(CS-135) Rethinking Surgery for Hidradenitis Suppurativa: A Staged Reconstruction with Resection, Repair with Restrata, and Recell

Nihal Sriramaneni, BS – Research Fellow, New Jersey Medical School; Mark Granick, MD – Medical Director University Hospital Wound Center, Department of Surgery, New Jersey Medical School

Introduction:

Traditional surgical approaches for hidradenitis suppurativa (HS) have remained largely unchanged for more than half a century. Patients with chronic, severe disease have historically undergone wide local excision with healing by secondary intention, and when feasible, skin grafting allowed for coverage of open wounds. Recent advances have focused on skin substitutes and regenerative materials that promote granulation even over poorly vascularized surfaces, creating a dermis-like layer capable of accepting skin grafts. However, the anatomic locations commonly affected by HS are prone to significant pain, poor graft adherence, high infection rates, and frequent reoperation, contributing to prolonged recovery and increased healthcare utilization. To address these limitations, the authors are utilizing newer medical products and technologies designed to enhance granulation, improve wound closure, and optimize outcomes for patients with HS.

 

Methods:
A two-stage reconstructive approach was developed incorporating modern wound care technologies. Stage 1 involves wide local excision, wound cleansing with hypochlorous acid wound solution°, and placement of a granular synthetic wound matrix*. After approximately one month, adequate granulation develops to permit Stage 2 closure. At Stage 2, the superficial granulation layer is debrided using a hydrosurgery system‡, and final wound closure is performed with a 3:1 meshed split-thickness skin graft (STSG) combined with spray-on autologous skin cell suspension†.

A retrospective chart review identified recent patients undergoing this staged approach. Time from Stage 1 to Stage 2 was measured as a proxy for granulation tissue maturity. Wound closure and recurrence were also evaluated.
 

Results:
Six consecutive patients met inclusion criteria (two female, four male). Surgical sites included the axilla, perineum, perianal region, buttock, and scrotum. Mean defect size was 220 cm² (range, 100–375 cm²). The mean interval from Stage 1 to Stage 2 was 22.7 days (SD, 11.91). Five of six patients reported postoperative pain after Stage 1. All patients achieved complete wound closure following Stage 2, with no recurrence during early follow-up and high patient satisfaction.


Discussion:
This staged reconstructive approach, integrating synthetic wound matrices and regenerative principles, offers an effective and reproducible option for HS management. Early outcomes demonstrate reliable closure and favorable patient-reported results. Further investigation is warranted to better understand and mitigate postoperative pain.