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

Abstract

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.

Keywords: Case reports; Delayed diagnosis; Hidradenitis suppurativa; Perforator flap.

Fig. 1

Initial photographs. A 32-year-old man with recurrent abscesses in the bilateral postauricular areas. (A) Left side. (B) Right side.

Fig. 2

After incision and drainage. Postauricular chronic inflammatory lesion and scar. (A) Left side. (B) Right side.

Fig. 3

Intraoperative photographs. Wide excision was performed and defect was covered with a posterior auricular artery perforator-based keystone flap. (A) Left postauricular area. (B) Right postauricular area.

Fig. 4

Postoperative photographs. No recurrence occurred during 2 years of postoperative follow-up, and no wound complication was encountered. (A) Left side. (B) Right side.