Surgical Outcomes of Hidradenitis Suppurativa Excision: Factors Impacting Wound Healing Time

Hidradenitis suppurativa (HS) can be treated surgically to excise recurrent and recalcitrant regions of disease activity. However, surgical outcomes are highly variable depending on closure method, concomitant medical management and area of excision. In this study, we aim to characterise the healing courses from HS excision in a case series. To reduce operator variability, we opted to conduct a case series from a single surgeon. Surgeries conducted from June 2024-December 2025 by surgeon S.T. were included, and the postoperative course was followed until February 2026. Surgical details and postoperative course for 34 sites of HS across 20 patients were analysed. For operations undergoing primary closure (14/34), median wound healing time was 131 days, while sites healing by secondary intention (20/34) had a median wound healing time of 161 days. Four out of seven surgically closed sites on patients undergoing tumour necrosis factor alpha (TNF-α) inhibitor therapy experienced dehiscence, while six out of ten surgically closed sites while the patient was on interleukin-17 (IL-17) inhibition experienced dehiscence. Surgical excision of HS with either primary or secondary closure had a median wound healing time of 138 days. Primary closure of excisions, even with mobilisation of flaps to reduce tension, results in high rates of dehiscence, especially for patients on adjuvant biologic therapy. Our limited case series observed high rates of dehiscence amongst patients receiving either IL-17 inhibitors or TNF-α inhibitors. To our knowledge, this is the first study comparing wound healing between patients on TNF-α inhibitors versus IL-17 inhibitors versus no biologic therapy. HS patients considering surgery should be counselled on these possible risks and expected wound healing times for primary versus secondary intention healing.