Name of the Procedure:

Excision of Skin and Subcutaneous Tissue for Hidradenitis, Axillary; with Complex Repair

Summary

This surgical procedure involves removing infected skin and underlying tissue from the underarm area, primarily to treat hidradenitis suppurativa. The repair after excision is complex and may include closing the wound with special techniques to minimize scarring and enhance healing.

Purpose

This procedure targets hidradenitis suppurativa, a chronic skin condition causing painful abscesses and scarring in the sweat gland areas, like the armpits. The primary goals are to alleviate symptoms, prevent future outbreaks, and improve the patient's quality of life.

Indications

• Chronic inflammation and infections in the underarm area (hidradenitis suppurativa)
• Frequent painful abscesses and boils
• Scarring and sinus tract formation
• Poor response to other treatments such as antibiotics or lifestyle changes

Preparation

• Follow fasting instructions, typically not eating or drinking for 8 hours before surgery.
• Discuss current medications with your doctor; may need to adjust or discontinue certain medications.
• Blood tests or imaging studies may be required to assess the extent of the condition.
• Ensure proper hygiene and avoid shaving the armpit area before surgery as advised by your doctor.

Procedure Description

1. The patient is given anesthesia, typically general anesthesia, to ensure comfort during the surgery.
2. The surgeon makes an incision to remove the affected skin and underlying tissue.
3. Complex repair techniques are utilized, which may involve skin grafts, local flap construction, or advanced suturing methods to close the wound and promote optimal healing.
4. Dressings are applied to protect the surgical site and to aid in the initial healing process.

Duration

The procedure usually takes between 1 to 3 hours, depending on the severity of the condition and the complexity of the repair needed.

Setting

The procedure is performed in a hospital or surgical center, often on an outpatient basis, but may require an overnight stay depending on individual circumstances.

Personnel

• A board-certified surgeon, often specialized in dermatology or general surgery
• Anesthesiologist to administer and monitor anesthesia
• Surgical nurses and technicians to assist during the procedure

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Scarring or cosmetic dissatisfaction
• Nerve damage leading to numbness or changes in sensation
• Recurrence of hidradenitis suppurativa
• Delayed wound healing

Benefits

• Significant reduction in pain and discomfort from abscesses and boils
• Prevention of future outbreaks in the treated area
• Improved skin appearance and reduced scarring

Recovery

• Follow surgeon's post-operative care instructions, including keeping the surgical area clean and dry.
• Pain management may include prescribed medications or over-the-counter pain relievers.
• Avoid strenuous activities and heavy lifting for several weeks.
• Attend follow-up appointments to monitor healing and remove stitches, if necessary.
• Full recovery may take a few weeks to a few months, depending on the extent of the surgery and individual healing rates.

Alternatives

• Medical management with antibiotics or anti-inflammatory medications
• Lifestyle changes, including weight management and smoking cessation
• Less invasive procedures like laser therapy or minor excisions, which may be less effective for severe cases

Patient Experience

• Will be under general anesthesia during the procedure, ensuring no pain felt.
• Post-surgery, may experience mild to moderate pain manageable with medication.
• Some discomfort, swelling, or bruising around the surgical area can be expected.
• Gradual improvement in symptoms and daily function as healing progresses.