Name of the Procedure:

Excision of Skin and Subcutaneous Tissue for Hidradenitis, Axillary; with Simple or Intermediate Repair

Summary

This procedure involves surgically removing the affected skin and underlying tissue in the axillary (underarm) area that has been damaged by hidradenitis suppurativa. It is followed by simple or intermediate repair of the area to promote healing.

Purpose

This procedure targets hidradenitis suppurativa, a chronic skin condition characterized by painful lumps and abscesses. The goal is to remove infected or inflamed tissue to reduce symptoms, prevent recurrence, and improve the quality of life by creating a healthier tissue environment.

Indications

• Persistent, painful lumps or abscesses in the axillary area
• Failure to respond to other treatments such as antibiotics or lifestyle changes
• Severe stages of hidradenitis suppurativa
• Recurrent infections and formation of fistulas

Preparation

• Patients may be instructed to fast for 6-8 hours prior to surgery.
• Adjustments to medication, such as pausing blood thinners.
• Preoperative assessment including blood tests, and medical history review.

Procedure Description

1. The patient is positioned appropriately in the surgical suite.
2. Local or general anesthesia is administered.
3. A scalpel is used to excise the affected skin and subcutaneous tissue.
4. The area is cleaned, and any excess fluid is drained.
5. The wound is closed using stitches with a simple or intermediate repair technique.
6. Sterile dressing is applied to the site post-closure.

Duration

The procedure typically takes about 1 to 2 hours, depending on the extent of the tissue excision.

Setting

The procedure is usually performed in a hospital or outpatient surgical center.

Personnel

• Surgeon
• Surgical nurses
• Anesthesiologist (if general anesthesia is used)
• Surgical technician

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Scarring and issues with wound healing
• Recurrence of hidradenitis suppurativa in the same or different location
• Adverse reactions to anesthesia

Benefits

• Reduction in pain and inflammation
• Prevention of future flare-ups in the treated area
• Improved mobility and comfort
• Increased quality of life

Recovery

• Keep the area clean and dry; follow wound care instructions.
• Monitor for signs of infection.
• Limit physical activity to avoid stress on the wound.
• Follow-up appointment within one to two weeks post-procedure.
• Full recovery may take several weeks.

Alternatives

• Oral or topical antibiotics
• Corticosteroid injections
• Laser treatments
• Other surgical options like laser excision or wider extensive tissue removal
• Pros of alternatives: Less invasive, quicker recovery
• Cons of alternatives: Potential lower efficacy in severe cases

Patient Experience

During the procedure, anesthesia ensures minimal to no pain. Post-procedure, patients may experience discomfort, swelling, and bruising which can be managed with prescribed pain medications and proper wound care. Most patients can return to normal activities within a few weeks, although complete healing may take longer.