Name of the Procedure:

Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermediate repair

Summary

This procedure involves the surgical removal of infected skin and underlying tissue in the groin area to treat hidradenitis suppurativa, followed by repairing the area with stitches. The repair can be simple or intermediate depending on the size and complexity of the wound.

Purpose

This procedure is performed to address hidradenitis suppurativa, a chronic skin condition characterized by small, painful lumps under the skin, particularly in sweat gland-bearing areas like the groin. The goal is to eliminate the affected tissue to reduce symptoms, prevent recurrence, and improve quality of life.

Indications

• Recurrent or severe hidradenitis suppurativa
• Persistent pain, infection, or abscess formation
• Nonresponsive to conservative treatments such as antibiotics or lifestyle changes
• Significant impact on the patient's quality of life

Preparation

• Patients may need to fast for several hours before the procedure, depending on the type of anesthesia used.
• Preoperative assessment, including medical history, physical examination, and possibly blood tests
• Adjustments to medications, especially blood thinners, as instructed by the physician
• Surgical site cleaning and shaving, if necessary

Procedure Description

1. Anesthesia: The patient is given local or general anesthesia to numb the area or put them to sleep.
2. Incision: The surgeon makes an incision over the affected area in the groin.
3. Excision: Infected and inflamed skin and subcutaneous tissue are carefully removed.
4. Repair: The wound is closed with stitches. If the wound is intermediate in size, layered closure techniques may be used.
5. Dressing: A sterile dressing is applied to protect the wound.

Tools and equipment include scalpels, surgical scissors, forceps, sutures, and sterile dressings.

Duration

The procedure typically takes 30 to 60 minutes.

Setting

This procedure can be performed in a hospital operating room or an outpatient surgical center.

Personnel

• Surgeon
• Surgical nurse
• Anesthesiologist (if general anesthesia is used)
• Operating room technician

Risks and Complications

• Infection
• Bleeding or hematoma
• Pain and discomfort
• Scarring
• Recurrence of hidradenitis
• Adverse reaction to anesthesia

Benefits

• Relief from painful and recurrent lumps
• Reduced risk of infection and abscess formation
• Improved quality of life
• Decreased likelihood of recurrence

Recovery

• Patients may be advised to rest and avoid strenuous activities for a few days.
• Instructions on wound care and signs of infection to watch for
• Pain management with prescribed medications
• Follow-up appointments for wound inspection and suture removal

Alternatives

• Conservative treatments, including antibiotics and lifestyle changes
• Incision and drainage of abscesses
• Laser therapy
• Biologic treatments or systemic medications

Pros of alternatives: Non-surgical options can be less invasive and have shorter recovery times.

Cons of alternatives: They may not be effective for severe or recurrent cases and may have additional side effects.

Patient Experience

During the procedure, the patient should experience minimal discomfort due to anesthesia. Post-procedure, pain and swelling are common but manageable with medication. Patients will need to care for the surgical area and may experience some limitations in movement. Overall, many patients report significant improvement in their condition following the procedure.