Outcomes of Surgery for Dermatofibrosarcoma Protuberans and Risk Factor Analysis for Recurrence

PURPOSE: Dermatofibrosarcoma protuberans is a relatively rare tumor that originates from the dermis and subcutaneous tissue. It is generally known that this tumor easily recurs but can be successfully treated with a wide excision. Therefore, this study was conducted to investigate postoperative outcomes and risk factors for recurrence in patients with dermatofibrosarcoma protuberans who were treated at a single institution for 20 years. METHODS: We retrospectively reviewed the medical records of 35 patients who had underwent surgery between June 1992, and September 2010. The patients were assessed in terms of predilection site and size of the tumor, the incidence according to sex, discrepancy between biopsy results and histopathological diagnosis of the surgical specimen, additional treatment after recurrence, recurrence rate and the time interval to recurrence. RESULTS: In multivariate analysis, the depth and site of the tumor were significant risk factors for tumor recurrence. The recurrence rate was significantly higher in tumors occurring in the upper extremity than those occurring in other regions(p=0.0348). In addition, the recurrence rate was significantly higher in tumors with involvement of the fascia and the deeper structures(p=0.0324, odds ratio=6, relative risk=1.588). Since dermatofibrosarcoma protuberans has strong invasiveness, its tissue involvement is difficult to evaluate accurately. CONCLUSION: The results of this study shows that involvement of the fascia and the deeper structures and occurrence in the upper extremity were associated with tumor recurrence. Therefore, clinicians should be aware of these risk factors to achieve better treatment outcomes.

Treatment of Velopharyngeal Insufficiency in Kabuki Syndrome: Case Report

PURPOSE: Kabuki syndrome is a multiple malformation syndrome that was first reported in Japan. It is characterized by distinctive Kabuki-like facial features, skeletal anomalies, dermatoglyphic abnormalities, short stature, and mental retardation. We report two cases of Kabuki syndrome with the surgical intervention and speech evaluation. METHODS: Both patients had velopharyngeal insufficiency and had a superior based pharyngeal flap operation. The preoperative and postoperative speech evaluations were performed by a speech language pathologist. RESULTS: In case 1, hypernasality was reduced in spontaneous speech, and the nasalance scores in syllable repetitions were reduced to be within normal ranges. In case 2, hypernasality in spontaneous speech was reduced from severe level to moderate level and the nasalance scores in syllable repetitions were also reduced to be within normal ranges. CONCLUSION: The goal of this article is to raise awareness among plastic surgeons who may encounter such patients with unique facial features. This study shows that pharyngeal flap operation can successfully correct the velopharyngeal insufficiency in Kabuki syndrome and post operative speech therapy plays a role in reinforcing surgical result.

Effect of Platelet-rich Plasma on Burn Wounds according to Time of Application: An Experimental Study on Rats

PURPOSE: One of the main subjects that burn researches are focused on is saving the zone of stasis. Platelet-rich plasma stimulates angiogenesis, promoting vascular in-growth and fibroblast proliferation. In addition, platelet-rich plasma functions as haemostatic agent by forming a fibrin clot. Also application of platelet-rich plasma enhances wound-healing in both soft and hard tissue. In this study, the effect of the platelet-rich plasma on the zone of stasis was evaluated. METHODS: Sixteen F344/N Slc Inbred Rats were used and randomly separated into four groups. Autologous platelet-rich plasma was harvested and applied to each group of burn wound model at different times. RESULTS: After 20 days, burn wounds of each group healed well. However, healing speed was different in each group. The group to which platelet-rich plasma was applied 4 hours after burn injury had healed about 1.38 times faster than control group. CONCLUSION: The results showed that platelet-rich plasma is an effective substance for saving the zone of stasis. It is not only well-known, but also easy to harvest and easy to use. Thus autologous platelet-rich plasma could be a valuable addition to existing burn treatment methods.