A combined approach of several surgical modalities may be required for complex HS. A combination of incisional drainage, un-roong, debridement, and primary and secondary inten­tion is often used for complex cases. For large, extensive areas of disease, staged excision is often employed. The authors prefer to divide areas of HS disease into functional anatomic regions and address each separately, with an eye on preserv­ing anatomic function for the treatment duration. For instance, a patient with bilateral perianal, perineal, and inguinal disease may be treated with four smaller staged debridements, with each debridement addressing a quadrant of active dis­ease (right inguinal, left inguinal, left anal margin, right anal margin) whereby preserving relatively normal function in the remaining three quadrants. Such staged strategies allow a patient to rest or weight-bear on healed (or yet- to- be treated) tissue until the active surgical area heals.