Surgical Techniques for HS 1: Incision & Drainage

Throughout the history of HS, surgery has the main treatment of choice for physicians treating patients. While the relatively recent major developments in drug development have given physicians more treatment options, surgical procedures are still widely used for managing HS and particularly so in more advanced or severe HS cases (stages II–III in the Hurley HS staging system). In this post I will present some of the main surgical procedures used in HS treatment, and focus on one of these. In future posts I will focus on some of the other surgical techniques.

HS Surgery: An Overview

This video, from the excellent online WebMD, neatly describes in ~ 1 minute three of the main surgical options using ‘cold steel’ to treat HS.

Incision and Drainage (I & D)

I & D is a popular option for providing fast-acting relief on acute HS flares. In the WebMD video, a summary of the I & D process is presented at approx. 18 seconds to 28 seconds. The following clinical education video, based on the work of Fitch et al. (2007), presents some background on I & D, what physician’s need to know when performing the technique, and how to carry out an I & D

The main advantages of I & D are that it:

• is quick (can take just a few minutes)
• is usually effective at instantly relieving pain in an inflamed HS area
• can be performed by many non-specialist healthcare professionals in a non-hospital setting (e.g., a doctor’s surgery).
• does not require specialised medical equipment

The main disadvantage of I & D is that very high recurrence rates have been reported with the procedure (Ellis 2012, Kohorst et al., 2016). Consequently, I & D is discouraged as a long-term practice for managing HS (Scuderi et al., 2017).

References:

Ellis, L.Z. (2012) ‘Hidradenitis suppurativa: surgical and other management techniques’,  Dermatol Surg., 38, 517–536, [online], available at: doi: 10.1111/j.1524-4725.2011.02186.x, [accessed 13 Jul 2019].

Fitch, M.T., Manthey, D.E., McGinnis, H.D., Nicks, B.A. and Pariyadath, M. (2007) ‘Videos in clinical medicine. Abscess incision and drainage’, N. Engl. J. Med., 357(19):e20., [online], available at: doi: 10.1056/NEJMvcm071319 [accessed 13 Jul 2019].

Kohorst, J.J., Baum, C.L., Otley, C.C., Roenigk, R.K., Schenck, L.A., Pemberton, J.H., Dozois, E.J., Tran, N.V., Senchenkov, A. and Davis. M.D. (2016) ‘Surgical management of hidradenitis suppurativa: outcomes of 590 consecutive patients’, Dermatol Surg., 42(9), 1030–1040, [online], available at: doi: 10.1097/DSS.0000000000000806, [accessed 13 Jul 2019]

Scuderi, N, Monfrecola, A., Dessy, L.A., Fabbrocini, G., Megna, M.and Monfrecola, G. (2017) ‘Medical and surgical treatment of hidradenitis suppurativa: a review’, Skin Appendage Disord., 3(2), 95–110, [online], available at: doi: 10.1159/000462979, [accessed 13 Jul 2019].