Surgical treatment of postauricular hidradenitis suppurativa with delayed diagnosis: a case report and literature review

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.

Pseudoaneurysm of the superficial temporal artery after blunt trauma: case report and literature review

An 88-year-old man presented with a left temporal pulsatile mass that developed after blunt trauma. Based on suspicion of hematoma, needle aspiration was performed with the removal of approximately 15 mL of blood. No evident improvement was noted, and active arterial bleeding was observed at the needle puncture site. Doppler ultrasonography revealed a “yin-yang” sign, and the mass was diagnosed as a pseudoaneurysm of the left superficial temporal artery. Under general anesthesia, the superficial temporal artery was ligated and the pseudoaneurysm was removed. Superficial temporal artery pseudoaneurysm is a rare facial tumor that generally occurs after blunt trauma. Due to its rarity, pseudoaneurysms are often misdiagnosed as hematoma. The treatment of choice is excision, although endovascular intervention is a potential treatment option. However, when a pseudoaneurysm is small, conservative treatment can be used.

A Case Report: A Rare Case of Extraocular Sebaceous Carcinoma on the Chin in 22-Year-old Asian Young Man / 대한두경부종양학회지

Sebaceous carcinoma (SC) is a rare malignant tumor, with an estimated incidence of approximately 1 to 2 per 1,000,000 per year. Approximately 75% of SCs are reported to occur in eyelids. Most of these tumors are diagnosed at age 40 or over and exhibit a wide variety of patterns in addition to the general appearance previously reported. SC is difficult to diagnose clinically, but can be diagnosed by accompanying biopsy. In cases of SC, additional examinations, such as endoscopy and computed tomography, may be necessary because of its association with Muir-Torre Syndrome. We present the case of a 22-year-old Asian man who complained of a rapidly growing chin tumor. The tumor was treated by surgical resection and adjuvant radiation therapy.

A Burn after Alexandrite Ⓡ Laser Hair Removal on a Forehead Flap: A Case Report

The nose is a complex three-dimensional structure and represents a major aesthetic focus of the face. As a gold standard for nasal soft tissue reconstruction, the ‘forehead flap’ provides reconstructive surgeons a robust pedicle and large amount of tissue to reconstruct almost any defect. However, during this process, some hair can be unintentionally introduced to the nose. Accordingly, laser hair removal is sometimes needed, but blood circulation and flap survival should be carefully monitored.Despite careful evaluation, a third-degree burn occurred in our patient that required eight weeks to heal. Here, we report on a burn resulting from epilation conducted 2 weeks after forehead flap for nasal reconstruction.

A Case Report: A Rare Case of Extraocular Sebaceous Carcinoma on the Chin in 22-Year-old Asian Young Man / 대한두경부종양학회지

Sebaceous carcinoma (SC) is a rare malignant tumor, with an estimated incidence of approximately 1 to 2 per 1,000,000 per year. Approximately 75% of SCs are reported to occur in eyelids. Most of these tumors are diagnosed at age 40 or over and exhibit a wide variety of patterns in addition to the general appearance previously reported. SC is difficult to diagnose clinically, but can be diagnosed by accompanying biopsy. In cases of SC, additional examinations, such as endoscopy and computed tomography, may be necessary because of its association with Muir-Torre Syndrome. We present the case of a 22-year-old Asian man who complained of a rapidly growing chin tumor. The tumor was treated by surgical resection and adjuvant radiation therapy.

A Burn after Alexandrite Ⓡ Laser Hair Removal on a Forehead Flap: A Case Report

The nose is a complex three-dimensional structure and represents a major aesthetic focus of the face. As a gold standard for nasal soft tissue reconstruction, the ‘forehead flap’ provides reconstructive surgeons a robust pedicle and large amount of tissue to reconstruct almost any defect. However, during this process, some hair can be unintentionally introduced to the nose. Accordingly, laser hair removal is sometimes needed, but blood circulation and flap survival should be carefully monitored.Despite careful evaluation, a third-degree burn occurred in our patient that required eight weeks to heal. Here, we report on a burn resulting from epilation conducted 2 weeks after forehead flap for nasal reconstruction.

A case report of hidradenitis suppurativa after subdermal excision for axillary osmidrosis

Hidradenitis suppurativa (HS) is a chronic inflammatory condition with an unclear etiopathogenesis that is considered to be a follicular occlusive disease. We present a case of HS that was suspected to have developed as a complication of subdermal excision. A 19-year-old man who had undergone subdermal excision due to osmidrosis presented 7 months after surgery with a persistent painful mass in his left axilla. Despite medical treatment, incision, and drainage, a painful enlarged abscess recurred in the left axilla and was cured completely by deroofing surgery. However, 15 months after subdermal excision, he revisited the hospital because of a painful mass in the right axilla. The patient’s condition met the diagnostic criteria of HS. After several recurrences, a cure was achieved by radical wide excision. Mechanical stress like that associated with subdermal excision is considered to be a possible etiological factor of HS. In addition, pathological changes at the sebofollicular junction allow rupture and leakage of folliculopilosebaceous units upon exposure to mechanical stress, which may result in the aggressive subcutaneous extension of inflammation. We suggest that HS should be considered in patients with a recurrent abscess after subdermal excision, and recommend surgical treatment as a possible option if conservative treatment is clinically ineffective.

Polyacrylamide hydrogel (Aquamid) filler removal after a decade

The removal of fillers used for soft-tissue augmentation is an issue of concern, as the possible need for extensive surgery to remove fillers deters their use by many surgeons. Several studies have demonstrated the safety and efficacy of polyacrylamide hydrogel (Aquamid) gel, but to date no report has described its removal after 10 years. Here, we report a case of Aquamid removal. A 33-year-old woman, who had undergone forehead augmentation 12 years previously with an Aquamid injection, visited the department of plastic and reconstructive surgery of our medical center due to a severe forehead contour irregularity. Removal of 20 mL of excess gel was performed by direct incision and squeezing under local anesthesia. Our experience shows that Aquamid removal is possible, but should be performed with appropriate surgical precautions.

New lower blepharoplasty technique for elderly patients using bony fixation of the sub-orbicularis oculi fat pad

Conventional sub-orbicularis oculi fat (SOOF) lifting during lower blepharoplasty is performed by anchoring the SOOF to the periosteum of the infraorbital rim. This procedure helps to improve the concavity at the central portion of the lower eyelid and the lid-cheek junction. However, over time, the periosteum becomes progressively weaker, diminishing the anchoring effect. This paper introduces a new lower blepharoplasty technique in which the SOOF is fixed to a bony hole to strengthen the holding force and provide sustainability.

A case of acute skin failure misdiagnosed as a pressure ulcer, leading to a legal dispute

It is difficult to differentiate acute skin failure (ASF) from pressure ulcer (PU). ASF is defined as unavoidable injury resulting from hypoperfusion caused by severe dysfunction of another organ system. We describe a case of ASF mistaken as PU that resulted in a legal dispute. A 74-year-old male patient was admitted to our intensive care unit with sepsis due to bacterial pneumonia. Despite the use of air cushions and regular position changes, skin ulcerations occurred over his occiput, back, buttock, elbow, and ankle. After improvement in his general condition, he was transferred to the department of plastic and reconstructive surgery. Debridement was performed immediately, followed by conservative treatment (including a vacuum-assisted closure device) for 6 weeks. The buttock and occiput wounds were treated surgically. Despite complete healing, his caregivers sued the hospital for failing to prevent PU formation. ASF is a pressure-related injury resulting from hemodynamic instability due to organ system failure. Unlike PU, ASF may occur despite the implementation of all appropriate preventive measures. Furthermore, misdiagnosis of ASF as PU can lead to litigation. Therefore, it is critical for the proper diagnosis to be made quickly, and for physicians to explain that ASF occurs despite proper preventative treatment.

Deep Second Degree Burn of Ferrous Chloride in a Worker at a Wastewater Treatment Facility

FeCl₂ is often used in stainless steel surface processing, wastewater treatment, or in laboratories. Effects of exposure to FeCl₂ include predominantly systemic side effects that can occur when inhalation or oral intake occurs. However, it is known that skin irritation or burning can be caused by exposure to skin, but there has never been reported a case of deep FeCl₂ burns. We will introduce a case of a patient treated with deep second degree burn due to FeCl₂ exposure. A 27-year-old healthy man came in contact with FeCl₂ on his right wrist. The patient didn't wear any protective clothing, and the clothes were contaminated with FeCl₂ about one hour ago, but the patient was not aware of the danger of exposure. After an hour, the patient felt tingling, so he took off his exposed clothes and washed exposed skin, then came to our hospital. Initially there were mild erosion, erythema, and tingling symptoms. Two days later, eschar began to develop and wound began to deepen. Surgical procedure was not performed and it took 5 weeks for the patient's wound to heal. As a rule, workers using FeCl₂ are required to wear protective clothing. In Korea, companies and laboratories using FeCl₂ are not strictly required the use of protective clothing. Workers handling FeCl₂ should be strictly encouraged to wear protective clothing, if exposed, should be instructed to visit the hospital after a quick washing away.

Mayonnaise and the Treatment of Molten Polyethylene Burns: A Case Report

Polyethylene is the most common plastic and is mainly used to produce plastic bags, film and bottles. When the molten polyethylene contacts skin,it causes burns and solidifies, so it is important to remove this material properly. However, no report has been issued to date on molten polyethylene contact burns. Here, we present such a case, in which the solidified polyethylene was successfully removed using mayonnaise. A 48-year-old man was burned on the face and neck by molten polyethylene, which had been heated to 200℃. Burned regions were covered with solidified polyethylene. About 15 minutes after spreading mayonnaise on the patient's face and neck, gently rubbing of the mayonnaise into the solidified polyethylene resulted in its successful removal. Mayonnaise has several advantages as it does not evaporate or flow across surfaces like other liquids, and unlike butter does not need to be melted before use. These properties and its ability to emulsify polythene mean that it can be used for the initial treatment of hot polyethylene burns and probably to treat contact burns caused by other petrochemical products.

Nipple Reduction Using an S-Shaped Excision Technique

Many people experience psychological distress because of large nipples. In this article, the authors would like to introduce our simple nipple reduction method that addresses the drawbacks of previous methods. This technique for nipple reduction using an S-shaped excision is simple, safe, and predictable. It is also a suitable method for nipple reduction in men and in women who have completed breastfeeding.

Pediatric Orbital Medial Wall Trapdoor Fracture with Normal Computed Tomography Findings

With advances in diagnostic technology, radiologic diagnostic methods have been used more frequently, and physical examination may be neglected. The authors report a case of pediatric medial orbital trapdoor fracture in which the surgery was delayed because computed tomography (CT) findings did not indicate bone displacement, incarceration of rectus muscle, or soft tissue herniation. A healthy 6-year-old boy was admitted to the emergency room for right eyebrow laceration. We could not check eyeball movement or diplopia, because the patient was irritable. Thus, we performed facial CT under sedation, but there was normal CT finding. Seven days later, the patient visited our hospital due to persistent nausea and dizziness. We were able to perform a physical examination this time. Lateral gaze of right eye was limited. CT still did not show any findings suggestive of fracture, but we decided to perform exploratory surgery. We performed exploration, and found no bone displacement, but discovered entrapped soft tissue. We returned the soft tissue to its original position. The patient fully recovered six weeks later. To enable early detection and treatment, thorough physical examination and CT reading are especially needed when the patient shows poor compliance, and frequent follow-up observations are also necessary.

Pediatric Orbital Medial Wall Trapdoor Fracture with Normal Computed Tomography Findings

With advances in diagnostic technology, radiologic diagnostic methods have been used more frequently, and physical examination may be neglected. The authors report a case of pediatric medial orbital trapdoor fracture in which the surgery was delayed because computed tomography (CT) findings did not indicate bone displacement, incarceration of rectus muscle, or soft tissue herniation. A healthy 6-year-old boy was admitted to the emergency room for right eyebrow laceration. We could not check eyeball movement or diplopia, because the patient was irritable. Thus, we performed facial CT under sedation, but there was normal CT finding. Seven days later, the patient visited our hospital due to persistent nausea and dizziness. We were able to perform a physical examination this time. Lateral gaze of right eye was limited. CT still did not show any findings suggestive of fracture, but we decided to perform exploratory surgery. We performed exploration, and found no bone displacement, but discovered entrapped soft tissue. We returned the soft tissue to its original position. The patient fully recovered six weeks later. To enable early detection and treatment, thorough physical examination and CT reading are especially needed when the patient shows poor compliance, and frequent follow-up observations are also necessary.

Eccrine Poroma of the Postauricular Area

Eccrine poroma is a common benign cutaneous tumor that originates in an intraepidermal eccrine duct. This tumor exhibits acral distribution (sole, palm), and is rarely encountered in the head and neck area. In fact eccrine poroma in the postauricular area has only been rarely reported. A 55-year-old female visited our hospital with a main complaint of a mass that first developed in the left postauricular area about a year previously. The mass was painless, soft, protruding, domed, and dark red in color, and had slowly enlarged (at presentation it measured 1×1 cm). Excisional biopsy was performed. Histological examination showed distinct features, and eccrine poroma was diagnosed. Follow-up at 6 months postoperatively showed no recurrence. The frequency of eccrine poroma is dependent on eccrine sweat glands density, and thus, usually occurs on the palms or soles. For eccrine poroma in the head and neck region, the differential diagnosis must rule out other masses, such as nevus, skin tag, pyogenic granuloma, cyst, basal cell carcinoma, and seborrheic keratosis. Importantly, 18% of poromas show malignant transformation, and can develop into porocarcinoma. For these reasons, an eccrine poroma in the facial area requires histological examination, complete excision, and follow-up.

A Rapid Growing Giant Cutaneous Horn from Burn Scar: A Case Report

A giant cutaneous horn (GCH) is a morphological description of huge, conical, dense, hyperkeratotic protrusion. Because of its bizarre shape and associated risk of malignancy, GCH requires proper treatment. A 48-year-old male patient visited our department with a GCH on a burn scar of his right hand. It had started to develop about 8 months previously. At initial physical examination, the lesion presented as a hard, dark brown mass of basal area 4×3.5 cm², and height 3.5 cm. Preoperative biopsy confirmed the absence of malignancy. We performed excision of the entire GCH, and biopsy and repaired the resulting defect with full-thickness skin graft. Histopathologic results revealed that all surgical margin were negative for malignancy. Microscopically, the lesion exhibited marked regular acanthosis, parakeratosis and hyperkeratosis with granular layer loss. At 3 months postoperatively, no complication was observed. According to Mantese et al., 58.56% of GCHs originate from malignant or premalignant lesions. And thus, a histopathologic examination is mandatory, and if an accompanying malignant lesion is found, additional resection should be undertaken. In another study, it was concluded the risk of premalignancy or malignancy depends on development time. In our case, the GCH had grown from a burn scar, this has not been previously reported in Korea. Surgeons need to be aware cutaneous horn harbors risks of premalignancy or malignancy, and that histopathological evaluation is indispensable for treatment decision making.

Delayed-Onset Methicillin-Resistant Staphylococcus aureus Infection at 18 Months after Absorbable Plate Fixation for Zygomaticomaxillary Complex Fracture

None of the reports of delayed infection mentioned a latent period exceeding 13 months. we report an infection that developed 18 months after implantation of an absorbable plate. A 16-year-old adolescent girl had undergone reduction and fixation with an absorbable plate for Lefort I and zygomaticomaxillary complex fractures 18 months prior at our hospital. In her most recent hospital visit as an outpatient, abscess was observed in periocular area. Computed tomography revealed sinusitis with an abscess above the infraorbital rim. Wound culture yielded methicillin-resistant Staphylococcus aureus . Despite conservative treatments, wound state did not improve. Therefore, our department decided to perform surgery. Absorbable plate had been mostly absorbed but remained a bit. Bony depression of infraorbital rim and mucosal exposure of maxillary sinus anterior wall were observed. After the surgery, the patient recovered. We believe that the reason the wound infection and sinusitis manifested at the same time is because of several factor such as alcohol abuse, smoking, and mucosal exposure of maxillary sinus anterior wall. Absorbable plate takes 9 months to 3 years to be completely absorbed, thus we suggest studies with a follow-up of at least 3 years be undertaken to determine the outcomes of patients with many risk factors.

A Retrospective Clinical View of Basal Cell Carcinoma and Squamous Cell Carcinoma in the Head and Neck Region: A Single Institution's Experience of 247 Cases over 19 Years

BACKGROUND: The two most common skin cancers are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The purpose of this study was to describe the detailed clinical behavior of BCC and SCC in the head and neck region over 19 years at a single institution. METHODS: A retrospective analysis was performed for all patients with non-melanoma skin cancer who had undergone surgical resection over an 18-year period. Patient charts were reviewed for demographic information, tumor size, onset-to-diagnosis, anatomic location, clinical subtype, histologic differentiation, method of surgical treatment, and recurrence. RESULTS: The review identified 265 cases of either BCC or SCC in 226 patients. Of the 226 patients, 80 (35.4%) were men and 146 (64.6%) were women. BCC (n=138, 55.9%) was more frequent than SCC (109, 44.1%). The most frequent age group was 70-to-79 year olds (45 patients, 35.2%) for BCC and 80-to-89 year olds (41 patients, 41.8%) for SCC. By aesthetic units of the face, the most common location was the nasal unit (44 cases, 31.9%) for BCC and the buccal unit (23 cases, 21.1%) for SCC. The most common clinical subtype of BCC was the nodular type (80 cases, 58.0%). Local flaps were most commonly used to cover surgical defects (136 cases, 55.1%). Recurrent rates were 2.2% for BCC and 5.5% for SCC. CONCLUSION: In our study, many characteristics of BCC and SCC were compared to previously published reports were generally similar, except the ratio of BCC to SCC. Further study can help to establish the characteristics of BCC and SCC.

Correction of Sunken Upper Eyelids by Anchoring the Central Fat Pad to the Medial Fat Pad during Upper Blepharoplasty

BACKGROUND: Many methods have been proposed for the correction of sunken upper eyelids. These methods include surgical treatments, such as micro-fat, dermofat, or fascia-fat grafts, or the use of alloplastic materials. Here, we present our experience of sunken upper eyelid correction involving the simple addition of anchoring the central fat pad to the medial fat pad during upper blepharoplasty. METHODS: We performed 74 cases of upper blepharoplasty with sunken upper eyelid correction between October 2013 and September 2014. The lateral portion of the central fat pad was partially dissected to facilitate anchoring. The medial fat pad was gently exposed and then pulled out to facilitate anchoring. After the rotation of the dissected lateral portion of the central fat pad by 180degrees to the medial side, it was anchored spreading to the medial fat pad. Photographs taken at 6 months postoperatively were presented to three physicians for objective assessment. Of the 74 patients, 54 patients followed at 6 months postoperatively were included in this retrospective, objective assessment. RESULTS: Sunken eyelids were effectively corrected in 51 of the 54 patients, but 3 had minimal effect because preaponeurotic fat pads had been removed during previous upper blepharoplasty. In addition to correcting sunken eyelids, lateral bulging was corrected and a better definition of the lateral portion of upper lid creases was obtained. CONCLUSIONS: Anchoring the central fat pad to the medial fat pad provides an effective means of correcting sunken upper eyelids during upper blepharoplasty.