Hidradenitis suppurativa (HS) is an uncommon disease involving chronic infection of the apocrine sweat glands. When conservative treatment fails, radical surgical excision yields the best rate of cure. The areas of involvement can include the axilla, buttocks, groin, perineum, and perianal area.
Wound closure after excision most commonly occurs via primary closure in small wounds and via secondary intention or skin grafting in large wounds. The defects that remain can be difficult to repair particularly in areas traditionally difficult to reconstruct. The present case involves the repair of disfigurement from serial excisions in the perineum utilizing medial thigh flaps.

Case Report

A healthy, 37-year-old woman was referred for assessment of perineal-thigh crease deformities. The patient had a long history of HS in the perineum and had 2 excisions in the year prior to presentation. The first excision had been closed via a layered technique that subsequently broke down. A secondary procedure with skin grafting was later performed, which apparently cleared the disease. The patient was dissatisfied with the large contour defects left by the secondary procedure (Figure 1A and 1B).
Physical examination revealed bilateral inguinoperineal defects with no evidence of recurrent disease. The patient requested surgical treatment. Excision of the skin grafts was followed by advancement of medial thigh flaps into the defects. No residual disease was noted at surgery or in the surgical specimen pathology. Follow-up at 2 months showed a good aesthetic outcome (Figure 2).