{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T12:47:06Z","timestamp":1792586826026,"version":"4.5.0"},"reference-count":105,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acad Dermatol Venereol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Surgery is central to managing the irreversible lesions of hidradenitis suppurativa (HS). Technique should be matched to disease extent: focal procedures (e.g. deroofing) for isolated or localized tunnels; regional excision (e.g. skin\u2010tissue\u2010sparing excision with electrosurgical peeling (STEEP)) for confluent tunnels; and wide excision for extensive disease. This narrative review summarizes the evidence and expert consensus on refining surgical treatment of HS. We discuss patient selection and the \u2018surgical\u2019 window of opportunity, whereby surgery performed at the right time, on medically controlled damaged tissue, yields the best results and involves the least surgical complexity. Pre\u2010operative imaging with high\u2010frequency ultrasound and, in deep or anogenital disease, magnetic resonance imaging allows accurate mapping of tunnels and margins, reducing incomplete excision and local complications. Standardized procedural terminology (lesional versus regional) clarifies the spectrum of techniques, from deroofing and skin\u2010tissue\u2010sparing excision with electrosurgical peeling (STEEP) to wide excision, each with characteristic recurrence rates. Reconstruction is individualized: secondary intention healing remains the workhorse for large defects and facilitates recurrence surveillance, while primary closure, skin grafts and flaps have specific roles and limitations. Post\u2010operative care centres on structured wound\u2010bed preparation, exudate\u2010appropriate dressings and negative\u2010pressure therapy for selected wounds. Finally, combining surgery with targeted systemic therapy is increasingly regarded as a holistic strategy; emerging randomized and observational data suggest improved response rates without a consistent rise in adverse events. We conclude that effective HS surgery is multidisciplinary, imaging\u2010guided, personalized and integrated with medical therapy, and we identify priorities for higher\u2010quality prospective research.<\/jats:p>","DOI":"10.1111\/jdv.70768","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T12:25:45Z","timestamp":1792585545000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing surgery in hidradenitis suppurativa"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6507-0534","authenticated-orcid":false,"given":"Eva","family":"Vilarrasa","sequence":"first","affiliation":[{"name":"Department of Dermatology Hospital de la Santa Creu i Sant Pau  Barcelona Spain"},{"name":"Universitat Aut\u00f2noma de Barcelona  Barcelona Spain"},{"name":"European Hidradenitis Suppurativa Foundation e.V. EHSF  Dessau Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5449-3897","authenticated-orcid":false,"given":"Philippe","family":"Guillem","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V. EHSF  Dessau Germany"},{"name":"Department of Surgery Clinique du Val d'Ouest  Ecully France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8559-3674","authenticated-orcid":false,"given":"Barbara","family":"Horv\u00e1th","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V. EHSF  Dessau Germany"},{"name":"Department of Dermatology University Medical Center Groningen, University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Romanelli","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V. EHSF  Dessau Germany"},{"name":"Department of Dermatology University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin","family":"E.Frost","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V. EHSF  Dessau Germany"},{"name":"International Centre for Hidradenitis Suppurativa\/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology Ruhr\u2010University Bochum  Bochum Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Falk G.","family":"Bechara","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V. EHSF  Dessau Germany"},{"name":"International Centre for Hidradenitis Suppurativa\/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology Ruhr\u2010University Bochum  Bochum Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6783-4534","authenticated-orcid":false,"given":"\u00d8ystein","family":"Grimstad","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V. EHSF  Dessau Germany"},{"name":"Department of Dermatology University Hospital of North\u2010Norway  Troms\u00f8 Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Martorell","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V. EHSF  Dessau Germany"},{"name":"Dermatology Department Hospital de Manises  Valencia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"issue":"5","key":"e_1_2_18_2_1","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1111\/jdv.20472","article-title":"European S2k guidelines for hidradenitis suppurativa\/acne inversa part 2: treatment","volume":"39","author":"Zouboulis CC","year":"2025","journal-title":"J Eur Acad Dermatol Venereol"},{"issue":"7","key":"e_1_2_18_3_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ad.2026.104639","article-title":"Spanish clinical management guideline for hidradenitis suppurativa. 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