Reconstruction after Excision of Hidradenitis Suppurativa: Are Skin Grafts Better than Flaps?

1 H idradenitis suppurativa is an apocrine adenitis characterized by infection of hair follicles, which causes painful induration, sloughing, and pus drainage. Fistula formation caused by reeruptions leads to refractory and chronic disease. Although surgical treatment is considered the best option for advanced hidradenitis suppurativa,1,2 a high rate of recurrence has been reported even with wide excision and various reconstruction methods.1 Currently, there is still no consensus regarding the optimal surgical strategy. In fact, a recent systematic review and meta-analysis reported that there is insufficient evidence to show the advantages of flaps over skin grafts although they are superior to primary closure.3 In this report, we present a case of hidradenitis suppurativa in the bilateral perineal region in which reconstruction with a skin graft clearly had a better postoperative outcome than that with a skin flap. This experience provides an opportunity to reconsider the optimal reconstruction method after excision of intractable hidradenitis suppurativa in terms of recurrence.