Recovering After Hidradenitis Suppurativa Surgery - What to Expect

Understanding Hidradenitis Suppurativa Surgery

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by painful abscesses and lesions forming in areas where skin rubs together, like the armpits, groin, and under the breasts. For many HS patients, these lesions can severely impact quality of life. While there are medications and lifestyle changes that can help manage HS symptoms, some patients may require surgery to remove damaged tissue and promote healing.

There are several different types of surgery that may be recommended for hidradenitis suppurativa. The goals of HS surgery are typically to remove inflamed tissue, eliminate tunnels under the skin caused by the disease progression, reduce the number of lesions/abscesses, and minimize scarring. For patients with severe, recurrent symptoms that have not responded well to other treatments, surgery can provide lasting relief.

When Is Surgery Considered?

HS surgery is usually only recommended after more conservative treatments have failed to adequately control symptoms. Your dermatologist may suggest surgery if you have:

• Frequent flare-ups and abscesses in a particular area
• Tunnels (known as sinus tracts) under the skin that connect lesions
• Thick, painful scarring in the armpits, groin, or other flex areas
• Significant impact to quality of life from HS symptoms

Surgery is very much personalized to each patient. The location and severity of your lesions, amount of scarring, and your individual health profile and medical history will all be considered when determining if and what type of surgery may help.

Types of Hidradenitis Suppurativa Surgery

Some of the specific surgeries that may be used to treat hidradenitis suppurativa include:

Incision and Drainage

This minor surgical procedure can help drain large, extremely painful abscesses. It is done by making a small incision and gently squeezing out the pus and fluid inside. However, incision and drainage alone typically does not prevent new lesions/abscesses from forming.

Wide Local Excision

This is one of the most common and effective surgeries for HS. During wide local excision, the affected skin area is removed, including any sinus tracts or scar tissue underneath. The wound is left open to heal on its own. Wide local excision can minimize recurrence in the specific area treated, but does not prevent the development of new lesions in other locations.

Laser Surgery

A carbon dioxide laser can be used to vaporize lesions, tunnels, and scar tissue, layer by layer. This precise approach helps destroy diseased tissue while preserving as much healthy tissue as possible. Laser surgery can be done alone or in combination with wide local excision.

Deroofing

In this procedure, the roof or top layer of skin over a chronic lesion/tunnel is removed. Deroofing promotes drainage and allows the underlying tissue to better heal. It may be recommended when there are recurrence in the same locations despite other treatment attempts.

Radical Excision

The most extensive HS surgery, radical excision involves removing all hair follicles and scarred tissue from the affected area. This may be an option after other less invasive surgeries have failed. Radical surgery can significantly decrease recurrence but recovery can be lengthy and challenging.

What to Expect With Recovery

Recovering from hidradenitis suppurativa surgery requires patience. You will need to follow all your surgeons postoperative care instructions carefully to support healing and prevent complications like infection.

In general, you can expect:

• Activity restrictions Avoid strenuous exercise and activities for several weeks after surgery. Too much movement can impair healing.
• Incision care Incisions may need to be cleaned daily and covered with a dressing. Watch for any increased redness, swelling, oozing, or worsening pain.
• Pain management You will likely experience pain, swelling and soreness. This should gradually improve with rest, medication, and time.
• Drainage tubes You may have temporary surgical drains to help fluid build-up leave the body. Follow instructions on drain care.
• Compression garment Your doctor may recommend wearing a tight fitting garment over the surgery site to help reduce swelling.
• Time away from work Recovery may take several weeks. You may need to take medical leave or arrange to work remotely until you can resume normal activities.

Your specific recovery plan will depend on the location and extent of your surgery. Work closely with your doctor to ensure proper wound care and monitor for any complications during healing.

Results and Recurrence Risks

When successful, hidradenitis suppurativa surgery can significantly improve quality of life. Removing chronically inflamed tissue helps eliminate pain, drainage, and deformity in the affected area.

However, even after surgery, HS remains a chronic condition with the possibility of recurrence. Some patients find surgery provides lasting relief for years, while others may see symptoms gradually return. Continuing medical treatments and lifestyle adjustments can help maintain surgical results.

Recurrence risks may be higher with more limited procedures like incision and drainage. More extensive surgeries like radical excision provide the best chance for long-term remission.

Complementary Treatments

While HS surgery aims to remove existing damaged tissue, it does not correct the underlying disease process. Using complementary medical treatments and lifestyle approaches can enhance surgical outcomes and help keep symptoms in remission.

Options to discuss with your dermatologist include:

• Antibiotics
• Anti-inflammatory drugs
• Hormonal therapies
• Biologic medications
• Laser hair removal
• Smoking cessation
• Weight loss if overweight
• Avoiding heat, friction, tight clothing
• Stress reduction techniques

A customized treatment plan combining surgery with the right medications, laser treatments, and lifestyle changes offers the best chance for long-term hidradenitis suppurativa remission.

Preparing for Hidradenitis Suppurativa Surgery

Undergoing surgery of any kind can be stressful. Properly preparing for your upcoming hidradenitis suppurativa (HS) procedure can help ease some of that anxiety and support your recovery.

Here are some tips on getting ready for HS surgery:

Learn All You Can

The more you understand about your specific surgery, the less daunting it will seem. Dont be afraid to ask your surgeon questions. Important topics to review include:

• The type of surgery being performed
• Where on your body the incisions will be made
• What to expect in terms of pain and mobility post-surgery
• How long your recovery may take
• Risks and complications to watch out for

Understanding the ins and outs of your procedure will empower you to play an active role in your care.

Choose Your Support Team

Ask loved ones to assist with tasks like shopping, childcare, transportation, and home upkeep while you recover. If possible, have someone stay with you for at least the first few days after you return home.

If you'll be alone during your healing process, prepare as best you can by stocking up on groceries, medications, and other necessities ahead of time.

Get Your Home Ready

An HS-friendly environment will make recovery much more comfortable:

• Clean and declutter your home so spaces are easy to navigate
• Remove loose rugs and clutter that could cause falls
• Pick up any bath mats, loofahs, or other damp items that could harbor bacteria
• Prep healthy meals and snacks you can easily reheat
• Place items youll need often within easy reach medicines, bandages, tissues, etc.
• Adjust sleeping area with extra pillows to keep surgical areas elevated

Pack a Hospital Bag

Having personal items on-hand can increase comfort during your hospital stay. Recommended to pack:

• Phone, laptop, books, magazines to stay occupied
• Earplugs and sleep mask for restful sleep
• Comfortable, loose-fitting clothes to wear home after surgery
• Any medications you take routinely
• List of all your current medications and dosages
• Photo ID, insurance card, payment method if needed
• Toiletries like lip balm, lotion, dry shampoo
• Slippers or socks with grips on the bottom

Make an Aftercare Plan

Before your surgery date, set up any follow-up medical appointments and create a detailed plan for your at-home recovery, including:

• Wound care instructions incision cleaning, changing dressings, etc.
• Medications to manage pain and prevent infection
• Compression garment use if prescribed by your surgeon
• Restrictions on bathing, activity, driving until approved
• Signs and symptoms to watch for that may indicate complications
• Detailed list of all preparation tasks completed and help lined up from family/friends

Thorough planning takes the stress out of recovery so you can focus fully on healing.

Recovering After Hidradenitis Suppurativa Surgery

Successfully recovering after hidradenitis suppurativa (HS) surgery requires diligent at-home wound care and gradual return to normal activities under your doctors guidance. Proper aftercare minimizes complications and supports the best possible surgical results.

Caring for Your Incision

Keep your incision clean, dry, and protected:

• Follow all instructions on cleansing, dressing changes, ointment application
• Watch for increased redness, swelling, oozing, or foul odor
• Avoid submerging incisions in baths/pools until completely healed
• Use caution and keep incisions covered when showering
• Pat gently when drying to avoid tearing delicate new skin
• Avoid rubbing, bumping, or irritating incision sites

Call your doctor immediately at any sign of infection like fever, increased pain, or pus-like drainage.

Manage Any Drainage Tubes

Surgical drains are sometimes placed temporarily after surgery to prevent fluid build-up. Proper drain care is essential:

• Monitor and record drainage amount as instructed
• Clean skin around tube insertion points daily
• Anchor drains to prevent tugging or pulling
• Avoid kinking or clamping drains accidentally
• Keep drainage collection bulbs below chest level
• Notify your doctor if drainage odor changes or increases

Drains are generally removed when output drops below a certain threshold, as determined by your surgeon.

Stay on Top of Pain Control

Dont let pain spiral out of control. Stay ahead of it with:

• Prescription medication on schedule, avoid missing doses
• Over-the-counter pain relievers as needed between prescription doses
• Ice packs applied gently to surgical sites in 15-20 increments
• Comfortable, loose-fitting clothing that avoids rubbing incisions
• Rest, relaxation, and distractions like reading or listening to music
• Healthy eating and hydration to support healing

Report any severe or unrelenting pain to your doctor.

Watch for Potential Complications

Call your doctor promptly for any of the following issues:

• Fever over 101 F
• Sudden, severe increase in pain
• Heavy bleeding that soaks through dressings
• Signs of infection - redness, heat, swelling, foul odor
• No improvement in pain, swelling, or mobility after several weeks
• New lesions or abscesses forming in or near surgical sites

Rarely, serious complications like deep tissue infection or wound separation can occur. Report any worrying or unusual symptoms immediately.

Get Plenty of Rest

Your body needs extra rest while repairing surgically-treated areas. Help it out by:

• Taking time off work or limiting hours initially
• Staying off your feet as much as possible
• Accepting help from loved ones for household tasks
• Avoiding physically demanding chores and exercise
• Elevating legs periodically to improve circulation
• Sleeping more hours per night than usual
• Listening to your body - rest when tired

Dont push yourself to return to a normal schedule prematurely. Rest is crucial for proper healing.

Stay Active, Within Limits

While strenuous exercise is off-limits initially, some gentle activity can promote recovery, like:

• Light walking around the house or outside
• Gentle stretching and range of motion exercises
• Chair yoga, meditation, deep breathing
• Changing positions and moving around periodically when resting

Start slow, go at your own pace, and stop immediately if you feel pain. Listen closely to your body and surgeons guidance.

Dont Ignore Emotional Health

Its very common to feel worried, frustrated, or down at times after surgery. Coping tips include:

• Communicating openly with loved ones about your experience
• Joining a support group to connect with other HS patients
• Allowing yourself to feel and process the emotions
• Trying journaling, art, or music therapy
• Seeking counseling if mood remains very low

Prioritizing emotional healing speeds your overall recovery. Let friends and family help lift your spirits when needed.

Long-Term Outcomes After Hidradenitis Suppurativa Surgery

Hidradenitis suppurativa (HS) surgery aims to provide long-lasting relief of symptoms like recurring abscesses, tunneling lesions, and fibrotic scars in specific body areas. However, its important to have realistic expectations about its potential to cure this chronic skin condition.

Heres an overview of the longer-term outlook after HS surgery:

Results Vary

There is no definitive predictor of how successful surgery will be for an individual HS patient. Some see great improvement lasting years, while others have a temporary reduction in symptoms before gradual recurrence. Outcomes depend on:

• Severity and extent of pre-operative disease
• Type and extent of surgery performed
• Skill and experience of the surgeon
• Patient commitment to postoperative care and follow-up treatment
• Use of effective adjunctive medications and lifestyle modifications

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.