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Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that severely impairs quality of life and often requires surgical intervention in advanced stages. Reconstruction after wide excision is critical to restore function, prevent recurrence, and improve patient well-being.

We retrospectively analyzed 60 patients with Hurley stage II–III HS who underwent wide excision and reconstruction between 2019–2024. Reconstruction methods included perforator flaps (n=36), split-thickness skin grafts (n=9), local flaps (n=12), and secondary intention healing (n=3). Functional outcomes, complications, recurrence, and quality of life using the Dermatology Life Quality Index (DLQI) were evaluated.

Perforator flaps were used for larger defects and provided faster wound healing (3.5 ± 0.5 weeks), shorter hospital stays (5.6 ± 1.4 days), and lower complication rates (11.1%) compared with alternative methods. No recurrences occurred in the perforator flap group, whereas grafts and secondary intention healing showed higher recurrence and contracture rates. Functional outcomes were superior with perforator flaps, with no range-of-motion limitations. DLQI scores improved markedly in the perforator flap group (19.4 ± 4.2 to 4.1 ± 2.3), demonstrating substantial enhancement in quality of life.

Perforator flap reconstruction offers well-vascularized, function-preserving coverage, reliable aesthetic outcomes, and significant quality-of-life improvement in patients with advanced HS. These findings highlight its pivotal role in reconstructive surgery, particularly in restoring function and patient well-being.

Different imaging techniques have long been used to support the planning of microsurgical reconstructions. In recent years, an increasing number of microsurgeons have begun performing ultrasound themselves, without relying on radiologists. However, achieving an adequate level of proficiency requires time and effort, and many surgeons remain hesitant to incorporate it into their practice.

In the present study, we report our experience with ultrasound to date. The device was employed in the preoperative planning of all microsurgical cases from September 2022 to the present.

Cases involving lower limb, head and neck, and breast reconstruction were analyzed, and the role of ultrasound in facilitating reconstruction and preventing complications was assessed. The time invested in learning and mastering the technique was offset by shorter operative times and a reduction in unsuccessful surgical explorations. Furthermore, additional applications of ultrasound emerged over time.

In our opinion, when considering its advantages and limitations, the use of ultrasound by the microsurgeon is worthwhile.