Beyond excision: modern plastic surgery techniques for hidradenitis suppurativa reconstruction

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterized by recurrent abscesses, sinus tract formation and extensive scarring. In severe cases, surgical excision and complex reconstruction are often required. This case report aims to highlight the role of modern plastic surgical techniques, including regenerative technologies, in managing severe HS. A 37-year-old Hispanic male with a 17-year history of HS presented with extensive lesions involving the buttocks, groin, genitalia, thighs and perianal region. He underwent staged wide excisions totaling over 2,400 cm². Reconstruction included split-thickness skin grafts (STSG), NovoSorb^® BTM (Biodegradable Temporizing Matrix) and RECELL^® autologous skin cell suspension. Postoperative recovery was marked by successful graft take, wound healing and return to normal function, including physical activity and sexual function, by postoperative day 69. This case underscores both the complexity of managing stage III HS and the evolving role of regenerative technologies in improving outcomes. While wide local excision remains the cornerstone of treatment for extensive disease, adjunctive use of BTM and RECELL enhances dermal regeneration, reduces donor-site morbidity and optimizes aesthetic and functional results. These innovations reflect a shift in reconstructive strategy, emphasizing a more tailored, patient-centered approach. The integration of regenerative modalities such as Biodegradable Temporizing Matrix (BTM) and RECELL autologous cell suspension technology into contemporary plastic surgical reconstruction offers significant benefits in treating severe hidradenitis suppurativa. By complementing traditional excisional techniques, these technologies contribute to improved healing, minimized morbidity and restored function, aligning with the goals of modern, multidisciplinary HS management.