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DEROOFING
DEROOFING
Elective surgical procedures are indicated when medical treatment fails and HS lesions are persistent or recurrent at fixed locations. This is best done with the least possible destruction of normal tissue. The deroofing (also called unroofing) technique has
emerged as one of the most effective methods of HS surgery.25 The procedure was described for the first time in 1959 by Mullins et al.: โThe multiple cavities containing pus and gelatinous material were adequately drained, and the lining was curetted thoroughly.โ26 The key element of the procedure is the complete exteriorization of the roof of the cavity, that is, abscess or sinus tract, leaving the (partly) epithelialized floor and walls exposed (Fig. 54-5).27,28 This lining is preserved, and the resection remains within the borders of the lesion. Excision of the area is only necessary if an epithelial lining cannot be recognized during the surgical procedure.
Figure 54-5. Schematic display of the deroofing procedure. (A) Sinuses with epithelialized floor containing pus and gelatinous material. (B) Deroofing procedure without damaging the epithelialized floor of the sinus tract. (C) Postoperative healing with regeneration of the epidermal layer.