Thursday, April 11, 2024

Hidradenitis Suppurativa Surgery Before And After

You Are Not Alone With Hs

Must See Before and After! The Best Bandages for Hidradenitis Suppurativa

Dr. Richmond knows that life with HS can be difficult. Its painful, its really impactful to daily life and theres an embarrassing factor, she said. So some people are hesitant to talk about it. But, she emphasized, Youre not alone. Its a really common problem that I think people dont talk about.

Will Hidradenitis Suppurativa Removal Leave Scars

Surgical excision will result in scarring in the places where the infected tissue is removed. However, these areas tend to already be scarred due to the nature of the infection. Dr. Hadeed will make the incisions and resulting scars as inconspicuous as possible.

If skin grafts are used, there will be additional scarring at the donor site. These scars can be significant, but most patients believe scars are worth the beneficial results. All scars fade over time.

Are You A Candidate For Hidradenitis Suppurativa Surgery

If you have been diagnosed with acne inversa, also known as hidradenitis suppurativa, youve likely been in search of relief from this chronic, sometimes painful and debilitating disease. In moderate-to-severe acne inversa, antibiotics and the injected biologic adalimumab have provided clinical benefit for some patients. Though no definitive cure has been found, surgery has also been shown to be an effective treatment for many individuals. Using what is known as a wide excision, the entire diseased area, as well as a border of healthy tissue surrounding it, is surgically removed. But how do you know if you are a candidate for this procedure?

To answer this question, its important to address both how this disease physically manifests itself and how it affects your quality of life.

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Primary Suture And Flap

There are few published studies on the post-surgical management of primary closure for hidradenitis. One study highlighted that primary excision and closure with a gentamycin sulfate collagen sponge yielded a reduction in the number of postoperative complications compared to primary excision and closure without antibiotics .

Weyand suggests positioning of the drainage and systemic administration of antibiotics to prevent complications in post-surgical management of flaps in HS. It is our opinion that the indications of post-surgical management do not differ from the general recommendations on the same surgical approaches in other disease contexts.

How Do Dermatologists Diagnose Hidradenitis Suppurativa

Groin Area Hidradenitis Suppurativa Surgery

Hidradenitis suppurativa can look like another skin condition, such as worsening acne, boils, or herpes. Dermatologists have the training needed to spot the differences between HS and other conditions. This unique training allows them to diagnose HS more quickly.

If your dermatologist suspects that you may have HS, heres what typically happens. Your dermatologist will:

  • Ask where you have lumps, draining, and other signs of HS. HS tends to occur in certain areas.

  • Examine some the bumps and sores. HS has certain features, which to the trained eye, distinguish it from acne, boils, or other conditions.

  • Talk with you about what they see on your skin. Asking about your symptoms, when the bumps appear, and other specifics helps your dermatologist give you an accurate diagnosis.

If you have a sore or wound that is leaking fluid, your dermatologist may swab a bit of the fluid onto a slide and test it. This can tell your dermatologist whether you have an infection.

Thats usually all thats needed for a dermatologist to diagnose HS. If you have HS, your dermatologist will create a treatment plan tailored to your needs.

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Who Gets Hidradenitis Suppurativa

Hidradenitis suppurativa affects between 1% to 4% of people in the U.S. It is more commonly seen in females than males. Hidradenitis suppurativa is typically seen in young people, starting at puberty up to about age 40. It is also more common people who are Black, have overweight or obesity and people who smoke.

Are You Aware Of The Risk Of Recurrence

All surgical patients must understand that although hidradenitis suppurativa shouldnt return to the area that was removed, it may reappear on other parts of the body. Risk factors such as obesity, smoking, chronic skin infection, and stress have also been linked to higher likelihood of recurrence. Those who are willing to make some lifestyle changes may be more likely to have a positive outcome after surgery.

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Reconstruction After Radical Wide Excision

The choice of the reconstructive technique largely depends on the size and location of the defects. Reconstruction after radical wide excision is important to maintain function, reduce contracture, and provide good aesthetic outcomes. Nicoli et al. described an innovative treatment for severe HS using an innovative and alternative method with platelet-enriched plasma to promote neovascularization and a dermal substitute named Hyalomatrix , a delivery system for hyaluronic acid, to induce neodermis at the wound bed and to stimulate regeneration in a humid and protected environment. The procedure was well tolerated and achieved complete wound healing after 2 months. No recurrence was observed during the 1 year after the surgical procedure, as well as no wound dehiscence and no scar contractures occurred.

What To Know About Surgery For Hidradenitis Suppurativa

Surgery For Hidradenitis Suppurativa? WATCH THIS FIRST

Hidradenitis suppurativa sometimes called acne inversa is a chronic inflammatory skin condition that causes painful lumps that develop under a persons skin. When medications fail to control someones HS symptoms, surgery may be their best option.

When myHSteam interviewed Dr. Heather Richmond of the Dermatology & Laser Surgery Center in Houston, Texas, we asked about hidradenitis suppurativa surgery. We wanted to find out what everyone with HS should know and expect about the surgery. Dr. Richmond, a board-certified dermatologist with years of experience treating people with HS, laid it all out for us. Heres what she shared.

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Why And Where It Develops

Essentially, hidradenitis suppurativa starts in areas of the body where the skin tends to rub up against other skinor in areas where there are oil- and sweat-producing glands. The hair follicles become clogged with bacteria and other debris. Thats when pimples begin to form.

The condition isnt contagious, and you cant give it to someone else. Its not the result of poor hygiene, either. However, no one really knows what causes it, although experts speculate it could be due to a combination of environmental and genetic factors. It is more common in people who are overweight, people who smoke, and people with a family history of hidradenitis suppurativa. Women are also far more likely to develop the condition. And the American Academy of Dermatology notes that its possible the immune system overreacts to the clogged follicle in people who have acne inversa.

What Is Hidradenitis Suppurativa

Hidradenitis suppurativa is a painful and debilitating skin condition characterized by inflamed hair follicles or sweat glands, leading to the appearance of pimples, boils and an uncomfortable rash on the surface layers of the skin. The disorder often begins after puberty and tends to affect areas where skin rubs together like the underarms, groin, buttocks and breasts. The recurrence of the lesions after initial healing may also result in a growing web of scarring in the affected tissue. The condition can significantly impact a persons quality of life, as some individuals avoid activities and people due to the painful and noticeable symptoms.

Early signs of hidradenitis suppurative include pimples like an acne breakout. In some cases, the breakouts clear up, only to reappear. Other people might have breakouts persist. As the condition progresses, the breakouts become more severe and may include large boils that can rupture and emit a foul-smelling fluid. Scars become deeper and larger from the lesion and tracks may start to form between the lesions under the skin. The breakouts can lead to infection and rarely, skin cancer may eventually develop in the area.

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Talk With Others Who Understand

MyHSteam is the social network for people with hidradenitis suppurativa and their loved ones. On myHSteam, more than 24,000 members come together to ask questions, give advice, and share their stories with others who understand life with hidradenitis suppurativa.

Have you undergone surgery for hidradenitis suppurativa? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Options In Hidradenitis Suppurativa Surgery

Can Surgery Treat Hidradenitis Suppurativa?

There are different methods Dr. Barrett might use for your hidradenitis suppurativa surgery, depending on your specific symptoms and the severity of the condition:

  • Unroofing This process uncovers the tunnels by cutting away the skin that covers them. In many cases, this procedure only has to be performed once to achieve the desired effect.
  • Drainage and Incision Dr. Barrett can use this technique when the affected area is still relatively small. Surgical drainage of the lesions offers relief from discomfort, although the positive effects may be only temporary.
  • Excision This involves cutting the lesions out of the skin, as well as a surrounding layer of healthy skin to prevent a recurrence. If a significant amount of skin is removed, a skin graft may be required to cover the area. Even though the lesions are completely removed, other breakouts can eventually occur in other areas.

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Hidradenitis Suppurativa Surgery: Yes Or No

When I first felt those few lumps under the skin, I thought they would go away. I had them under my armpits and my breasts, and I was shy about going to the doctor. The growth was a sudden one. However, I became concerned when they didnt even after a few weeks. It was weird to feel those lumps, and I was worried whether they were tumors. Then one day I remember, one of them broke open, and it was quite painful.

I went to a doctor. He stated that it was HS, and that I may need hidradenitis suppurativa surgery. While that did bring me relief that it wasnt a tumor that I had to worry about, I knew I had to make them go away they were quite painful to deal with, and as each of them broke open, I saw foul smelling pus coming out.

Hidradenitis Suppurativa is a common type of chronic skin disease among women that normally happens in the late teen period. My doctor asked me different questions like whether I wore tight and fitting clothes, or had excessive sweating, or had experienced any significant hormonal changes. He also asked me whether I was dealing with excessive stress. Apparently, these were reasons for why it happened. The doctor also told me that environmental conditions like heat and humidity could cause it.

Leave Open To Heal By Secondary Intension

Following surgical excision of the involved area, the wound is left to heal by granulation, contraction, and epithelialisation. Secondary intention healing is recommended as a safe and efficient form of healing of postoperative defects in certain areas of the body.36 This technique avoids the morbidity associated with donor site healing as in grafts and flaps however, a long duration is required for complete healing and is limited in terms of size of wound.

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What Are The Symptoms Of Hidradenitis Suppurativa

When it first develops, hidradenitis suppurativa can have symptoms that range from mild itching and discomfort to the appearance of a red, tender, and swollen areas. Pimple- and/or boil-like bumps appear and can grow, fill with pus, and then break open. The pus that drains sometimes has a foul odor due to the presence of bacteria. Healing of the bumps can cause scarring. Symptoms vary from person to person.

In some patients, the breakouts can reoccur in the exact spot in others, breakouts occur in the same area but not in the exact same spot. Some people have constant breakouts on their skin in others, scars are the only sign present at that point in time.

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Recurrences Of Hidradenitis Suppurativa After Radical Surgery

My Hidradenitis Suppurativa Surgery
Dermatologic Surgery

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    What To Expect From Recovery After Surgery

    Aftercare from your HS surgery depends on the specific procedure. For other procedures like deroofing and excision surgery, your doctor will discuss a recovery plan with you beforehand. In general, there are some dos and donts to follow after your surgery.

    For most surgeries, its best to keep moist and covered , Dr. Daveluy advises. The most common way to accomplish this is by covering the area with a layer of petroleum jelly and a gauze bandage. Your doctor also may suggest other bandages or other products for and give you instructions on how to wrap wounds and how often to change them out. Sometimes, a device is attached to the skin that uses vacuum pressure to help eliminate drainage and promote healing, Dr. Daveluy adds. This is called vacuum-assisted closureyour healthcare provider will apply the device and you wear it throughout the duration of healing, according to Johns Hopkins Medicine.

    Healing time also varies based on the procedure. For example, when stitches are used after surgery, you may need to limit your activity for several weeks to let the skin heal and not pop the stitches out, Dr. Cotton says. Deroofing procedures can take longer to fully heal, often six to eight weeks, but people can often return to their regular activities within a few days to a week, Dr. Cotton says. Excisions that are left open to heal often fall somewhere in the middle.

    Relatively Minor Surgical Techniques

    Numerous helpful and relatively minor surgical techniques include drainage exteriorization Nd:YAG laser treatment curettage electrocoagulation of the sinus tracts simple excision of the troublesome areas with direct closure placement of local cutaneous flaps, musculocutaneous flaps, pedicled and free flaps, or skin grafts and secondary-intention healing.

    Local incision and drainage of purulent lesions are often required in the acute phase, and, although these procedures are helpful in providing short-term relief, recurrent inflammation is almost inevitable. Deroofing of sinus tracts and curettage of fistulous tracts have distinct roles as preliminary treatments before more definitive intervention, and are especially suited for recurrent hidradenitis suppurativa lesions at fixed locations in Hurley I or II stage, particularly in the acute phase of perianal disease. An alternative surgical approach may be used in so-called bridging lesions. These lesions have 2 distant cutaneous orifices connected by a subcutaneous fistula. Periorificial fusiform skin incisions are made parallel to the skin folds, followed by a viral blue dye injection for accurate visualization of the fistula tract, and the subcutaneous tubular fibrotic tissue is completely removed en bloc.

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    Skin Grafts Or Flap Closure

    Since broad excision will leave a large open area, Dr. Hadeed uses advanced plastic surgical techniques to close the wound. The options for closure of the areas include either skin grafts or flap closure.

    Flap Closure Technique

    Flap closure involves folding healthy skin over the wound and suturing it in place. This is used when the excised area is narrow with healthy skin on either side.

    The advantage of this process is that it is fast and effective, and it requires no added complexity. The disadvantage is that it can only treat some wounds and may pull your skin tight for a time.

    Skin Graft Technique

    Skin grafts involve taking a healthy section of skin from another area of the body and grafting it over the wound. This is highly effective but more complex and has a higher chance of complications. For this reason, Dr. Hadeed will perform a skin graft only when necessary.

    The advantage of a skin graft is that any size wound can be treated. The disadvantage is that a skin graft requires additional incisions in other areas of your body.

    What Is Hidradenitis Suppurativa Surgery

    Axillary Hidradenitis Suppurativa: A Further Option for Surgical ...

    While some patients with hidradenitis suppurativa see improvements with a treatment plan of skin care and medications, other patients who experience more severe forms of the disease may be candidates for surgery.

    There are a number of surgical options for hidradenitis suppurativa. Some can be handled in a doctor’s office while others take place in a hospital.

    Procedures a dermatologist may recommend include:

    • Botulinim toxin: Also known as Botox, an injection of this prescription compound may help reduce sweating, which can reduce infections in people with hidradenitis suppurativa.
    • Incision and drainage: This procedure is performed to drain pus-filled lumps that can occur in hidradenitis suppurativa. It can help reduce pain and feelings of pressure. But in most cases, the abscesses will recur.
    • Deroofing: In this procedure, the doctor removes skin that covers either an abscess or a sinus tract, a tunnel leading from the surface of the skin deep into soft tissue. Once the skin is removed, an open wound is left to heal by itself.
    • Excision surgery: This surgery involves removing an entire lesion or tunnel. This typically leaves a large wound following surgery.
    • Laser surgery: In this procedure, a laser is used to vaporize lesions associated with hidradenitis suppurativa.

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