenter Comparison of Reconstruction Strategies after Wide Excision for Severe Axillary Hidradenitis Suppurativa

An appropriate reconstruction strategy after wide excision for severe cases of axillary hidradenitis suppurativa (HS) is important to optimize outcomes, but no consensus exists on which reconstruction strategy should be preferred. OBJECTIVE: Evaluate which reconstruction strategy after wide excision in patients with severe axillary HS is associated with improved outcomes in terms of recurrence rate, complications, post-reconstruction limb function, aesthetics, and patient satisfaction. METHODS: Retrospective analysis between 2008 and 2018 of wide excision and reconstruction by primary closure (PC), secondary intention healing (SIH), split thickness skin grafts (STSG), or fasciocutaneous flaps (FCF). The primary endpoint was the rate of recurrence during follow-up. RESULTS: A total of 107 surgical interventions were performed on 54 patients. The overall recurrence rate was 31.8% after a median follow-up of 30 months, with a significant difference between PC (48%), SIH (16%), STSG (29%), and FCF (10%) (P = 0.03). Surgical complications requiring reoperation occurred in 2% after PC, 0% after SIH, 13% after STSG, and 15% after FCF (P = 0.11). The median score regarding function, aesthetics, and satisfaction after all interventions was 17 out of 20 points, but the score was lower after FCF than PC, SIH, and STSG (P = 0.03). CONCLUSIONS: Reconstruction by PC should be reserved for patients with limited HS lesions, whereas FCF was most effective in avoiding recurrence, but was associated with unfavorable short-term results and patient-reported outcomes regarding function and aesthetics. FCF should generally be reserved for patients with recurrent, severe HS comprising an extensive surface of the axillary skin.