HS Surgery Guide
Deroofing & Wide Excision
Preparing, recovering, and caring for your wound — everything you need to know about surgical options for Hidradenitis Suppurativa, created for the HS community by HS Connect.
Content in this guide is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider regarding your specific medical condition.
Understanding Hidradenitis Suppurativa
HS is a chronic inflammatory skin condition — not a hygiene issue. Understanding it is the first step toward better care.
Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition affecting the hair follicles. It affects approximately 1–4% of the global population and can occur in anyone, regardless of ethnicity or age.
About 1 in 3 patients report a family history of HS. It is not related to hygiene — it is a systemic inflammatory disease that requires proper medical management.
Surgery for HS focuses on removing diseased tissue to reduce lesions, drainage, scarring, and pain. The right procedure depends on your Hurley Stage and the size and location of affected areas.
Procedures Most Recommended by HS Specialists
The right procedure depends on your Hurley Stage and the size and location of the affected area. Below are the two most recommended options.
Deroofing
Punch / Wide — Minimally Invasive
Deroofing is a minimally invasive option often recommended for recurring HS abscesses or areas with tunneling. Unlike I&D, which has a high recurrence rate, deroofing removes underlying inflammation and allows the wound to heal from the inside out.
Wide Excision
For Larger Areas — Most Lasting Results
Considering wide excision? This video explains when it’s typically used, what the procedure looks like, and the different ways your body can heal afterward.
A Note on Incision & Drainage (I&D)
- I&D is NOT recommended as a long-term treatment for HS. While it provides short-term pain relief, lesions almost always return.
- There is no evidence that I&D reduces recurrence or promotes true healing.
- If I&D has been suggested for your HS, ask your provider about deroofing or wide excision as more definitive alternatives.
When Is It More Than a Flare?
HS is not an infection, but it’s important to know when something may be. Understanding your baseline helps you recognize what’s not normal.
- HS is NOT an infection, but antibiotics are sometimes prescribed for their anti-inflammatory effects, not to treat infection.
- Antibiotics may be helpful as short-term or “rescue” therapy, but are not recommended as a long-term solution for HS management.
- A helpful way to monitor changes is to draw a circle around the area and track if redness spreads beyond it.
Spreading redness beyond the usual flare area
Worsening pain outside your normal HS pattern
Fever or feeling unwell — a sign your body is fighting something
Red streaking or stretch mark-like lines extending from the wound
Preparing for Your Procedure
Being well prepared before surgery can meaningfully improve your recovery. Use these checklists to get ready.
Pre-Op Checklist
Home Prep Checklist
Questions to Ask Your Surgeon
Recommended Wound Care Supplies
Get these before your procedure — some items like saline can be hard to find in a hurry. Find links to all of these products on our products page.
| Supply | Notes & Tips |
|---|---|
| 4×4 Gauze | Preferred for wound packing and coverage. Stock up generously. |
| Adaptic | Cut to size; prevents gauze from sticking to the wound bed. |
| Kerlix Gauze Roll | Wide-open weave is best; good for wrapping and securing dressings. |
| ABD Pads | Highly absorbent outer layer for larger or smaller wounds. |
| Allevyn Gentle Border | Silicone foam dressings. Gentle and comfortable. |
| Saline Solution | For wound irrigation and moistening gauze. Hard to find — order early. |
| Petroleum Jelly | Safer than Aquaphor for wound beds. Use as a moisture barrier. |
| Hypafix Tape | Preferred tape for securing dressings; gentle on skin. |
| Gloves | Wear gloves for every dressing change to keep the wound clean. |
| Medical Honey | Optional; apply directly to wound or on dressing. |
Looking for support after surgery? Explore our wound care resources and expert video guidance from Katie Scherling, ARNP.
Recovery and wound care after HS surgery
Healing takes time, consistency, and the right supplies. This section walks through wound healing phases, daily dressing changes, healing expectations, and wound care principles to support recovery.
The Phases of Wound Healing
Understanding how wounds heal helps you set realistic expectations. HS surgical wounds go through three overlapping phases.
Inflammatory Phase
Redness, swelling, warmth, and pain. Your immune system is fighting bacteria and triggering healing.
Proliferative Phase
New tissue fills the wound. Edges begin to contract. New skin forms from wound margins.
Maturation Phase
Scar tissue forms and strengthens. This phase can last up to 2 years depending on wound size and overall health.
Daily Wound Care: Step-by-Step
Follow these steps every time you change your dressing. Consistency and clean technique are the most important factors in healing.
Wash Your Hands & Put On Gloves
Always start with clean hands. Gloves protect both you and the wound from bacteria.
Remove the Old Dressing
Gently peel away the dressing. If gauze is stuck, moisten with saline before removing.
Irrigate the Wound
Rinse the wound with saline solution. Avoid hydrogen peroxide or undiluted antiseptics.
Apply a Contact Layer
For open wounds, place Adaptic or petroleum-jelly-coated gauze directly against the wound bed.
Apply Filler for Deep Wounds
Lightly fill with saline-moistened gauze to wick drainage and maintain moisture balance. Do not pack tightly.
Cover with an Absorbent Pad
Place an ABD pad or cloud bandage over the contact layer to absorb drainage.
Secure the Dressing
Use Hypafix tape, bordered foam dressing, mesh netting, or clothing to hold the dressing in place.
Dispose & Document
Remove gloves, wash hands again, and consider photographing the wound to track healing.
Wound Care Principles to Live By
These principles guide every successful recovery. Keep them in mind throughout your healing journey.
Maintain moisture balance — not too wet, not too dry.
Do not leave wounds open to air for extended periods.
Do not occlude wounds too tightly.
Do not use hydrogen peroxide or strong antiseptics directly on the wound bed.
Benzoyl peroxide is not recommended because it can cause excessive drying and irritation.
Neosporin has no proven advantage over plain petroleum jelly and may cause allergic reactions.
Change dressings daily or more often if saturated.
Track your healing with photos to help monitor progress.
Warning Signs — Seek Care Immediately If You Notice:
- Increasing redness, warmth, or swelling around the wound
- Fever over 100.4°F
- Significantly increased pain after the first few days
- Thick, foul-smelling discharge
- Wound edges pulling apart or not beginning to close
- Streaking redness extending from the wound
Real photos. Real experiences. Shared to help others understand HS.
These images were shared with consent by people living with HS. They help patients, caregivers, and providers better recognize symptoms, understand healing, and see the many ways HS can appear.
WARNING: Some photos below are graphic in nature and represent real photos of real HS abscesses, surgeries, scars, and healing. All images were shared with consent.
