Surgical Treatment of Hidradenitis Suppurativa

In many cases of Hidradenitis Suppurativa (HS), antibiotics alone are not enough to treat the condition. In most cases of moderate to severe HS, some type of surgery is required. Antibiotics without surgery almost always fail in such cases. The antibiotics and all the other medications are not able to penetrate the abscess cavity and in addition, the acidic environment of the abscess makes the antibiotics ineffective.

Surgery is generally required when the condition is severe or the patient has fever and severe pain. The cysts can be very large, tender and the individual is practically disabled from walking or using the arm. The pain can be so bad that that one can not sleep. Despite all conservative measures, many large cysts do not respond.

In such cases, surgery is most effective treatment for recalcitrant Hidradenitis. Aggressive surgery will cure an area of severe, chronic Hidradenitis but it may often require the removal of scars and seven large amounts of involved skin.

Skin grafts may sometimes be needed to close the residual defects. Because surgery is very invasive and can result in scars and pain, medical therapy is always the first choice in the treatment of HS.

The types of surgery used to treat HS include:

Incision and drainage: This is the most frequent type of procedure done in HS; the individual has very large painful cysts in the groin or the axilla. The area is cleaned with some sterile solution. The patient is generally given some IV sedation or local anesthetic. Following this the softest part of the cysts is cut with a scalpel and there is immediate pain and pressure relief. This causes all the pus to drain and the majority of individuals feel improvement immediately. All the large cysts are incised in this way. After the procedure, the wound is cleaned and a dressing is applied over it. The patient is asked to soak the area in warm water and clean the area everyday.

In some cases, the condition is chronic and associated with a large number of old cysts with thick wall; in such cases the entire area is removed. The surgery is done under general anesthesia. The defect is generally left open and allowed to close on its own. This helps reduce the chance of recurrent infections.

Radical surgery: In some cases, the entire skin and cysts area is removed. This type of radical surgery is cosmetically deforming and only done in the most severe cases of HS.

Laser: Today laser has been tried to treat HS. It has proved successful in the few cases so far. The laser has the ability to shrink the cysts and clear up the secretions. However, deeper cysts require powerful lasers which are also associated with scars formation. The carbon dioxide laser can penetrate the deeper skin with ease and has been successful in treating HS.

was frequently used in the past for the treatment of HS. Because of concern for safety, radiation therapy declined over the past 3 decades. However, there is now a resurgence of this therapy. With newer machines and more controlled methods of delivering radiation therapy, there has been a significant improvement in patients who received radiation. However, there are a certain number of individual who fails to respond to radiation.

The type of surgery for HS is generally decided after reviewing your condition and the experience of the treating physician.

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