Preparing For a De-roofing and Excisions

Approach your surgery with confidence to ensure a better healing process

Surgeon performing surgery, Pexels, Feb. 12, 2024

Undergoing a de-roofing or excision surgery can be a daunting experience. Proper preparation can help ease you're concerns and contribute to a smoother recovery. This article will guide you through key steps to take before your HS surgery. You will better understand the procedure, what to ask during pre-op consultations and how to best preparing your'e home for post-surgery recovery.

What is the difference between De-Roofing, Wide Excision and Local Excision Surgery?

For a De-roofing surgery a surgeon will target sites of sinuses and tracts (tunnels under the skin caused by HS) and the overlying skin around these areas will be de-roofed, in other words, removed.

Local Excision surgery is similar to de-roofing surgery and is a surgery that typically treats patients on the lower hurley stage. During this procedure, the surgeon will remove select areas and abscesses where the disease has attacked.

A Wide Excision is when a large area is de-roofed and removed. This is typically a more intensive surgery and the patient is left with a significantly bigger wound.

It's important to ask during your consultations leading up to the surgery what type of surgery the surgeon thinks will need to take place. It's good to keep in mind that even the best surgeons who have performed countless HS surgeries may not know how much they need to remove until they are in and actively performing the surgery. Despite that unfortunate reality, well-experienced surgeons will likely be able to estimate what route they believe will be the best way to go about treating you.

Arranging Consultations

Do not be afraid to request consultations with both your dermatologist team and the surgeon who will be performing the surgery. For local Excisions, I have been in a situation where the surgeon is ready to cut right there and then without prior consultation. I do not advise this. When preparing for your surgery, especially with the understanding that surgeons may not know how wide of an area they will need to remove will have a big impact on how big of an open wound you will be left with post-op and how much time you may need to heal. When going to your consultation appointments be your best advocate and ask as many questions as you need to. Bringing a notepad and pencil to write down notes and or bringing a support person who may also have a list of questions on your behalf is a good idea.

Preparing For Surgery

Local Excisions can be done while the patient is awake and the area will be frozen. There isn't too much to prepare for this one. The De-Roofing and more particularly the Wide Excision will often mean the patient is put under anesthesia sedation. For this, you will want to prepare better.

Make sure you don't eat or drink for at least 24 hours before surgery, often you will be allowed a small glass of water or a small black coffee but confirm with the surgeon before.

You will be asked to show up on surgery day with no jewellery or nail polish on. If you have long hair I would bring an elastic so you can put your hair in a bun under the surgical hat.

Make sure you have a supportive person who can drive you home and monitor you for 24 hours post-op. Before leaving your house prior to surgery setting up a place to lie down on either a couch or a bed with a bowl is suggested. It's very common for people to be nauseous from the anesthesia accompanied by vomiting is very typical. Most people will feel best in a dark room where they can just rest it off. Once your able to hold food and water down the nausea will subside and you will regain energy.

Post-Op Wound Care

Post-Op wound care will be a pain. Surgeries for HS now usually leave the wound open for a thicker more flexible scar and ultimately better mobility. Wound care will be vital to arrange. Ask the surgeon in the consultation if they will arrange wound care for you or if that is something you need to do. Healing processes can vary depending on what surgery you got, the health of the wound when healing and the fact that everyone heals at different times. For myself and other friends who have had the Wide Excision surgery, the wound can take up to a year to heal and close. For most Local Excisions depending on how much is taken, I would prepare for 2-3 months.

Wound care is typically daily until the nurses believe every other day or three days is appropriate. For someone who feels comfortable a lot of nurses will encourage at home care where you or a loved one changes the dressings on your own. I recommend this, it will save you a lot of time however be confident before to ensure you feel fully comfortable with the regiment.

If you plan to travel post-op, you will likely need to contact the coordinator of the nursing company and arrange for your file to be transferred to whatever nursing clinic will take you closer to where you will be.

Post- Op Exercises

Since you will be left with an open would stretching will be really important. It may feel like it's prolonging the healing especially if the wound keeps ripping open again but it's important to get a thick and flexible scar for better mobility. Tight scaring particularly in crease areas can have long-term effects on your future mobility. I'ts encouraged to try and use it as much as you can as you regularly would.

Once your wound is closed and you no longer have dressings on it, you will notice the area is highly sensitive and in many ways more uncomfortable than the open wound. This will subside with time (sometimes a lot of time) and massaging it to desensitize the area will help. The sensitivity is due your your nerves being freshly regenerated during the healing process. This is also why as the wound bed begins to lift and your wound begins to heal the closer to the surface it rises the more painful it will feel.

Fresh after post-op expect a deeper throbbing pain and closer to the end prepare for a scrape-tingy sort of pain. Note that it shouldn't scab the way a scrape does it will lift and get smaller and smaller until closed.

Emotional Preparation

The severity of trauma to the area varies depending on what surgery you get done. For local excision, it can be small little blips but can be bigger blips as well. For bigger surgeries like the Wide Excision prepare for serious trauma in the area especially if the surgeon has de-roofed in a crease for example the crease of your armpit. If the crease has been de-roofed prepare for healing to take longer, stretching to be more painful with occasional rips as well.

Wide Excisions can mean your entire underarm is essentially skinned and is all an open wound. This can be a lot psychologically and seeing it on your first wound care appointment will likely be highly uncomfortable. Bringing music to these appointments does help.

A journal is a good way of taking care of the emotional aspect when healing and makes a great way to track your regimen as it changes and your healing progress.

Support groups are a fantastic way to engage in discussion or questions you may have for others with HS who have potentially gone through the same surgery.

HS social media is a great tool. Many HS advocacy pages are ways to find relatable content and even meet people who have HS and have been through similar things as you.

Talking It Out

Talking with friends or family who are wanting to support you through this can really help. Therapy is also a good option if you feel talking to a professional is needed. Post-Op can be rigorous and there can be some frustrating and low moments in recovery. Making sure your mental health is okay is key.