What is Deroofing?

A deroofing procedure is performed most typically to treat patients with hidradenitis suppurativa who have persistent abscesses or sinus tracts. This procedure includes the surgical removal of the “roof” of a sinus tract or abscess.

How do you prepare for Deroofing?

  • Consultation: Meet with a dermatologist or surgeon to assess suitability for the procedure.
  • Medical Evaluation: Undergo necessary health evaluations, including blood tests and imaging.
  • Medication Review: Discuss all current medications with your doctor, especially those affecting blood clotting, which may need to be paused.
  • Infection Control: Manage any active infections with antibiotics as prescribed.
  • Smoking Cessation: Stop smoking in advance of the surgery to enhance wound healing.
  • Logistics: Arrange transportation and post-operative assistance for the day of the surgery.
  • Home Preparation: Ready your home for recovery, including wound care supplies and comfortable rest areas.
  • Mental Preparation: Understand the procedure, recovery process, and potential risks to mitigate anxiety.
  • Follow-Up: Schedule appointments post-surgery for monitoring and care guidance.

Why is Deroofing performed?

Deroofing is a surgery used to treat hidradenitis suppurativa (HS), a skin condition that causes painful lumps and fluid-filled tunnels under the skin. This procedure removes the top part of these tunnels, allowing the trapped fluid to escape, which helps relieve pain and pressure. It promotes better and faster healing by turning the closed-off tunnels into open wounds. Deroofing is especially helpful when other treatments haven’t worked well, significantly improving comfort and reducing future problems from HS.

What can you expect during Deroofing?

  • Preparation: You’ll get ready for surgery, change into a gown, and meet with your surgical team for any last details.
  • Anesthesia: You will receive local anesthesia, numbing only the area to be treated, forthe procedure.
  • The Procedure:
    • The surgeon makes a cut over the affected area.
    • The top part of the tunnels under your skin (the “roof”) is removed.
    • The area is cleaned out to remove any pus or infected material.
  • Wound Care: The wound is left open to heal from the inside out, which helps prevent the tunnels from forming again.
  • Post-Operative Care: After surgery, you’ll receive instructions on how to care for the wound at home, including pain management and dressing changes.
  • Recovery: Recovery time varies but generally involves managing discomfort and caring for the wound until it heals, which might take a few weeks.

What is the followup and recovery like for Deroofing?

  • Wound Care: You’ll need to take care of the open wound, which involves regular cleaning and dressing changes to promote healing and prevent infection.
  • Monitoring: Regular check-ups with your doctor are important to ensure the wound is healing properly and to address any complications early.
  • Rest and Recovery: You may need to take it easy for a few days to several weeks, depending on the extent of the procedure. Avoid strenuous activities until the doctor confirms it’s safe.
  • Long-term Management: HS is a chronic condition, so ongoing treatment and lifestyle adjustments may be necessary to manage symptoms and prevent new flare-ups.

What are the potential costs for Deroofing?

Insurance can significantly influence out-of-pocket costs. Coverage varies by provider and plan, with some insurers covering the procedure if deemed medically necessary, while others might not. It’s essential to check with your insurance provider to understand what portion of the cost they will cover. This is not a cosmetic procedure.

What are the potential risks for Deroofing?

  • Infection: Since the procedure involves opening and cleaning out infected areas, there is a risk that the infection could worsen or spread if not properly managed.
  • Scarring: Deroofing can result in significant scarring, especially since HS itself often causes scarring. The appearance and extent of scarring can vary.
  • Pain: Post-operative pain is common, though it is typically manageable with medications. In some cases, pain may persist longer than expected.
  • Recurrence of HS: While deroofing is effective in treating existing sinus tracts, it does not cure HS. New lesions may develop in other areas.
  • Delayed Healing: The open wounds left after deroofing are intended to heal from the inside out, which can be a slow process. In some cases, healing may be incomplete or delayed.
  • Reaction to Anesthesia: There are always risks associated with anesthesia, ranging from mild reactions like nausea to more severe effects like respiratory issues, particularly with general anesthesia.
  • Hematoma or Seroma Formation: Accumulation of blood (hematoma) or fluid (seroma) in the area of the surgery can occur, potentially requiring further intervention.

Discussing these risks with a healthcare provider is crucial, as they can provide more detailed information and help weigh the benefits of the procedure against the potential complications for your specific situation.

Are there related procedures to Deroofing?

  1. Incision and Drainage (I&D): This is often the first-line treatment for acute abscesses in HS. It involves making a cut to drain pus and fluid but does not typically prevent recurrence as it does not remove the sinus tracts.
  2. Excision: This procedure involves the complete surgical removal of affected skin areas, including deeper tissues, which can be more extensive than deroofing. Excisions can be minor (limited) or wide. Wide excisions remove larger areas of skin and require closure with skin grafts or flaps but have a lower rate of recurrence in the treated area.
  3. Laser Therapy: Laser treatments can be used to ablate affected tissues or reduce the severity and number of flare-ups. Techniques like CO2 laser are utilized for this purpose.
  4. Cryotherapy: Applying extreme cold to destroy affected tissue, cryotherapy can be used for smaller lesions and is less invasive than surgical options, though it may require multiple sessions.

A healthcare provider specializing in dermatology or surgical management of HS can provide guidance on the best treatment approach based on an individual’s particular circumstances.