대한두개안면성형외과학회지 (Archives of Craniofacial Surgery)

  • 제24권2호
  • /
  • Pages.73-77
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  • 2023
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  • 2287-1152(pISSN)
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  • 2287-5603(eISSN)
대한두개안면성형외과학회 (Korean Cleft Palate-Craniofacial Association)
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Surgical treatment of postauricular hidradenitis suppurativa with delayed diagnosis: a case report and literature review

  • Inho Kang (Department of Plastic and Reconstructive Surgery, Dongguk University College of Medicine) ;
  • Gyu Yong Jung (Department of Plastic and Reconstructive Surgery, Dongguk University College of Medicine) ;
  • Min Jun Yong (Department of Plastic and Reconstructive Surgery, Dongguk University College of Medicine) ;
  • Yujin Ahn (Department of Plastic and Reconstructive Surgery, Dongguk University College of Medicine) ;
  • Joon Ho Lee (Department of Plastic and Reconstructive Surgery, Dongguk University College of Medicine)
  • 투고 : 2023.03.16
  • 심사 : 2023.04.06
  • 발행 : 2023.04.20
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초록

Hidradenitis suppurativa (HS) is a chronic inflammatory condition that is difficult to diagnose, with a period of 10.0±9.6 years from symptom onset to diagnosis. A 32-year-old Asian man presented with bilateral postauricular abscesses that first appeared 5 years previously. Despite several incisions and drainage, the symptoms only temporarily improved and continued to recur. On physical examination, chronic scars and sinus tracts were observed around the lesion. Postauricular HS was diagnosed, and surgical treatment was performed. We performed a wide excision and reconstructed the defect using a posterior auricular artery perforator-based keystone flap. Histological examination confirmed the diagnosis of HS. The reconstruction was successful, and there was no recurrence for 2 years after surgery. HS is difficult to diagnose without specific attention. Although the postauricular region is not a typical site of HS, it can occur in this area. Therefore, if a patient presents with recurrent abscesses in the postauricular region, HS should be considered. Additionally, if HS is diagnosed in the postauricular region, wide excision with reconstruction using a posterior auricular artery perforator-based keystone flap can lead to a favorable outcome.

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참고문헌

  1. Preda-Naumescu A, Ahmed HN, Mayo TT, Yusuf N. Hidradenitis suppurativa: pathogenesis, clinical presentation, epidemiology, and comorbid associations. Int J Dermatol 2021;60:e449-58.  https://doi.org/10.1111/ijd.15579
  2. Taylor EM, Hamaguchi R, Kramer KM, Kimball AB, Orgill DP. Plastic surgical management of hidradenitis suppurativa. Plast Reconstr Surg 2021;147:479-91.  https://doi.org/10.1097/PRS.0000000000007677
  3. Napolitano M, Megna M, Timoshchuk EA, Patruno C, Balato N, Fabbrocini G, et al. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol 2017;10:105-15.  https://doi.org/10.2147/CCID.S111019
  4. Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa: Epidemiology, clinical presentation, and pathogenesis. J Am Acad Dermatol 2020;82:1045-58.  https://doi.org/10.1016/j.jaad.2019.08.090
  5. Kokolakis G, Wolk K, Schneider-Burrus S, Kalus S, Barbus S, Gomis-Kleindienst S, et al. Delayed diagnosis of hidradenitis suppurativa and its effect on patients and healthcare system. Dermatology 2020;236:421-30.  https://doi.org/10.1159/000508787
  6. Saunte DML, Jemec GBE. Hidradenitis suppurativa: advances in diagnosis and treatment. JAMA 2017;318:2019-32.  https://doi.org/10.1001/jama.2017.16691
  7. Kelly G, Hughes R, McGarry T, van den Born M, Adamzik K, Fitzgerald R, et al. Dysregulated cytokine expression in lesional and nonlesional skin in hidradenitis suppurativa. Br J Dermatol 2015;173:1431-9.  https://doi.org/10.1111/bjd.14075
  8. Tchero H, Herlin C, Bekara F, Fluieraru S, Teot L. Hidradenitis suppurativa: a systematic review and meta-analysis of therapeutic interventions. Indian J Dermatol Venereol Leprol 2019;85:248-57.  https://doi.org/10.4103/ijdvl.IJDVL_69_18
  9. Kohorst JJ, Baum CL, Otley CC, Roenigk RK, Schenck LA, Pemberton JH, et al. Surgical management of hidradenitis suppurativa: outcomes of 590 consecutive patients. Dermatol Surg 2016;42:1030-40.  https://doi.org/10.1097/DSS.0000000000000806
  10. Hamaguchi R, Wearda TL, Volk AS, Kramer KM, Kimball AB, Chaffin AE, et al. Surgical management of hidradenitis suppurativa: a two-center retrospective study. Plast Reconstr Surg 2022;150:1115-27.  https://doi.org/10.1097/PRS.0000000000009658
  11. Zhang YZ, Li YL, Yang C, Fang S, Fan H, Xing X. Reconstruction of the postauricular defects using retroauricular artery perforator-based island flaps: anatomical study and clinical report. Medicine (Baltimore) 2016;95:e4853. 
  12. Lee JY, Seo JH, Jung SN, Seo BF. Chondrocutaneous posterior auricular artery perforator free flap for single-stage reconstruction of the nasal tip: a case report. Arch Craniofac Surg 2021;22:337-40.  https://doi.org/10.7181/acfs.2021.00556
  13. Mohan AT, Rammos CK, Akhavan AA, Martinez J, Wu PS, Moran SL, et al. Evolving concepts of keystone perforator island flaps (KPIF): principles of perforator anatomy, design modifications, and extended clinical applications. Plast Reconstr Surg 2016;137:1909-20.  https://doi.org/10.1097/PRS.0000000000002228
  14. Khouri JS, Egeland BM, Daily SD, Harake MS, Kwon S, Neligan PC, et al. The keystone island flap: use in large defects of the trunk and extremities in soft-tissue reconstruction. Plast Reconstr Surg 2011;127:1212-21.  https://doi.org/10.1097/PRS.0b013e318205f36f
  15. Lim SY, Yoon CS, Lee HG, Kim KN. Keystone design perforator island flap in facial defect reconstruction. World J Clin Cases 2020;8:1832-47. https://doi.org/10.12998/wjcc.v8.i10.1832