Successful treatment of pustulotic arthro-osteitis with apremilast: a case report with follow-up MRI

Abstract

EJD, vol. 29, n◦ 6, November-December 2019 tion time was 62.2 (45-75) minutes. The flap design differed from a conventional design (figure 1A) in that parallel lines were vertically drawn from the lateral borders with a length that was 1.0-1.5-fold longer than the vertical diameter of defects (figure 1B), and the Burow’s triangles were excised depending on tissue redundancy. Relative to conventional design, our method is superior with respect to the traction vector applied on the cheek (figure 1A, B). In the field of aesthetic surgery, recent refinements in rhytidectomy have yielded a simple but effective technique termed “the minimal access cranial suspension lift” [6]. This procedure takes advantage of the vertical vector, as with our design, and avoids horizontal traction, whereas traditional rhytidectomy comprises horizontal traction, similar to the conventional design and results in redraping in an oblique direction [6]. Moreover, due to greater flap extensibility, a relatively smaller area of undermining was necessary compared with the conventional method, which could prevent postoperative bleeding complications. Although there may be controversy over vertically lined parallel scars, our procedure follows the guiding principles that the surgical margins are hidden within the natural borders of the cheek unit, and the vertical lines follow relaxed skin tension lines [7]. In fact, skin laxity minimized postoperative scar formation, resulting in superior cosmetic acceptability, so long as it was performed in elderly patients (figure 1C-E). Since NMSCs are rarely fatal, there is an ongoing debate as to whether short-life expectancy should be taken into account in treatment decision-making [5]. However, the fact that the periauricular area is an independent highrisk factor for SCC should be considered [2]. Therefore, the invasiveness of procedures should not be determined based on patients’ age and a one-size-fits-all basis [5], and complete disease control should always be sought [2]. Indeed, we experienced two cases of local recurrence or lymph node metastasis after surgery; the former (Case 4) (figure 1E) was managed by extended resection followed by chemoradiotherapy using fluorouracil plus cisplatin for up to 30 months (figure 1E), and the latter remains in complete remission, 10 months after cervical lymph node dissection (Case 7). Therefore, following meticulous consideration and close observation, our simple and efficient method could be an attractive reconstructive option.