Deroofing & Wide Excision: Preparing, Recovering & Caring for Your Wound

This guide was created for the HS community by HSConnect to help you understand your surgical options for Hidradenitis Suppurativa (HS), what to expect before and after surgery, and how to care for your wound during recovery.

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.

About Hidradenitis Suppurativa (HS)

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.

Surgical Options for HS

Surgery for HS focuses on removing diseased tissue to reduce lesions, drainage, scarring, and pain. The right procedure depends on your Hurley Stage (disease severity) and the size/location of affected areas. Below are the two procedures most recommended by HS specialists.

Deroofing (Punch/Wide)

Best for:

What happens:

Healing Time:

Anesthesia:

Recurrence:

RECOMMENDED ✔

Recurrent abscesses or those spots that just won’t heal.

The ‘roof’ of the abscess or tunnel is removed, exposing the wound bed to heal openly from the inside out.

1-3 weeks, depending on size.

Local anesthesia in-office or under general anesthesia (varies by provider and lesion size)

Lower than I&D; higher than wide excision.

De-roofing is a minimally invasive surgical option often recommended for recurring HS abscesses or areas with tunneling. Unlike incision and drainage (I&D), which has a high recurrence rate, de-roofing removes underlying inflammation and allows the wound to heal from the inside out. Watch the video below to learn when this procedure may be considered and what to expect.

Wide Excision

Best for:

What happens:

Healing Time:

Recurrence:

Closure:

Most Definitive ✔

Larger areas, Stage II–III HS; diffuse or interconnected sinus tracts.

A margin of disease-free tissue is removed around the entire affected area. The wound may be closed with a skin graft, flap, or left open to heal by secondary intention (inside out).

Weeks to months depending on wound size and closure method.

Lowest of all surgical options (13% overall recurrence rate).

Primary closure • Skin graft • Flap • Secondary intent (open wound healing)

Considering wide excision surgery for HS?
This video explains when it’s typically used, what the procedure looks like, and the different ways your body can heal afterward—helping you feel more prepared for conversations with your care team.

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.

Watch the video below to better understand how I&D works, why recurrence happens, and how to advocate for alternative treatment options with your care team.

When Is It More Than a Flare? (Signs of Infection)

• 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 they are not recommended as a long-term solution for HS management.

• It’s important to understand how your typical HS flares behave so you can recognize when something is not normal.

• Signs that an HS lesion may be infected include:

Spreading redness beyond the usual flare area
Pain that is worsening outside your normal HS pattern
Red streaking or “stretch mark–like” lines
Fever or feeling unwell

• A helpful way to monitor changes is to draw a circle around the area and track if redness spreads beyond it.

• If you notice these signs, seek medical care immediately—untreated infection can lead to serious complications like sepsis.

Watch the video below to better understand when antibiotics are used in HS, how to identify signs of infection, and when to take action.

Surgery for HS focuses on removing diseased tissue to reduce lesions, drainage, scarring, and pain.

Preparing for Surgery

In the Weeks Before Your Procedure

Being well prepared before surgery can meaningfully improve your recovery. Work with your surgical team and use this checklist to get ready:

Pre-Op Checklist

• Confirm your pre-op appointment and bring a list of all medications

• Discuss anesthesia options with your surgeon

• Ask about stopping blood thinners, supplements, or smoking beforehand

• Arrange transportation home — you will not be able to drive yourself

• Take ‘before’ photos of the wound area for tracking healing progress

Home Prep Checklist

• Order wound care supplies in advance (see supplies list on next page)

• Stock up on easy-to-prepare meals and stay well hydrated

• Arrange help at home for the first few days to a week

• Prepare a comfortable recovery area with pillows, loose clothing, and easy access to supplies

• Ask your provider about pain management and fill prescriptions before surgery day

Questions to Ask Your Surgeon

What type of closure will be used and why?
How long will healing take for my specific wound?
Will I need wound packing? (Note: most current guidelines do NOT recommend packing for HS wounds)
What activity restrictions should I expect and for how long?
What are the signs of infection I should watch for?
When should I follow up with you after surgery?
Is there a wound care nurse or specialist I can contact with questions?

Recommended Wound Care Supplies

The following supplies are commonly needed for post-surgical wound care at home. Get these before your procedure — some items, like saline, can be hard to find in a hurry. Find links to all these products (and more) here.

Supply	Notes/Tips
4×4 Gauze (unwrapped)	Preferred for wound packing and coverage. Stock up generously.
Adaptic (non-stick contact layer)	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	8″X10″ for larger wounds; 5″X9″ for smaller. Highly absorbent outer layer.
Allevyn Gentle Border (“Cloud Bandages”)	Silicone foam dressings in 2″X2″, 3″X3″, or 4″X4″ sizes. Gentle, comfortable.
Saline Solution	For wound irrigation and moistening gauze. Hard to find — order early!
Petroleum Jelly (Vaseline)	Safer than Aquaphor for wound beds. Use as a moisture barrier or emollient.
Hypafix Tape	Preferred tape for securing dressings; gentle on skin.
Gloves (any kind)	Wear gloves for every dressing change to keep the wound clean.
Medical Honey (optional)	Anti-inflammatory and antimicrobial; apply directly to wound or on dressing

Looking for support after surgery? Explore our wound care resources and watch expert video guidance from Katie Scherling, ARNP, an Advanced Registered Nurse Practitioner and Certified Wound Care Advanced Practice Provider.

Wound Care

Download the Guide

What to Expect and How to Care for Your Wound at Home

The Phases of Wound Healing

Understanding how wounds heal helps you set realistic expectations. HS surgical wounds go through three overlapping phases:

1. Inflammatory Phase (Days 1-6)

Redness, swelling, warmth, and pain. Your immune system is fighting bacteria and triggering healing.

2. Proliferative Phase (Days 4–28)

New tissue (granulation) fills the wound. Edges begin to contract. New skin forms from wound margins.

3. Maturation Phase (21 days – 2 years)

Scar tissue forms and strengthens. This phase can last up to 2 years depending on wound size and your health.

Daily Wound Care: Step-by-Step

1 Wash Your Hands & Put On Gloves
Always start with clean hands. Gloves protect both you and the wound from bacteria.

2 Remove the Old Dressing
Gently peel away dressing. If gauze is stuck, moisten with saline before removing to avoid trauma to healing tissue

3 Irrigate the Wound
Rinse the wound with saline solution. This removes debris without damaging new tissue. Avoid hydrogen peroxide or undiluted antiseptics — these can damage healing cells.

4 Apply a Contact Layer (if needed)
For open wounds, place Adaptic or petroleum-jelly-coated gauze directly against the wound bed to prevent sticking.

5 Apply Filler for Deep Wounds
For deeper wounds, lightly fill with saline-moistened gauze to wick drainage and maintain moisture balance. Do NOT pack tightly.

6 Cover with an Absorbent Pad
Place an ABD pad or cloud bandage over the contact layer to absorb drainage.

7 Secure the Dressing
Use Hypafix tape, a bordered foam dressing, mesh netting, or clothing to hold the dressing in place.

8 Dispose & Document
Remove gloves, wash hands again. Consider photographing the wound at each change to track healing progress.