Radical Treatment of Verneuil's Disease: Interest of Split-Thickness Skin Grafting and Perforating Fasciocutaneous Flaps

Background: Advanced Verneuil's disease (hidradenitis suppurativa) may require radical excision, leaving substantial axillary or perineal defects for which an appropriate method of coverage must be selected Aims: To compare reconstructive coverage using split-thickness skin grafts with that using local flaps (including arm fasciocutaneous and perineal keystone flaps) after radical surgery for advanced Verneuil's disease (hidradenitis suppurativa) in the axillary and perineal regions. Place and duration of Study: Department of Plastic, Reconstructive, and Burn Surgery at the Mohamed V Military Instruction Hospital in Rabat, Morocco; with patients treated between 2019 and 2021. Methodology: A retrospective, single-centre review of five male patients presenting with axillary and perineal hidradenitis, with unilateral (two cases) or bilateral (three cases) involvement. All patients underwent radical surgical excision of the entire inflammatory and fistulous plaque, extended to the entire hair-bearing area under general anesthesia. Reconstruction was performed using either a secondary split-thickness skin graft harvested from the thigh (three cases) or single-stage coverage using flaps (two cases), specifically a fasciocutaneous flap from the inner aspect of the arm for axillary defects and a keystone fasciocutaneous flap for perineal defects. Results: The mean skin graft take rate was 90% at the first dressing change (third postoperative day), with an overall average take rate of 80%. Full graft lysis occurred in one patient, who was subsequently managed via secondary intention healing. The mean time to complete healing was 32 days for the split-thickness skin graft group, compared to 10 to 15 days for the local flaps group. The flap group demonstrated a 60% reduction in hospital stay, alongside decreased convalescence, lower postoperative functional disability, and a greater improvement in quality of life compared to the graft group. No disease recurrence was reported in either group during the follow-up period. Conclusion: Local flaps provide high-quality skin morphologically close to the recipient region, without the risk of retraction or take failure seen with split-thickness skin grafts. Flaps achieve rapid, high-quality healing in a single surgical procedure, effectively reducing hospital stay, minimising patient discomfort, lowering donor-site morbidity, and reducing overall management costs for advanced Verneuil's disease.