Reconstruction of bilateral inferomedial gluteal defects after resection of hidradenitis suppurativa with symmetrical keystone flaps designed parallel to relaxed skin-tension lines: A case report

Rationale: Surgical treatment of hidradenitis suppurativa (HS) is challenging. Wide excision of affected lesions followed by skin graft or flap coverage has been recommended to achieve remission and prevent recurrence. Herein, we present our experience of bilateral inferomedial gluteal defects coverage using symmetrical keystone flaps (KFs) designed parallel to relaxed skin-tension lines (RSTLs). Patient concerns: An 18-year-old man was admitted for chronic inflammatory lesions in both inferomedial gluteal areas. Diagnoses: Physical examination revealed multiple sinuses with broad surrounding scars in both inferomedial gluteal areas, which led to a diagnosis of HS. Interventions: We performed wide excision on all affected lesions. The size of the final defects was 6 × 10 cm on the right side, and 5 × 9 cm on the left side. We covered the defects with KFs 9 × 15 cm (right) and 8 × 12 cm (left), which were based on the hotspots of the interior gluteal artery and internal pudendal artery perforators, and parallel to RSTLs. Outcomes: The flaps were inset without tension on each side, and the donor sites were closed primarily. All flaps fully survived and there were no postoperative complications. The patient was satisfied with the final outcome after 6 months of follow-up. Lessons: Successful reconstruction of bilateral inferomedial gluteal defects was achieved after resection of HS using symmetrical KFs designed pa...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

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ConclusionsAxillary HS requires complete excision to prevent future recurrence. Reconstructive method with soft tissue coverage presented a better outcome compared to split thickness skin grafting in terms of surgical time, recovery rate, morbidity, as well as functional and esthetic outcomes.Level of evidence: Level IV, therapeutic study.
Source: European Journal of Plastic Surgery - Category: Cosmetic Surgery Source Type: research
Accumulating data on cellular and molecular pathways help to develop novel therapeutic strategies in skin inflammation and autoimmunity. Examples are psoriasis and atopic dermatitis, two clinically and immunologically well-defined disorders. Here, the elucidation of key pathogenic factors such as IL-17A/IL-23 on the one hand and IL-4/IL-13 on the other hand profoundly changed our therapeutic practice. The knowledge on intracellular pathways and governing factors is shifting our attention to new druggable molecules. Multiple cytokine receptors signal through Janus kinases (JAKs) and associated signal transducer and activato...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Conclusion: These findings confirm that the propeller flap procedure can be effective for immediate or delayed defect closure after radical excision of localized axillary hidradenitis suppurativa, providing that no perifocal signs of infection are present after debridement.
Source: Plastic and Reconstructive Surgery Global Open - Category: Cosmetic Surgery Tags: Original Article Source Type: research
Conclusions: Reconstruction by PC should be reserved for patients with limited HS lesions, whereas FCF was most effective in avoiding recurrence, but was associated with unfavorable short-term results and patient-reported outcomes regarding function and aesthetics. FCF should generally be reserved for patients with recurrent, severe HS comprising an extensive surface of the axillary skin.
Source: Plastic and Reconstructive Surgery Global Open - Category: Cosmetic Surgery Tags: Original Article Source Type: research
Huidi Tchero, Christian Herlin, Farid Bekara, Sergiu Fluieraru, Luc TeotIndian Journal of Dermatology, Venereology, and Leprology 2019 85(3):248-257 Hidradenitis suppurativa is a chronic inflammatory condition that affects skin regions bearing apocrine glands. Although hidradenitis suppurativa is difficult to treat and cure, the currently available treatments are directed toward managing the lesions and associated symptoms. This review presents an evidence-based outline of the available treatment options. We searched four electronic databases and extracted data from retrieved studies for qualitative or quantitative analys...
Source: Indian Journal of Dermatology, Venereology and Leprology - Category: Dermatology Authors: Source Type: research
We present a 43 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa, it limits his normal activity. The patient was referred to our center after unsuccessful medical treatment (doxycycline and clindamycin cycles). Surgical treatment consisted of total excision of the skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. The result was satisfactory both functionally and aesthetically. PMID: 30951036 [PubMed - in process]
Source: Cirugia y Cirujanos - Category: Surgery Authors: Tags: Cir Cir Source Type: research
Multiple step-by-step surgeries in place of a major procedure to remove diseased skin related to hidradenitis suppurativa can eliminate the need for skin grafts, a small pilot study shows.Medscape Medical News
Source: Medscape Medical News Headlines - Category: Consumer Health News Tags: Dermatology News Source Type: news
This article describes the cases of 2 patients with chronic HS in which lesions were resected with disease-free margins and the reconstruction of the defect is carried out with lateral thoracic wall perforator flaps and the subsequent improvement in their life quality after surgery.
Source: Plastic and Reconstructive Surgery Global Open - Category: Cosmetic Surgery Tags: Case Report Source Type: research
We present a 43 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa, it limits his normal activity. The patient was referred to our center after unsuccessful medical treatment (doxycycline and clindamycin cycles). Surgical treatment consisted of total excision of the skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. The result was satisfactory both functionally and aesthetically. PMID: 29681638 [PubMed - in process]
Source: Cirugia y Cirujanos - Category: Surgery Authors: Tags: Cir Cir Source Type: research
We present a clinical case of a patient with severe, bilateral axillary hidrosadenitis. In the first surgical step we excised the lesions and applied the artificial dermis secured with negative pressure wound therapy. In the second step we used a split thickness skin graft to close the wound and again applied negative pressure wound therapy. The graft take was very good, without complications. The cosmetic outcome is acceptable and shoulder mobility was not compromised. No recurrence was detected (nine months follow up). PMID: 29573770 [PubMed - in process]
Source: Acta Medica Portuguesa - Category: General Medicine Tags: Acta Med Port Source Type: research
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