Abstract
CO2 Laser Excision as a Surgical Approach for Severe Hidradenitis Suppurativa
Lasers in surgery and medicine, v 58(S38), pp S29-S29
30 Jul 2026
Abstract
Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disorder that presents with painful nodules, abscesses, draining tunnels, and scarring, preferentially affecting intertriginous regions including the axillae, inframammary folds, groin, and buttocks. Procedural intervention alongside medical management is necessary in moderate to severe disease, particularly since conservative and targeted therapies often fail to achieve adequate symptom and disease control (1).
Excision and marsupialization with carbon dioxide (CO2) laser has the advantage of offering ambulatory based surgery with local anesthesia, along with the potential for improved long‐term outcomes including lower recurrence rates (2,3). Evaluation of surgical outcomes after excision for HS is limited and is largely to case reports with non‐standardized functional outcomes. Herein, we report our early experiences with CO2 excision in patients with advanced disease focusing on safety, healing dynamics, tolerability, and recurrence.
Study Design/Materials and Method: We performed a retrospective chart review of patients with Hurley stage III HS who underwent CO2 laser excision and marsupialization. Extracted variables included demographics, surgical site, post‐operative pain (numeric scale 0‐10 numeric, when available), time to complete healing, recurrence, and complications. Complete healing time was defined as full re‐epithelialization without drainage or open sinus. Recurrence was defined as presence of new inflammatory nodules, abscesses, or tunnels occurring within or immediately adjacent to the surgical site. Data were compiled into a structured outcomes table, and descriptive analysis was performed.
Results: Seven patients (six male, one female; age range 17‐64 years) underwent excision with CO2 laser involving axillary, inframammary, or thigh regions. Follow‐up ranged from 1 to 9.9 months. Minimal postoperative pain was recorded in all evaluable cases, with most entries documenting scores of zero. One patient reported positional discomfort (8/10) related to shoulder movement rather than incision‐based pain. No major postoperative complications, functional deficits, or wound‐related adverse events were reported. Time to healing varied from approximately 3 to 6 months for cases with documented closure timelines. Recurrence was uncommon: most treated anatomical fields demonstrated no active disease at last follow‐up, while mild recurrence occurred in a minority of sites. Overall healing patterns aligned with expected secondary‐intention closure following large‐area excisional procedures. This report is limited by small sample size and variable follow‐up period.
Conclusion: Excision with CO2 laser of inflammatory plaques in advanced HS may be a potentially effective and well‐tolerated approach for patients also optimized on medical therapies. Prospective studies evaluating standardized outcomes and comparing excision modalities may inform best practices and refine integration into procedural care pathways for patients with moderate to severe HS.
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Details
- Title
- CO2 Laser Excision as a Surgical Approach for Severe Hidradenitis Suppurativa
- Creators
- Jared Kahn - Northwell HealthKelly Frasier - Northwell HealthAmit Garg - Northwell HealthAlex Silberzweig - Hofstra UniversityAlexander T Velaoras - Drexel University, College of Medicine
- Publication Details
- Lasers in surgery and medicine, v 58(S38), pp S29-S29
- Number of pages
- 1
- Resource Type
- Abstract
- Academic Unit
- College of Medicine
- Other Identifier
- 991022208045004721