Defining Surgical Recurrence Patterns in Hidradenitis Suppurativa: Insights from 206 Procedures and Literature Review

Surgical treatment is a key strategy for managing advanced hidradenitis suppurativa (HS), but postoperative recurrence remains a challenge. Understanding recurrence patterns and associated risk factors may help improve outcomes. The objectives were to evaluate surgical outcomes in patients with HS undergoing wide excision, to characterise surgical recurrence patterns, and to identify factors associated with each recurrence type.

This was a retrospective, observational, single-centre study conducted on patients who underwent HS surgical procedures between 2018 and 2024. Demographic, clinical, surgical and follow-up data were analysed. Recurrence was defined as the reappearance of inflammatory lesions within 1 cm of the surgical scar and subclassified as tunnel or abscess/inflammatory nodule (AN) recurrence.

A total of 165 patients underwent 206 surgical procedures. Wide excision with secondary intention healing was the most common approach. The mean time to complete wound healing was 46.4 days. The overall recurrence rate was 18.5%, with tunnel recurrence in 8.3% and AN recurrence in 10.2%. Tunnel recurrence was associated with Hurley stage III, larger and deeper excisions and higher postoperative IHS4 scores, while AN recurrence was associated with BMI > 30 and preoperative ultrasound assessment. In multivariate analysis of overall recurrence, excised area was the only independent predictor (OR per cm², 1.03; p = 0.020), while poorer preoperative inflammatory control and lack of ultrasound assessment showed trends toward increased risk.

Differentiating between recurrence types may better reflect true surgical failure. Tunnel recurrence should be prioritized when evaluating surgical outcomes. Preoperative ultrasound and postoperative inflammatory control are key factors in minimizing recurrence.