When Is Surgery Needed?
Surgery is not the first line of treatment for HS, but for many patients with moderate-to-severe disease, it is an essential part of comprehensive care. Medical therapy, antibiotics, biologics, hormonal treatments , manages the inflammatory disease systemically, but it cannot remove established sinus tracts and scar tissue. Surgery addresses the structural consequences of HS that medication cannot reverse.
Surgery is typically considered when:
- ✓Established sinus tracts are present and not responding to medical therapy
- ✓Recurrent abscesses occur in the same location despite treatment
- ✓Significant scarring is causing functional impairment (restricted movement, pain)
- ✓Stage II or III disease with localized areas of severe involvement
- ✓Quality of life is severely impacted by a specific area of disease
Surgery should be performed by a surgeon experienced in HS. Outcomes are significantly better at specialized centers. Ask your dermatologist for a referral.
Types of HS Surgery
Several surgical approaches are used for HS, ranging from minimally invasive office procedures to major surgery requiring general anesthesia. The right choice depends on your disease stage, the extent of involvement, and your surgeon's expertise.
Deroofing
Minimally InvasiveFast recovery, minimal scarring, can be repeated
Higher recurrence than WLE
Wide Local Excision (WLE)
Major SurgeryLowest recurrence at treated site
Longer recovery, may need skin graft
CO2 Laser Surgery
ModeratePrecise, less bleeding, good cosmetic outcomes
Requires specialized equipment and expertise
Incision & Drainage (I&D)
Minor ProcedureImmediate pain relief
Not curative; high recurrence; does not address sinus tracts
Choosing the Right Procedure
The right surgical approach depends on your Hurley stage, the number and location of affected areas, your overall health, and your surgeon's experience. Use the following framework as a starting point for your conversation with your dermatologist or surgeon.
Medical therapy first. If a single recurrent abscess does not respond, deroofing or CO2 laser is appropriate. Surgery is rarely the first choice at this stage.
Deroofing is the preferred option for limited sinus tracts. Wide local excision (WLE) is considered when multiple tracts are clustered in one region. CO2 laser is an alternative where available.
Wide local excision is the standard of care for extensive, confluent disease. Skin grafting or flap reconstruction may be required. Surgery should be combined with biologic therapy to prevent recurrence in adjacent areas.
Incision and drainage provides temporary relief but is not curative. It is appropriate for managing an acute painful abscess while awaiting definitive surgical planning.
Important: These are general guidelines. Your surgeon will make the final recommendation based on your individual anatomy, disease extent, and goals. Always seek a second opinion for major surgery.
Before Surgery: Preparation
Medical Preparation
- •Discuss biologic therapy timing with your surgeon (some require pausing before surgery)
- •Optimize nutrition, protein and zinc support wound healing
- •Quit smoking if possible , smoking significantly impairs wound healing
- •Manage blood sugar if diabetic
- •Discuss all medications including supplements
Practical Preparation
- •Arrange transportation home (you cannot drive after general anesthesia)
- •Prepare your recovery space at home before the procedure
- •Stock up on wound care supplies
- •Plan for time off work, be realistic about recovery duration
- •Arrange help with daily tasks for the first 1–2 weeks
Recovery Timeline
Recovery from HS surgery varies significantly by procedure type. Here is a general timeline for wide local excision, the most common major HS surgery:
Pain management is the priority. Take prescribed pain medication on schedule. Rest as much as possible. Keep the wound elevated if possible. Do not change dressings unless instructed.
Pain decreases significantly. Begin wound care as instructed by your surgeon. Light activity only. Watch for signs of infection: increasing redness, warmth, swelling, fever, or unusual odor.
Wound granulation and epithelialization. Continue wound care. Gradually increase activity as tolerated. Attend follow-up appointments. Scar tissue begins forming.
For detailed post-operative wound care, see our HS Surgery Recovery page.
Post-Op Wound Care
Proper wound care after HS surgery is critical for healing and reducing the risk of infection. Your surgeon will provide specific instructions, but the following principles apply to most HS surgical wounds.
Dressing Changes
- •Change dressings as instructed, typically once or twice daily
- •Use non-adherent dressings to prevent trauma on removal
- •Rinse wound gently with saline or clean water before re-dressing
- •Pat dry, never rub
- •Keep a wound care log to track healing progress
Signs of Infection
- •Increasing redness or warmth spreading beyond the wound edge
- •Swelling that worsens after the first 48 hours
- •Fever above 38 degrees C (100.4 degrees F)
- •Unusual or foul-smelling discharge
- •Wound edges separating (dehiscence)
Promoting Healing
- •High-protein diet supports tissue repair (aim for 1.2-1.5g/kg body weight)
- •Zinc and vitamin C supplementation may support wound healing
- •Stay hydrated
- •Avoid smoking, it significantly impairs blood flow and healing
- •Keep wound out of direct sunlight until fully healed
Activity Restrictions
- •Avoid submerging the wound (baths, swimming pools, hot tubs) until fully closed
- •No strenuous exercise or heavy lifting for 4-6 weeks after major surgery
- •Wear loose, breathable clothing over the wound site
- •Avoid friction or pressure on the wound area
- •Return to work timeline varies: desk work 1-2 weeks, physical work 4-8 weeks
For a comprehensive post-operative guide including the HS Dignity Care Kit and wound care product recommendations, visit our dedicated HS Surgery Recovery page.
Preventing Recurrence After Surgery
Surgery removes existing disease but does not prevent HS from developing in new areas. The most effective strategy for preventing post-surgical recurrence is continuing biologic therapy.
Post-Surgical Prevention Strategy
- •Resume biologic therapy as soon as your surgeon clears you (typically 2–4 weeks post-op)
- •Continue lifestyle modifications: diet, weight management, smoking cessation
- •Maintain regular dermatology follow-ups to monitor for new disease activity
- •Address new lesions early, early intervention prevents progression to sinus tracts
- •Consider adjuvant treatments (topical antibiotics, zinc supplements) as recommended
Questions to Ask Your Surgeon
What type of surgery do you recommend for my specific case, and why?
How many HS surgeries have you performed?
What is the expected recurrence rate at the treated site?
Will I need a skin graft? If so, where will the donor site be?
What are the specific risks for my case?
How long will recovery take, and when can I return to work?
Should I pause my biologic therapy before surgery?
What does post-operative wound care look like?
What signs of complications should I watch for?
How will we manage pain after surgery?
Frequently Asked Questions
Who is a candidate for HS surgery?
What is the difference between deroofing and wide local excision?
How long is recovery from HS surgery?
Does HS come back after surgery?
Is HS surgery covered by insurance?
What should I ask my surgeon before HS surgery?
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