Periumbilical Dermal Graft as a Good Option for Volume Enhancement in Secondary Cleft Lip Deformity: A Case Report

Volume deficiency and poorly defined cupid's bow of the upper lip are frequently encountered problems in secondary cleft lip deformities. In this report, we present the method of a periumbilical dermal graft for correcting secondary cleft lip deformity. A 17-year-old male patient presented with a poorly defined notching cupid's bow and volume deficiency of the upper lip. He had undergone cleft lip surgery when he was 2 years old. We planned to perform a periumbilical dermal graft. There were sufficient amount of periumbilical subdermis and fat tissue thickness to obtain abundant volume. The periumbilical contour was similar to the natural contour of the lip. Less scarring was expected. There was no need to change the posture during operation, making it easy to harvest. Postoperative evaluations showed vermilion symmetry. Ideal cupid's bow shape and position were achieved without color mismatch. As a result, we obtained an ideal volume of the upper lip. Therefore a periumbilical dermal graft is a good option for correcting volume deficiency of the lip with good aesthetic outcomes.

Reconstruction of Large Orbital Floor Defect Caused by Maxillary Sinus Mucocele

Maxillary sinus mucocele can occur due to many medical factors such as chronic infection, allergic sinonasal disease, trauma, and previous surgery. However, it occurs mainly after Caldwell-Luc operation, usually more than 10 years after surgery. There are a few cases of maxillary sinus mucocele with ocular symptoms. Also, a case causing ocular symptoms because of invasion to the orbital floor is rare. Therefore, we report a case of a 55-year-old male patient who underwent Caldwell-Luc operation about 30 years ago. Then, symptoms such as exophthalmos, diplopia, and visual disturbance developed suddenly 3 months prior to admission. Computed tomography showed a cyst invading the orbital floor which resulted in eyeball deviation. The orbital floor defect measured approximately 2.5×3.3 cm. Maxillary sinus mucocele was removed through an endoscopic approach. After this, we reconstructed the orbital floor through a subciliary incision. Observation was carried out after three years, and ocular symptoms such as diplopia and exophthalmos did not recur.

Coverage of a 4(th) Degree Contact Burn of Scalp and Calvarium Using a Fasciocutaneous Transposition Flap: A Case Report

Scalp and calvarium defects are caused by trauma, burn, tumor resection, or congenital diseases. We experienced a few cases of severe electrical burn of scalp and calvarium, but fourth-degree contact burn of scalp and calvarium is a rare case. A 67 years old man was presented with a 25% total body surface area contact burn. A 20 cm×15 cm thick eschar on the patient's scalp was observed. Among various techniques for scalp reconstruction, we planned fasciocutaneous transposition flap with split thickness skin graft for coverage of large defect. Considering aesthetically satisfactory outcome, we designed a fasciocutaneous transposition flap including the hair-bearing areas. We additionally used skin graft for uncovered surrounding areas. There were no flap necrosis, graft loss, or any other surgical complications after the surgical flap and skin graft. At 6-month follow-up, the operation site was stable. The patient satisfied with functional and aesthetical outcomes, so we report this case.

Nasal Tip Plasty Using a Batten Graft with Ear Cartilage in East Asians

BACKGROUND: Plastic surgeons have constantly investigated methods of nasal tip plasty and nasal lengthening in rhinoplasty. The septal extension graft has been widely applied as a very useful method for East Asians who have different internal nasal structures and nasal skin from those of Caucasians. In this study, we performed nasal tip plasty with a batten-type septal extension graft using ear cartilage. METHODS: Nasal tip plasty was performed for 48 patients by batten graft with ear cartilages at the Cocoa Plastic Surgery Clinic and in the plastic surgery unit of Hanil General Hospital from January 2009 to January 2015. A batten-type septal extension graft was constructed with cymba of the concha cartilage. An average area of 2.0 cm × 1.4 cm of the cymba and 1.0 cm × 1.0 cm of the cavum from the concha cartilage was harvested. RESULTS: Of the 48 patients who underwent batten-type septal extension graft using ear cartilages, nasal tip plasty and columellar lengthening were successfully achieved in almost all of the patients. The nasal tip's height was well-maintained for the follow-up period ranging from 6 months to 5 years after surgery. CONCLUSIONS: Nasal tip plasty using a septal extension graft is a very useful method for East Asians with a low nasal tip. The septal extension graft with ear cartilage enables the creation of a desirable nasal shape because there is a sufficient amount of ear cartilage to stably support the nasal tip, thus creating a natural and smooth nose shape.

Traumatic Boutonniere Deformity of the Thumb

Traumatic boutonniere deformity of the thumb is rare in non-rheumatoid patients. Non-rheumatoid patient develops a boutonniere deformity of the thumb following a closed injury to the dorsoradial aspect of the metacarpophalangeal joint. The patient had an extensor lag of the metacarpophalangeal joint and paradoxical hyperextension of the interphalangeal joint. The patient required surgical treatment which included advancement and reattachment of the extensor pollicis brevis insertion and imbrication of the dorsoradial capsule to restore the anatomical alignment of the extensor pollicis longus. Conservative care of the metacarpophalangeal joint may be effective, but once a boutonniere deformity is developed, surgical treatment is necessary.

Chondrocutaneous Branchial Remnant in Cervical Region: A Case Report

Cervical chondrocutaneous branchial remnants are rare and one of several maformations resulting from abnormal development of the branchial apparatus. These lesions are usually located over or near the insertions of the sternocleidomastoid muscles in the lower neck. It is important to recognize that they may be a visible marker for other malformations and/or anomalies. Treatment is complete surgical removal as promptly as possible in order to get an exact histopathological diagnosis. In this article, we report a rare case of cervical chondrocutaneous branchial remnants and some reviews of the literature.

Carcinosarcoma of the Scalp

Carcinosarcoma is a biphasic tumor composed of an intimate admixture of epithelial and mesenchymal element, both of which are malignant. Primary cutaneous cases are extremely rare. There have been reported only 18 cases of cutaneous carcinosarcoma in the world and only one case can be found in the korean pathology literature. Therefore it has been difficult to characterize the clinical course of carcinosarcoma of the skin. We present a further case of primary cutaneous carcinosarcoma in a 86-years-old woman with exophytic and hemorrhagic mass on scalp. Histologic and immunohistochemical studies revealed both squamous cell carcinoma and spindle cell sarcomatoid change intermingled in the same tumor. The clinical and histologic findings of cutanous carcinosarcoma were described.