Emergent surgical management of refractory hidradenitis suppurativa: A case report and literature review

Hidradenitis suppurativa (HS) is routinely managed in the outpatient setting by dermatologists, but can less commonly necessitate emergent surgical treatment. A 69-year-old man with a prior history of hidradenitis suppurativa previously controlled by adalimumab presented to the emergency department with bilateral buttock wounds. In the emergency department, the wounds displayed severe skin breakdown, sloughing, bleeding, and exposure of subcutaneous tissue. Ultimately, the patient was treated aggressively with surgical debridement, use of Myriad Morcell™ grafts, and culture-specific antibiotics. The Myriad Morcell™ graft is an advanced wound care technique, but its use in the treatment of hidradenitis suppurativa is not adequately discussed in the literature. The wounds revealed a variety of unusual microbes, and the patient suffered from anemia related to blood loss from the wounds. Pseudomonas aeruginosa, Proteus mirabilis, and Bacteroides ovatus were cultured from the wound, differing from the typical microbiome of hidradenitis suppurativa lesions. Empiric antibiotic treatment did not cover the typical microbes seen in HS patients; therefore, antibiotic therapy was tailored to these findings. This case emphasizes the use of Myriad Morcell™ grafts for the treatment of hidradenitis suppurativa. It also highlights the importance of antimicrobial stewardship in combination with a multidisciplinary treatment approach to these patients.