Surgery might be your best option for relief if you have inflamed deep tunnels and hard lumps (nodules) within your skin caused by advanced hidradenitis suppurativa.

While effective, due to the potential for scarring this treatment is usually reserved for people who have advanced hidradenitis suppurativa or whose condition can't be managed with lifestyle changes or medication.

If you're interested in surgery to treat your hidradenitis suppurativa, here's what you need to know.

Your doctor or surgeon can use several different procedures to remove nodules, lesions and tracts beneath your skin and help control inflammation. Options include:

• Incision and drainage. During this procedure your doctor will cut your skin and drain fluid from your lesion. The effects aren't long-term and won't prevent future lesions from forming, but the procedure can be helpful if you need immediate relief from a painful lesion. After the procedure your wound will be packed with sterile dressing.
• Punch debridement. Also called mini-unroofing, this minor surgery removes individual nodules or lesions. Typically, your doctor will be able to do this procedure in his or her office. Using a round instrument, your doctor will punch out a deep circle from your skin and the underlying tissue to remove a nodule or lesion. Then, your doctor will use his or her finger or a cotton swab to scrub away the tissue near the excised area to remove the follicle that caused your nodule or lesion. The area usually heals quickly. This procedure is effective in preventing regrowth of nodules and lesions.
• Unroofing. Also called deroofing, this is a common surgery to treat advanced hidradenitis suppurativa. You might need to have this procedure done on one lesion (local unroofing) or on several lesions within an area (extensive unroofing). Your doctor will cut away your skin and the flesh that covers any interconnected tunnels. He or she might use a carbon dioxide laser to remove the affected areas of skin. Unroofing surgeries don't usually have to be repeated.
• Excision. This is an aggressive surgical technique to provide relief for people with hidradenitis suppurativa that can't be managed with other types of therapy or surgery. Your surgeon will remove your lesions and the surrounding soft tissues, removing any tunnels and inflamed tissue, as well as any scar tissue. You might need a surgical procedure in which sections of your own healthy skin are used to replace the scar tissue (skin graft) to cover the area and help the wound heal.

After surgery, you'll likely also need treatment with lifestyle changes and, possibly, antibiotics, biologics, oral retinoids or hormonal therapy. These therapies can help prevent your hidradenitis suppurativa from returning. Your doctor can advise which treatment is appropriate for you based on the severity of your condition and how effective other treatments have been for you in the past.

Unfortunately, major surgery to remove the tunnels and nodules beneath the skin can cause significant disfiguring scars. However, it's often the best option to treat aggressive hidradenitis suppurativa that doesn't respond to other treatments. Before having surgery, make sure you understand the extent of the scarring you're facing and the healing process ahead.

Dec. 29, 2018

Original article: https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/in-depth/surgery-and-hidradenitis-suppurativa/art-20308339