Types of Surgeries

Hidradenitis Suppurativa Surgery

Overview

What is hidradenitis suppurativa (HS)? It is a condition characterized by small, painful lumps that form under the skin. These lumps usually occur in areas where your skin rubs together, causing friction. Thus, HS can typically be found in the armpits, groin, buttocks and under the breasts. Moreover, the lumps heal slowly, are prone to recurrence, and can lead to keloids (thickened, raised scars) and subdermal “tunnels”.

Symptoms of HS include:

  • Small, painful lumps.

  • Sores full of pus that can leak.

  • “Tunnels” under the skin that connect from lump to lump.

  • Pitted blackheads around the affected area of the skin.

Why?

Patients of HS often report the condition starting after puberty, persisting for many years and worsening over time. It can have serious effects on your emotional and mental well-being. Surgical treatment may be recommended for patients who have problems with chronic recurrence and want to treat the disease before it gets any worse.

All surgeries, whether they be big or small, carry risks. For HS surgery, these typically include:

Risks

Risks of Surgery

  • Infection of the surgical site.
  • Development of keloids (a thickened scar).
  • Excessive bleeding.
  • Pain, swelling, itchiness or tenderness at the site of incision.
  • Loss of sensation surrounding the surgical area if nerve endings need to be cut. This may be temporary or permanent depending on the damage.
  • Recurrence of HS after surgery (the chance of the disease returning is high).

What to expect prior to your surgery

You may need to take antibiotics before surgery. Routine blood work is usually not needed but may be ordered prior to surgery based on the patient's age and the presence of any existing medical problems.

HS surgery is a minor kind of surgery and is done on an outpatient basis (you will be able to go home after the surgery is completed). Before your surgery, a nurse or doctor will plan the site, clean the affected area, and consult with you for any questions you may have. Then, they will numb the area using a local anesthetic so that you won’t feel any discomfort during the procedure.

The procedure itself can last anywhere between a few minutes to an hour depending on the complexity of the disease at the time of surgery. Typically, your doctor will give you a heads-up on how long the procedure should last.

The procedure

There are many different types of ways to tackle this disease through surgery. Your doctor will recommend a type of surgery for you based on factors like how many growths you have, whether you are prone to recurrence, the affected area of the body, what stage of HS you have, etc.

Types of HS surgery include:

  • Wide excision: complete removal of the lumps (often along with surrounding healthy tissue). Wide excision is considered the most invasive type of surgery. Skin grafts may be required. Sometimes, general anesthesia will be used to sedate the patient rather than local anesthesia for this technique.

  • Tissue-sparing excision: removal of the affected skin, but excludes the surrounding healthy tissue. This technique is less invasive than wide excision, but recurrence is more likely to occur.

  • Local excision: the removal of one lump/growth at a time.

  • Deroofing: the surgeon removes the “roof” or top part of the tissue with surgical scissors, a laser, or electrosurgery. Leads to less scarring.

  • Incision and drainage: the surgeon curs open the lumps and drains them. This is the quickest technique for pain relief, but has the highest chance of recurrence.

After the procedure

Recovery time for HS surgery will vary, but you should feel back to normal within a few days to weeks depending on whether or not you received stitches. Be sure to keep the area clean and dry to avoid the possibility of infection. Itchiness or soreness is common, however let your doctor know if you experience swelling or excessive pain.

You will need to arrange for a ride home the day of your surgery and we recommend someone stay with you for the first 24 hours at home. When you leave the facility after surgery, we will want you to go home and rest. Avoid making any other plans on the day of your surgery. Starting the following day, you can increase your activity as you feel up to it.

You will likely be given a prescription for pain medication following your surgery. The recovery nurse will discuss a pain control plan following surgery specific to you and your needs including activities like ice applied over incisions and a medication regimen. Oftentimes we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication.

Did you know we have a support group?

Your questions and concerns have most likely been asked and answered in our support group. Moderated by our dietitian's, nurses, and staff. We provide you with reliable patient education and resources to help you throughout this life-changing process.