Name of the Procedure:

Excision of Skin and Subcutaneous Tissue for Hidradenitis, Perianal, Perineal, or Umbilical; with Complex Repair

Summary

This procedure involves the surgical removal of affected skin and underlying tissue in areas such as the perianal, perineal, or umbilical regions. It includes a complex repair to ensure proper healing and minimize scarring.

Purpose

The procedure addresses severe cases of hidradenitis suppurativa, a chronic skin condition causing painful lumps under the skin. The goals are to remove diseased tissue, reduce inflammation, prevent infection, and promote healing.

Indications

• Chronic hidradenitis suppurativa unresponsive to other treatments
• Recurrent abscesses or sinus tracts in the perianal, perineal, or umbilical areas
• Severe pain, swelling, or infection at the affected site

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to medications, especially blood thinners, may be necessary.
• Pre-operative imaging or blood tests might be required.

Procedure Description

1. The patient is put under anesthesia, usually general anesthesia.
2. The surgeon makes an incision to access the affected area.
3. Diseased skin and subcutaneous tissue are excised.
4. Complex repair techniques, such as skin grafts or flaps, are used to close the wound and ensure optimal healing.
5. The area is cleaned and dressed.

Duration

The procedure typically takes 1 to 3 hours, depending on the extent of the tissue removal and complexity of the repair.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses
• Possibly a plastic or reconstructive surgeon for complex repairs

Risks and Complications

• Common: Pain, bleeding, infection, scarring
• Rare: Damage to surrounding tissues, adverse reaction to anesthesia, delayed wound healing
• Management: Proper wound care, antibiotics, pain management

Benefits

• Removal of infected or diseased tissue
• Reduction of pain and discomfort
• Prevention of recurrent infections
• Improved quality of life

Recovery

• Patients may need to take antibiotics and pain relievers post-surgery.
• Wound care instructions will be provided.
• Recovery time is typically 2 to 6 weeks with follow-up appointments for monitoring.
• Any restrictions on activities will be advised by the doctor.

Alternatives

• Medical management with antibiotics and anti-inflammatory medications
• Laser therapy or minimally invasive drainage
• These alternatives may vary in effectiveness and not provide a permanent solution like surgery.

Patient Experience

• During the procedure, the patient is under anesthesia and feels no pain.
• Post-procedurally, there may be pain and discomfort in the treated area, managed with prescribed medications.
• Patients should anticipate some time off work or regular activities to allow for healing.