Object:
Hidradenitis suppurativa (HS) is a chronic inflammatory disease, which is multifactorial, recurrent, and debilitating. The pathogenesis including suppurating sinus tracts/tunnels and significant scarring over intertriginous areas of apocrine gland-bearing skin contributes to quality-of-life impairments in young patients. The timing of surgical ablation plays a key role in addition to conservative treatment with medication. In this study, we integrated four moderate to severe cases, under different reconstructive methods post excision separately, into a complete case report, willing to get the inkling of surgical timing under the basis of literature review and practical experience.

Material and Method:
We collected the cases who were diagnosed with HS and searched for surgical intervention in our institute. The location, lesion type, and medical recorded were reviewed. All the cases received wide excision and simultaneous reconstruction. Four different ways of reconstructive techniques were performed, including primary closure, local flap, pedicled flap, and free flap. Both of clinician-reported outcome and patient-reported outcome were reviewed.

Result:
Four cases were included in this study, and the lesions varied from bilateral axilla, inguinal, back, buttock, perianal, and posterior thigh. We evaluate the patient reported outcome by “36-Item Short Form Survey (SF-36)” and “The patient and observer scar assessment scale (POSAS)”. Moreover, there was no local recurrence by now in parallel with medication management throughout the process of surgical intervention.

Conclusion:
In the past, surgical management was the last place of treatment to HS due to high recurrent and infective rates. When medical treatment alone is less likely to improve patient’s clinical condition or quality of social life, surgical management should be considered. In recent studies, rather than sequential application, medical treatment combined with surgery is more encouraged, besides, simultaneous reconstruction still remains challenging to plastic surgeon. The choice of reconstructive ways remains multifactorial, which depends on size and location of the defect, patient’s compliance, or surgeon’s experience. Individual approaches are thus necessary. In conclusion, this study displays a complete case report as an option to treatment plan of HS, from different locations of lesions to variable ways to reconstruction with good outcomes, both functional and aesthetical. Furthermore, timing of surgery may be moved up once goals of surgery established as soon as patient could get more benefits from surgical management, being released from disease burden.