Name of the Procedure:

Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with simple or intermediate repair
Common name(s): Hidradenitis surgery, Skin excision for hidradenitis

Summary

This procedure involves the surgical removal of affected skin and the tissue underneath it to treat hidradenitis. The surgery targets areas like the perianal, perineal, or umbilical regions, followed by a simple or intermediate repair to close the wound.

Purpose

Medical condition: Hidradenitis suppurativa
Goals/Outcomes: To remove infected or inflamed tissue, reduce pain, prevent the recurrence of abscesses and sinus tracts, and improve the patient's quality of life.

Indications

• Persistent, severe hidradenitis suppurativa
• Recurrent abscesses or sinus tracts
• Pain and discomfort not relieved by other treatments
• Failed medical management including antibiotics and lifestyle changes

Preparation

• Fasting for a specific period before surgery as advised by the surgeon
• Medication adjustments, including stopping blood thinners
• Preoperative assessments like blood tests and physical examination

Procedure Description

1. Anesthesia: Administered either as local, regional, or general based on the extent of the excision and patient needs.
2. Incision: A surgeon makes an incision around the affected area.
3. Excision: Careful removal of the diseased skin and underlying subcutaneous tissue.
4. Repair: The wound is closed using either simple stitching or an intermediate repair technique.
5. Dressing: Application of a sterile dressing to protect the wound.

Tools/Equipment: Scalpels, surgical scissors, suturing materials, and possibly electrocautery devices.

Duration

Typically 1-2 hours, depending on the extent of the affected area.

Setting

Usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon: Performs the excision and repair.
• Nurses: Assist with the procedure and patient care.
• Anesthesiologist: Administers and monitors anesthesia.
• Surgical technicians: Provide support during the surgery.

Risks and Complications

Common risks: Bleeding, infection, pain, scar formation.
Rare risks: Delayed wound healing, recurrence of hidradenitis, anesthesia-related complications.

Benefits

• Relief from pain and discomfort
• Reduced risk of infection and abscess formation
• Improved quality of life
• Generally, benefits are observed within days to weeks post-surgery.

Recovery

• Post-op care: Wound care instructions provided, pain medication prescribed.
• Recovery time: Several weeks, depending on the extent of the surgery.
• Restrictions: Avoid strenuous activities and follow wound care protocols.
• Follow-up: Scheduled to monitor healing and manage any complications.

Alternatives

• Medical management: Antibiotics, anti-inflammatory medications.
• Minimally invasive procedures: Laser therapy, corticosteroid injections. Pros and cons: Non-surgical options may have less immediate risk but may not be effective for severe cases.

Patient Experience

During the procedure: Usually, patients will not feel pain due to anesthesia but may be aware of the procedure if under local or regional anesthesia.
After the procedure: Pain and discomfort managed with medication, possible temporary restrictions on activity levels, and instructions for home care to support wound healing and prevent infection.

Pain management strategies and regular follow-up appointments ensure the patient’s comfort and monitor the successful recovery from surgery.