Reconstruction of skin defects after resection of severe gluteal hidradenitis suppurativa with fasciocutaneous flaps

Background: Although skin grafting after resection of the hidradenitis suppurativa is frequently used, the contour after skin grafting is unsatisfactory. We studied four patients who suffered from severe gluteal hidradenitis suppurativa and needed total skin resection of the affected lesion. Methods: Reconstruction after total skin resection was performed with fasciocutaneous (FC) flaps of three different designs based on an arterial anatomical study: an island V-Y advancement flap based on the descending branch of the inferior gluteal artery; a rotation V-Y advancement flap based on the first perforator of the deep femoral artery and the descending branch of the inferior gluteal artery; and, a bilobed flap at each lobe containing either the descending branch or medial branch of the inferior gluteal artery. The flap designs were decided from the size and the location of the skin defect. Results: The contours after reconstruction were satisfactory and did not experience any recurrence of hidradenitis suppurativa for at least 1 year after operation. Conclusion: We showed three different designs of FC flaps to cover the gluteal skin defects based on the anatomical study. FC flaps may be chosen for reconstruction after resection of perianal hidradenitis suppurativa.