Hidradenitis Suppurativa (HS) is a chronic, inflammatory skin disease characterized by recurrent, painful nodules and abscesses, typically in body areas such as the armpits, groin, buttocks, and under the breasts. The condition often poses a significant burden on patients’ lives, affecting their mental, emotional, and physical well-being. The Canadian Hidradenitis Suppurativa Foundation strives to improve the lives and management of HS patients by raising awareness, promoting research, and educating dermatologists and the public on this complex skin disorder. One crucial aspect of this mission is creating awareness of the various treatment options available to patients, including surgical interventions that may provide relief and improve their quality of life.
Surgical solutions for HS may be considered in cases where the disease fails to respond to conservative measures such as antibiotics, hormonal therapy, or biologics, or when complications like severe scarring, sinus tracts, or persistent inflammation arise. A thorough understanding of surgical procedures, their benefits, risks, and expected outcomes, is essential to empower not only patients but also their healthcare teams, to make informed decisions about their care.
In this blog, we aim to provide an in-depth overview of the surgical options available to treat HS and shed light on their efficacy, indications, and outcomes. By exploring the intricacies of surgical interventions, we hope to guide patients and healthcare providers in navigating the challenges of this complex disease and help them make well-informed decisions in the pursuit of optimal treatment outcomes. Our goal is to give hope and practical insights to those living with HS, contributing to a brighter future for the entire community.
1. Incision and Drainage
Incision and drainage is a minimally invasive surgical procedure often used to treat acute HS abscesses. It involves making a small incision in the affected area to release pus and fluid, providing temporary relief from pain and inflammation. Although incision and drainage may offer prompt symptom relief, it does not address the underlying cause of HS or prevent the recurrence of new lesions. Therefore, this procedure is typically considered a short-term solution for acute cases or as part of a broader treatment plan.
Deroofing is a surgical technique designed to treat chronic, recurrent HS nodules and sinus tracts. The procedure involves cutting and removing the “roof” or top layer of an HS lesion, exposing and cleaning the underlying cavity. By removing the chronic inflammation’s source, deroofing encourages wound healing and potentially reduces the risk of lesion recurrence. Deroofing may be a more suitable option for patients with moderate HS or localized lesions that have not responded to conservative treatments. However, extensive disease or significant scarring may require more aggressive surgical intervention.
3. Wide Excision
A wide excision surgery involves removing the entire affected area, including the surrounding healthy tissue, to ensure complete removal of the HS lesions and prevent recurrence. This surgical treatment is typically reserved for severe HS cases, where other therapies have proven unsuccessful or when the disease has progressed to extensive scarring and widespread sinus tracts. Although wide excision offers the potential for prolonged symptom relief and better disease control, it also carries a higher risk of complications, such as wound infection, delayed healing, scarring, or recurrence. Patients should discuss their candidacy for wide excision and expected outcomes with their healthcare provider before undergoing this procedure.
4. Skin Grafting or Flap Reconstruction
In cases where wide excision leads to large, open wounds or extensive scarring, additional surgical procedures may be necessary to support healing and restore skin appearance. Skin grafting and flap reconstruction are two options for repairing large wounds following wide excision surgery. Skin grafting involves taking a thin layer of healthy skin, usually from an unaffected area of the patient’s body, and transplanting it onto the wound site to promote closure and healing. Flap reconstruction, on the other hand, entails transferring a larger section of skin, along with underlying fat and muscle, to cover and close the wound.
Both skin grafting and flap reconstruction may improve the functional and cosmetic outcomes of HS surgery but also come with their risks and complications. Patients considering these surgical options should discuss the potential benefits and risks with their healthcare provider to make an informed decision.
Surgical solutions for Hidradenitis Suppurativa, including incision and drainage, deroofing, wide excision, and skin grafting, offer hope and potential relief to those living with this challenging skin condition. The Canadian Hidradenitis Suppurativa Foundation believes that understanding these surgical options’ intricacies, risks, and outcomes is vital to empower patients and their healthcare teams in making well-informed decisions. Through a combination of surgical interventions, evidence-based medical treatments, and supportive care, HS patients can achieve improved quality of life and better disease control.
If you’re living with hidradenitis suppurativa, know that you’re not alone. The Canadian Hidradenitis Suppurativa Foundation is here to support you every step of the way. Visit our website to learn more about our resources and how we’re working to improve the lives of HS patients in Canada.