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Hidradenitis suppurativa (HS, also known as acne inversa) is a chronic inflammatory skin condition that affects hair follicles and sweat glands in areas where skin rubs together — such as the armpits, groin, buttocks, and under the breasts.
For moderate to severe hidradenitis suppurativa, or cases that have not responded to medical therapies, doctors may recommend a surgical intervention called wide local excision (WLE). This surgical approach removes diseased skin and underlying sinus tracts (tunnel-like connections underneath the skin) to improve symptoms and prevent HS from recurring (coming back).
This article explains what WLE involves, who may be a candidate, and what to expect from the procedure and recovery.
Oftentimes, people living with HS notice pus-filled nodules (lumps), abscesses, and wounds form in areas where skin rubs together. These skin lesions can merge, ultimately forming sinus tracts, which can lead to scarring and long-term inflammation.
Wide local excision is a surgical intervention in which a healthcare professional removes diseased skin, sinus tracts, and surrounding tissue to help prevent recurrence of hidradenitis suppurativa. Small excisions can be performed by a dermatologist, but wide local excisions are mostly performed by a plastic surgeon, due to the larger area of tissue removal. The procedure often involves cutting down to the fat layer (subcutaneous tissue) to ensure complete removal of affected areas.
In some cases, your dermatologist may recommend an ultrasound before surgery to identify the full extent of sinus tracts. Imaging techniques like ultrasound help ensure complete removal of affected tissue, reducing the likelihood of disease recurrence.
Once the affected areas are removed, the surgical site is typically closed with sutures (stitches), though other surgical techniques may be used depending on the size and location of the excision.
Wide local excision can be performed under local or general anesthesia. General anesthesia may be needed if the procedure will be more extensive or will require more complex closure.
By removing affected areas, wide local excision can significantly reduce the recurrence of HS in the treated area. In some cases, WLE may even lead to long-term remission (disappearance of symptoms), though a complete cure cannot be guaranteed, as hidradenitis suppurativa can develop in new areas over time.
People with mild HS are often treated with a combination of oral and topical antibiotics to control inflammation and prevent infections. Those with moderate to severe HS (Hurley stage 2 or 3) may require additional medications, including biologics. For moderate to severe cases of HS, stronger medical therapies — such as biologics, systemic antibiotics, or hormonal treatments — may be necessary.
If HS does not adequately respond to medical therapies, surgery may be necessary. Surgical procedures for HS include punch debridement and deroofing (also called unroofing). For HS that is more extensive and has incompletely responded to other therapies, wide local excision is typically recommended.
Anytime you consider surgery, it’s important to weigh the risks and benefits. Wide local excision for HS, just like any other procedure, has associated risks. These include the possibility for:
Your dermatologist or plastic surgeon will take preventive measures to reduce these risks, such as using appropriate surgical techniques, postoperative wound care, and infection prevention strategies.
The benefits of wide local excision for HS can be considerable. Most individuals report significant improvement in their symptoms as a result of the procedure, while some actually experience relative “cure” of their HS symptoms in the treated areas.
Additionally, aside from the physical improvement in symptoms, many individuals report improvement in their mental health and wellness as a result of wide local excision. One member of myHSteam shared, “I’ve had several surgeries and it gave me a lot of relief.”
Given that wide local excision carries some risks, consider these tips:
Overall, wide local excision for HS is well-tolerated by most people. If your procedure was performed under local anesthesia, you will be awake throughout the process so you likely won’t feel groggy afterward. If you were placed under general anesthesia, you may need to stay longer or overnight.
While every person’s recovery is different, estimates for wound healing range from two to four months after surgery. “It’s been a month since my excision surgery, and everything is healing slowly, but it’s healing,” one myHSteam member shared.
Most importantly, discuss postoperative care with your dermatologist. Key elements of postoperative care include:
Your doctor may also talk to you about signs of infection following your procedure. You should seek medical care immediately if you notice the following:
After the initial recovery period, one of the most common questions about wide local excision for hidradenitis suppurativa is whether the disease can come back. While WLE is one of the only treatment options that can potentially lead to long-term remission, recurrence rates range from 20 percent to 54 percent.
If HS comes back after a wide local excision procedure, it may indicate that some affected tissue was not fully removed during surgery. Additionally, the number of distinct areas of your skin affected by HS and the location of the excision may influence whether symptoms return. For example, wide local excision in the groin area has a reported recurrence rate between 37 percent and 40 percent.
While these factors are not always within your control, discussing recurrence risks with your dermatologist or plastic surgeon before surgery can help set realistic expectations. In addition, scarring may form as a result of wide local excision, and its severity may vary based on the size of the excision and individual healing factors.
The decision to undergo wide local excision can be difficult. As a result, it’s understandable to want to ensure you have the best possible outcomes, including avoiding your symptoms coming back.
Most people continue to need and benefit from medical treatments, including antibiotics and biologics. These medications help keep HS flares at bay and to decrease inflammation in your body. For certain individuals, a combination of both local surgical excision for recurrent lesions along with medical management has proven beneficial in improving their quality of life.
Additionally, as HS is often associated with risk factors such as obesity and smoking, your healthcare provider may speak with you about controlling the impact of these risk factors. Addressing modifiable risk factors before and after surgery may help reduce the likelihood of recurrence and promote better wound healing.
Finally, ensuring you keep an open line of communication with your dermatologist before and after your surgery is critical to giving you the best outcome possible. Asking questions during preoperative and postoperative visits and reporting any new or worsening symptoms can help ensure that your treatment plan is tailored to your recovery needs.
On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 46,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.
Are you living with HS? Has your HS not fully responded to medications? Have you considered or undergone wide local excision? Share your experience in the comments below, start a conversation by posting on your Activities page, or connect with like-minded members in Groups.
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