(CS-107) Biological Graft Use in the Treatment of Refractory Hidradenitis Suppurativa

Friday, April 10, 2026

Emma Amjad, BS; Jessica Wise, M.D. – Trauma Surgery / Emergency General Surgery – HCA Fort Walton Destin; Matthew Johnson, M.D., FACS – Trauma Surgery / Emergency General Surgery – HCA Fort Walton Destin

Introduction: Dermatologists typically manage hidradenitis suppurativa in the outpatient setting; however, severe or complicated cases may require emergent surgical intervention. We present a case in which the extent of tissue destruction prompted urgent operative management.

Methods: A 69-year-old man with a prior history of hidradenitis suppurativa previously controlled by adalimumab presented to the emergency department with a chief complaint of bilateral buttock wounds. In the emergency department, the wounds displayed severe skin breakdown, sloughing, bleeding, and exposure of subcutaneous tissue. The wounds revealed a variety of unusual microbes, and the patient suffered from anemia related to blood loss from the wounds. Ultimately, the patient was treated aggressively with surgical debridement, use of biological graft derived from porcine urinary bladder matrix, and culture specific antibiotics. Pseudomonas aeruginosa, Proteus mirabilis, and Bacteroides ovatus were cultured from the wound, differing from the typical microbiome of hidradenitis suppurativa lesions.

Results:
Postoperatively the patient was discharged after medical maximization. The patient is following up with general surgery and planning for an excision if necessary.

Discussion:
The porcine urinary bladder matrix graft is an advanced wound care tool, but its use in the treatment of hidradenitis suppurativa is not adequately discussed in literature. Empiric antibiotic treatment did not cover the typical microbes seen in hidradenitis suppurativa patients; therefore, antibiotic therapy was tailored to these findings. This case emphasizes the use of biologic grafts for the treatment of hidradenitis suppurativa and highlights the importance of antimicrobial stewardship in combination with a multidisciplinary treatment approach to these patients. Further exploration regarding the use of these grafts in hidradenitis suppurativa can alter the standard of care.