Immediate versus Delayed Wound Closure in Hidradenitis Suppurativa Surgery: A Comparative Outcomes Study

Background  Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting approximately 1% of young adults. Severe and refractory disease commonly requires surgical excision of the affected skin. To date, there is no consensus regarding the most appropriate reconstructive algorithm. Materials and Methods  We conducted a retrospective cohort study including all HS patients who underwent surgical excision in the framework of our multidisciplinary clinic. Operative data and postoperative outcome measures were compared between patients who underwent immediate versus delayed reconstruction. Additionally, reconstructive methods were compared and risk factors for adverse postoperative outcome were identified. Results  A total of 103 patients underwent 158 surgeries for HS excision. The overall complication rate was significantly higher in patients who underwent immediate versus delayed wound closure (31 vs. 16%, p  = 0.039). Any intervention for wound closure (immediate or delayed) was associated with increased risk of postoperative complications in comparison to secondary healing (33 vs. 4%, p  < 0.001). With delayed closure, the average time to wound closure was 85.4 days with secondary healing only and 57 days with negative pressure wound therapy assisted closure. Conclusion  Risk factors for adverse postoperative outcome in HS surgery are multifactorial and involve both timing and method of reconstruction in addition to various patient factors. The findings of this study strengthen the notion that delayed closure of post-HS excision wounds leads to the most uneventful course in regard to postoperative adverse events; however, this may take up to 3 months. Upon deciding on a reconstructive plan, the risk-to-benefit ratio should be assessed individually weighing the pros and cons of immediate closure and delayed secondary intention.