Reconstruction with the 'V-Y-S Flap' for the Facial Defect after the Excision of a Skin Cancer

PURPOSE: There are many methods for the reconstruction of the facial defect after an excision of a skin cancer; such as skin graft, local flap, free flap, etc... Skin graft has its' limitations; it could remain in different color with in regards of the recipient to donor, with an unfavorable scar. Free flap can lead to big donor site morbidity with long operation time and uncontrolled scar as a disadvantage factor. Compared to the prior, local flap offers several merits; sufficient blood supply, good tissue quality and short operation time. We revised 'V-Y-S flap' for the facial defect, which proved to have favorable outcomes. METHODS: Total 7 V-Y-S flaps were performed to patients with skin cancers(six squamous cell carcinoma and one basal cell carcinoma). Two of these flaps were combined with composite grafts, one with full thickness skin graft. Six patients were female and one male. The average diameter of defects after excision was 2.3cm. The follow-up period was 18 months maximally. RESULTS: We treated seven facial skin cancers with 'V-Y-S flap'. There were no flap necrosis, cancer recurrence and scar contracture as a result. Furthermore, this method also offers a favorable central scar line that is parallel to the nasolabial fold and the nasojugal groove, especially in the nasolabial area and superomedial side of the cheek. With this method, we could cover a maximum diameter of 4cm facial defect. CONCLUSION: In conclusion, it is suggested that V-Y- S flap is a useful mehtod to cover facial defects after the excision of a skin cancer.

A Clinical Experience of a Tumor Composed of Unknown-Natured Cystic Structures and Fibrosis on Face

Unknown-natured cystic structures on face refers to a very rare tumor. We report a case of unknown-natured cystic structures on face in a 31 years old woman. She had complained palpable mass of left cheek for 5 years. Radiographically, a dense inhenced mass of left maxillary area showed mild protruding external surface without cortical destruction. The maximum diameter of mass was 3.5cm. Microscopically, the mass was composed of unknown-natured cystic structures devoid of lining cell and fibrosis of cystic wall. The mass was successfully removed via subciliary incision. No tumor recurrence has been reported during the follow-up period. We described surgical approach, MR imaging finding, histopathological and immunohistochemical findings of this tumor.

A Surgical Experience of Cauliflower Ear with Osseous Metaplasia

Acute auricular hematoma is a common problem in wrestlers, boxers and secondary to trauma such as traffic accident. Early intervention can be limited to simple incision and drainage. Delay in treatment may allow the growth of ectopic fibroneocartilage derived from the damaged perichondrium and it can subsequently cause the unsightly cauliflower ear. Few paper deal with histopathologic analysis of removed excess cartilage fragment. Usual findings are cartilagenous tissue surrounded by fibrous tissue with hemosiderin deposits or cicatrix and foci of cartilage formation. But this case shows degenerative cartilage with osseous metaplasia and it has a stony hard consistency and is clinically a rare disease. The ear cartilage were exposed anteriorly and posteriorly. The deformed cartilage and bony tissue were removed and shaved to restore a normal form. The elevated cutaneous flap was sutured and silastic drainage was applied. We described histopathologic finding and surgical treatment of cauliflower ear with osseous metaplasia.

Correction of Unilateral Cleft Lip Using Surgeon-Made Nasoalveolar Molding Device

The unilateral cleft of the lip and palate is a very complex deformity. This deformity comprises wide separation of the lip, defect of the ipsilateral columella and distorted nose, wide interalveolar gap due to accompanying alveolar cleft and displacement of the premaxilla. These variable deformities must be treated at the appropriate time. If not, it would result in severe facial mutilation, growth disturbance of the maxilla and functional defect of the teeth. Its ideal correction involves alignment of the dental arch, creation of a growing platform for the lip and nose, joining of the separated lip and correction of the distorted nose. Since McNeil(1950), variable presurgical orthopedic techniques have been evolved by many authors, but there is no uniform consensus. One commonly used appliance consists of an alveolar molding plate made of a hard outer shell and a soft acrylic lining described by Gnoinski. The author treated unilateral cleft lip and palate using presurgical nasal and alveolar molding (NAM) device which was introduced in 1993 by Grayson. In our cases (n=17), the author made the device by himself and performed presurgical nasoalveolar molding for the unilateral cleft lip and palate patients. Presurgical NAM device was applied in the second week following birth, and nasal stent for nasal cartilage molding was applied during nasoalveolar molding process around 6weeks after birth. Presurgical NAM was continued until repositioning of the nasal cartilages and alveolar processes (interalveolar gap <2mm), and lengthning of the deficient columella (mean vertical height of columella in postop 3 months: preop. 1.5mm--> postop 4.5mm). The primary lip-nose repair and gingivoperiosteoplasty were performed within 6months after birth (mean age: 17 weeks). Even though not evaluating the long term follow-up study in our cases, this technique enables a one-stage repair of the lip, nose and alveolus while the three-stage repair was necessary previously: primary lip repair, secondary rhinoplasty and alveolar repair with bone graft. In addition, when presurgical nasoalveolar molding is performed by a surgeon, it can be avoided complications such as meganostril and delaying of operation time. But orthodontic postoperative care should be planned after operation for unilateral cleft lip and palate patient.

Correction of Cryptotia Using Combined Method of Fukuda and Onizuka

Cryptotia is a relatively common congenital anomaly in orientals. It is charaterized by obliteration of auriculocephalic sulcus and buried ear cartilage of upper pole beneath the scalp skin. In addition, there is often a posterior displacement of the superior crus of antihelix. The goals of surgical correction are the coverage of skin deficit, deepening of the auriculocephalic sulcus and the correction of deformed cartilage. Some authors stressed a tendency for the superior portion of the auricle to spring back to the original portion after surgery. We have devised a surgical method to prevent recurrence of the cartilagenous deformity using combined method of Fukuda and Onizuka. From March in 2001 to Jan, 2004, We have repaired 6 cryptotic deformities in 5 patients including one bilateral cryptotia. Between them We used combined method of Fukuda and Onizuka in 4 severely deformed cryptotic superior ear cartilage correction with satisfactory results. Single Fukuda's method was used in 2 mildly deformed cryptotias. The combined method composed of Z-plasty incision for skin releasing, and incision along the crus and then flattened the crus by mattress suture, multiple incisions in the back of the superior crus and then grafting the piece of conchal cartilage producing a splinting to hold the crus out in a smooth, curved configuration for the correction of the superior portion of the deformed ear. The results were remarkable improvement of profile in severely deformed cryptotia. And so this combined method is useful method for the correction of severely deformed cartilage in cryptotia.

Surgical Correction of Nipple Hypertrophy with "Modified Sinusoidal Wave form Resection" Method

INTRODUCTION: Nipple hypertrophy is a known, but rare condition. The cases described in the literature all refer to aesthetically unacceptable, long, prominently projecting nipples and reconstruction which, in principle, is aimed at height reduction. MATERIAL AND METHOD: 2 male and 3 female patients who did not need to feed. We modified several aspects of Sinusoidal wave form resection method. First, we changed the position of peaks from superior, inferior point to medial, lateral side to mask the possible dog ear. Second, We classified the types of nipple hypertrophy to pedunculated type and cylindrical type on the point of diameter and shape. Third, We designed the obtuse peak and acute through on pedunculated type because of small diameter of the neck. Forth, We designed the acute peak and obtuse through on cylindrical type because of large diameter of nipple. Fifth, purse string suture was not necessary. RESULTS: There was no postoperative complication with great satisfaction after 10 months follow up. CONCLUSION: Previously described surgical method for nipple hypertrophy was aimed at the reduction of height of nipple, only, but my method was aimed at the reduction of height and diameter of nipple with sinusoidal wave design, after classification of nipple shape. Moreover, dog ear was masked by design of sinusoidal wave, which was begun at the medial side of hypertrophied nipple. All patients were satisfied with the result without complication.