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Hidradenitis suppurativa (HS) frequently affects the skin in the groin, causing pain, scarring, and recurring lesions that can be difficult to treat. When medication and lifestyle changes are not enough to improve HS, you may need surgery.
Dr. Christopher Sayed is an associate professor of dermatology at the University of North Carolina at Chapel Hill and a member of the board of directors of the Hidradenitis Suppurativa Foundation, and he spoke with myHSteam about what people need to know about groin surgery for HS.
There are several different surgical treatments for HS, depending on the specific issue and desired outcome.
“If we are treating a small area that is a few centimeters in size, it is much different than a patient that needs very large excisions and reconstructive procedures,” said Dr. Sayed.
Smaller surgeries can be performed as outpatient procedures. “For very large procedures, it is possible you will remain in the hospital overnight or for a few days to help manage the wound and pain for a short time,” Dr. Sayed said. Here are some examples of HS surgeries.
Incision and drainage can provide immediate, temporary relief from extremely painful abscesses. However, it doesn’t effectively treat HS lesions permanently, and it is not a preferred treatment approach.
Punch debridement (also called punch unroofing) is a surgery that can remove a single small lesion using only local anesthesia. Using a skin punch, the surgeon removes a deep circle of skin but does not stitch the wound closed. Instead, it’s allowed to drain and scar over.
Unroofing, also called deroofing, is used to treat abscesses, nodules, larger lesions, and connected lesions. A portion of skin and deeper tissue is removed using local anesthesia to expose underlying damage and drain sinus tracts.
“Unroofing is typically used for lesions that have been persistent and recurrent for more than a month or two,” Dr. Sayed noted. “It is rarely used for new lesions, since most of those are likely to improve without surgery.”
Excision can remove large areas of affected skin and is often done under general anesthesia. “Excisions can also be performed with local anesthesia, depending on the size and patient preference,” Dr. Sayed said.
Excision can be a good option for people with severe HS. It can treat large areas affected by scarring and lesions. It can also target individual lesions when performed as a smaller outpatient procedure.
Often, the wound is bandaged and allowed to heal by secondary intention (on its own), without stitching the remaining skin back together. Although it may sound like this would leave unpleasant scarring, it can result in excellent healing with good cosmetic (visible) results, Dr. Sayed explained.
In some cases, larger wounds may need to be covered with skin grafts or skin flaps. However, “sometimes, even for a larger wound, [healing by secondary intention] is more desirable than a large graft or flap that may lead to more scars,” Dr. Sayed commented.
“Excision is different from deroofing because it typically goes deeper to the fat, whereas deroofings are more often only in the skin,” he added.
Dermatologists typically perform surgery for HS, but other types of doctors may also be involved. For surgeries that require extensive reconstruction, a reconstructive surgeon (plastic surgeon) may be needed.
If lesions are very close to the anus, a colorectal surgeon may be involved. For HS lesions in the groin that involve the scrotum, penis, or labia, a urologist or gynecologist may be needed.
Groin surgery for HS is not necessarily very different from other types of surgery for HS, but it does come with some unique considerations.
According to Dr. Sayed, recovery from groin surgery is potentially different from other surgeries: “Since the wound might be in an area that makes it painful to sit or do certain activities, it may be more of a challenge to do these things in the first few weeks, but the overall healing process is similar.”
Dr. Sayed also said that “smaller procedures are unlikely to create issues specific to either women or men, but very large reconstructions can have different implications.”
“Men requiring extensive procedures for the scrotum or at the base of the penis may require skin grafting, and the scrotum can heal with a scarlike texture that doesn’t perfectly match typical scrotal skin,” Dr. Sayed said. “For female patients who require removal of most of the labia and pubic area, the scar can become tight and create some discomfort if it creates tension around the vagina.”
Before surgery, make sure you know what you need to do to prepare.
Communication is crucial before surgery. Dr. Sayed explained: “Patients often know the areas that tend to cause the most trouble and have been around for a long time. Pointing this out to the surgeon to make sure they focus on the areas that matter to you most can be helpful.”
Dr. Sayed added, “Consider whether you want to have one or two big procedures that result in a bigger recovery all at once, or if you want to break it into smaller steps to make it feel more manageable.”
Dr. Sayed also encouraged people to ask questions about wound care and recovery, so you know what to expect after surgery.
HS is an inflammatory disease. It’s crucial to control inflammation before surgery. Having a flare-up at the same time as surgery can make matters worse.
“It’s often best to make sure the disease is well controlled, when possible, ahead of time. It can slow down wound healing and result in bigger wounds if the tissue is swollen and inflamed at the time of surgery,” according to Dr. Sayed.
Some people have a great deal of anxiety before procedures and may need help remaining calm.
Dr. Sayed offered reassurance: “If we do the procedure in the office, medication may be given to help a patient relax.” Make sure to let your doctor know if you need help dealing with the stress of surgery.
For procedures that require general anesthesia, you will be asked not to eat or drink anything beforehand. Your doctor should give you detailed instructions to follow before your procedure.
Surgery may give you the relief you need, but it may not be immediate. You can expect some postoperative pain, and you will need to be on the lookout for potential complications. You will also need to follow up with your surgeon to track the progress of your healing.
Every surgery comes with risks. Potential complications include:
Dr. Sayed said to watch for possible postoperative infections. “Infection is uncommon, but signs include redness, swelling, pain, discharge, and odor that worsen instead of improve after the first few days. These things are all common in the first week or two, but when they get worse instead of better, it can be a sign of a problem.”
He also recommended being careful about postoperative bleeding: “Sometimes, wounds can bleed through a bandage in the first day or two, and it is helpful to limit physical activity in the first 48 hours after surgery to avoid this.”
Dr. Sayed noted that it is important to prevent contractures, explaining, “In the long term, a large wound may develop a tight or thick scar that can feel restrictive. It is important to increase activity and make sure to stretch the skin in the area each day after the first couple of weeks to make sure the skin around the joints stays mobile as it heals.”
Some pain after surgery is normal, especially in the first three to five days. Your healthcare provider can recommend over-the-counter pain relievers to help you cope. However, if you’re really struggling with pain, reach out and let them know. It could be a sign that there’s a bigger issue, like an infection, or that you need more support to get your pain under control.
People with HS usually need ongoing treatment to manage their condition, even after surgery. But that’s not to say surgery isn’t worth getting. In a study of 111 people who had surgery for HS, most (82.6 percent) would recommend it to others. Participants reported a better quality of life after surgery. Even if their lesions came back, they were less severe than before.
On myHSteam, the social network for people with hidradenitis suppurativa, members come together to ask questions, give advice, and share their stories with others who understand life with hidradenitis suppurativa.
Have you ever considered surgical intervention for a severe case of HS? Have you tried any other treatment options for HS in the groin area? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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Cannot recomend vicks vapour rub enough, takes away the pain and shrinks abscesses, use a thick layer after washing area with hibiscrub, really works
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