Hidradenitis suppurativa. A case report Ann Ital Chir - 2023, 12 - May 8 - Online Epub 1 Ann Ital Chir, 2023; 12 - May 8 pii: S2239253X23038306 Online Epub Pervenuto in Redazione Giugno 2022. Accettato per la pubblicazione Dicembre 2022 Correspondence to: Emilia Maria Pătruţ, CF Clinical Hospital Cluj- Napoca, 4th, Surgical Clinic 18, Republicii Street, 400015, Cluj- Napoca, Romania, (e-mail: emilia.patrut@gmail.com) Ovidiu Fabian*/**, Emilia Maria Pătruţ*/**, Flaviu Mureşan*/**, Olga Hilda Orăşan*/*, Angela Cozma*/**, Mădălina Șteţca***, Octavian Vana**, Maximilian Vlad Muntean*/**** *Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania **CF Clinical Hospital, Cluj-Napoca, Romania ***Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania ****Ion Chiricuţă Oncological Institute, Cluj-Napoca, Romania Hidradenitis suppurativa. A case report. Hidradenitis suppurativa is a disease with underestimated incidence, consequences and treatment difculty. Regarded as a minor illness, for the patient it is disabling physically and socially, and for the doctor it is a challenge in choosing the appropriate treatment. We present the case of a 28-year-old man who presented with an advanced and persistent form of hidradenitis treated in a general surgery department. Solving the case combined conservative and surgical treat- ment (wide excisions, plasties with fasciocutaneous superior gluteal artery perforator fap, thoracodorsal artery perforator fap, free anterolateral thigh fap). Tis case illustrates the problems raised by a seemingly trivial disease. KEY WORDS: Fasciocutaneous Superior Gluteal Artery Perforator Flap, Follicular Occlusion, Free Anterolateral Tigh Flap, Hidradenitis Suppurativa, Skin Ulcer, Skin Fold, Toracodorsal Artery Perforator Flap gory leads to a possible efect of sex steroid hormones (androgens, in particular 9 ) on the apocrine sweat glands, but not all observations support this hypothesis 10 . Te disease belongs to the follicular occlusion tetrad, which also includes acne conglobata, dissecting cellulitis of the scalp and pilonidal sinus 11 . Te factors that cause the obstruction are extremely var- ied: genetic, hormonal, immunological, mechanical (using antiperspirants, hair shaving), constitutional (obe- sity) factors are incriminated as well as overexposure to heat and smoking 12-15 . However, poor hygiene is not a cause of hidradenitis 12 , which is consistent with the pathophysiological mechanism: infection is a secondary phenomenon 16 . Following the obstruction of the ducts of the apocrine glands, the glands dilate and rupture; secondary infection occurs, with the formation of abscess- es and fstulas with branched trajectories. Chronic infammation leads to fbrosis and the appearance of retractile scars 2,13,17 . Te anatomic regions most commonly afected are the axilla and groin, but the disease also occurs in mam- mary and submammary regions, perineum and sacral region 18 . Te distribution of lesions largely corresponds Introduction Hidradenitis suppurativa (Verneuil disease) is a chronic infammatory disease caused by obstruction of the ducts of apocrine glands 1 . Although the frst description of the disease, made by Alfred Velpeau, dates back to 1839 2 , and the connection with the sweat glands was made by Aristide Verneuil in 1854 2 , only in 2009 a defni- tion of the disease was adopted by consensus 3,4 . Te disease occurs after puberty, although there have been communicated cases of hidradenitis in children on the verge of puberty 5-8 . On the other hand, the disease is less common in men after 50 years and in post- menopausal women. Te association with this age cate- Digital Edition e-publish on-line ISSN 2239-253X Direttore Nicola Picardi