[Medical Human Story–Time Hidden Beneath the Skin]–Episode 50–Hidradenitis Suppurativa(4)

  The Silent Inflammation Blooming on the Nape of the Neck


Part IV- Excision, and the Scars Left Behind

The morning of the surgery was exceptionally clear. Like the sky after a long rain, everything seemed momentarily at peace. Yet, stillness is often just another name for the gathering storm.

I met him in front of the operating theater. Clad in his hospital gown, he looked smaller than usual. “Doctor.” “Yes?” “When this is over... will that smell finally be gone?” I looked into his eyes for a moment. “Yes. Once we excise the tracts completely, the chance of recurrence drops significantly.” He nodded. His wife stood beside him, unable to let go of his hand.

Hidradenitis Suppurativa. Nape sinus tracts. Chronic inflammatory disease. It was time to finally sever those tunnels.

The Act of Excision

The surgery was performed under general anesthesia. As the incision was made, the thickened, fibrotic tissue revealed itself. Beneath the small orifices visible on the surface lay a network of tunnels far more vast than expected.

Invisible paths. Tunnels were carved in two years. I recalled the pathways I had seen on the imaging. The MRI had been our map; the surgery was the labor of following that map to its end.

“It extends even to this area,” the lead surgeon noted in a low voice. I nodded. “It matches the imaging. We must resect everything up to that margin.” A sinus tract is not a mere hole; it is an epithelialized passage. If even a fragment is left behind, the fire of inflammation will ignite once more.


The Invisible Boundary

The nape of the neck is not merely skin. It is a complex tapestry of nerves, vessels, and muscle. Fortunately, the MRI had shown no muscular invasion. “The muscle can be preserved,” I said quietly. The surgeon nodded. The area of excision was wider than one might imagine. Though the room was filled with the sharp scent of antiseptic, I thought of the "smell" the patient had described. It wasn't just the scent of discharge; it was the scent of isolation.


The Moment of Awakening

The surgery concluded after three hours. When he opened his eyes in the recovery room, I was by his side. “Is it... over?” His voice was frail, but his consciousness was sharp. “Yes. We’ve removed all the tracts.” He closed his eyes briefly. “My neck... it feels tight.” “That’s normal. The excision was extensive.” His wife approached. “You did it,” she whispered, and his eyes grew moist.

Facing the Scar

Two weeks post-surgery. The day the sutures were removed. He stood before the mirror for a long time. Across the back of his neck ran a long scar—red, prominent, and still firm to the touch. “It’s... bigger than I thought,” he said, his voice steady. I replied quietly, “But the tunnels are gone.” He nodded slowly. “The smell... is gone.” In those four words lay the entire weight of the past two years.

The Turning Point

Three months after the operation, he sat in my clinic again. The skin on his nape was clear. Fibrosis remained, but the inflammation was gone. “How is your neck in the morning?” “A bit stiff, but nothing like before.” The diagnosis of Ankylosing Spondylitis had been confirmed by Rheumatology, and his TNF-α inhibitor therapy was ongoing. Hidradenitis Suppurativa and Ankylosing Spondylitis—two fires fed by the same fuel.


The Meaning of a Scar

“Doctor.” “Yes?” “When I look at this scar... I’m not ashamed anymore.” I found myself momentarily speechless. “Why is that?” “Because it’s proof of the time I spent hurting. I don't feel the need to hide it anymore.”

Excision is not merely the removal of tissue; it is the cutting away of a painful past. Yet the scar remains. And the scar speaks: “I endured.”

A Scentless Spring

Spring was arriving. He told me he had finally attended a company dinner. “For the first time... I didn't worry about it.” His wife laughed. “He’s started wearing cologne again lately.” I smiled. Hidradenitis Suppurativa is a disease of the skin, but the ultimate goal of its treatment is the restoration of a life.

A Physician’s Soliloquy

After he left, I remained in the clinic for a long time. I remembered the first day I met him: the purulent discharge seeping from his neck, the anxious eyes, the scent of isolation. And now. The clear skin. The lingering scar. The restored routine.

I turned off the monitor and thought: Hidradenitis Suppurativa does not easily grant the word "cure." But we can change the direction of the disease. The true turning point is not the moment of the incision, but the moment one decides not to give up.

To be continued!

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