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.

Treatment of Chronic Osteomyelitis on Medial Malleouls after Electrical Burn Injury by Propeller Flap: A Case Study

It is known that cases of osteomyelitis are less common than 5% in deep burn cases. This research presents a case of chronic osteomyelitis, presented 7 years after initial electrical burn injury. A 43-year-old male patient was admitted to the Department of Plastic Surgery, suffering from an 22900-voltage electrical burn on right medial malleolus in 2010. There was no postoperative complication for five years observation. In November 2016, he was admitted to the Plastic Surgery department, suffering from the skin and soft tissue defect on right medial malleolus without trauma history. The osteomyelitis on the right medial malleolus was found in bone scintigraphy. The medial malleolus was covered with a local flap two days after admission. Dehiscence was found after surgery and exudate was emerged continuously from the flap site. We decided to cover the raw surface with a perforator based propeller flap 22 days after admission considering reconstructive ladder. The flap survived successfully, and partial epidermal sloughing was healed completely by daily dressing at 51 days after the surgery. It is advisable to establish and access the prudent plan before surgery through many kinds of radiological tests and physical examinations considering vascular stability and delayed wound healing.

Severe Case of Low Temperature Contact Burn with Rhabdomyolysis

Although low temperature contact burn doesn't have clear definition, it is used to describe the burn occurred by long time exposure under 50℃ temperature. 4(th) degree burn can be occurred by low temperature contact burn because of low pain, especially in patients who are insensitive to stimulation by various reasons. The under-floor heating system such as Ondol or electronic heating pad is popular in Korea because of the cultural influence. Although the upper limit surface temperature of electronic heating pad is 50℃, severe burn injury can happen by long time exposure. So we report a low temperature contact burn case of 4(th) degree involving gluteus maximus muscle of the buttock caused by electric heating pad, which led to Rhabdomyolysis.

Clinical Consideration about Characteristics and Treatment of Scalding Burn Caused by Instant Noodle

PURPOSE: Instant noodle is one of the most popular noodle and its consumption is increasing annually. So scalding burns caused by Instant noodle are comparatively common. Instant noodle can lead to contact burn caused by noodle as well as scalding burn by soup. Because the depth of the burn can be deeper than general scalding burn, it can cause physical or psychological disability and the medical and social expense is not a few. The purpose of this study was to investigate the epidemiology and clinical features of the scalding burn caused by Instant noodle. METHODS: Retrospective research was conducted 165 patients with scalding burn by Instant noodle among patients admitted to our burn medical center from May 2011 to April 2016. Subjects were classified by age, gender, affected site and degree and treatment method. RESULTS: For 6 years, 165 subjects went through hospital treatment because of the scalding burn by Instant noodle. It consisted of 48 infants, 74 children and adolescence, and 43 adults. The average TBSA (total body surface area, %) was 3.43. The number of patients exceeding 10% were 3. The most common affected site was thigh in 35.5% and there was no big differences between each age group. 8 patients did operations and 6 did dermabrasion. CONCLUSION: From May 2011 to April 2016, about 7% of total scalding burn patients was injured by Instant noodle. Considering the characteristics of scalding burn by Instant noodle, conservative treatment was preferred to surgical treatment. 149 of total 165 patients were done conservative treatment using cultured allogenic keratinocytes.

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.

Dual Perforator Flap for Reconstruction of Large Sacral Defects: Superior Gluteal Artery Perforator Super-Flap with Parasacral Perforator

The superior gluteal artery perforator flap technique has increasingly been used for soft tissue defects in the sacral area following its introduction nearly 25 years ago. Advantages in covering sacral defects include muscle sparing, versatility in design, and low donor side morbidity. The bilateral superior gluteal artery perforator flap procedure is planned in cases of large sacral defects that cannot be covered with the unilateral superior gluteal artery perforator flap. Here, we report two cases of large sacral defects in which patient factors of poor general health, such as old age, pneumonia, and previous operation scar, led to use of a large unilateral superior gluteal artery perforator super-flap with parasacral perforator. The approach was utilized to reduce the operation time and prevent unpredictable flap failure due to the large flap size. Even though the parasacral perforator was included, the versatility of the large superior gluteal artery perforator flap was preserved because sufficient perforator length was acquired after adequate dissection.

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.

Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection / 한국유방암학회지

Lymphedema is a condition characterized by tissue swelling caused by localized fluid retention. Advanced lymphedema is characterized by irreversible skin fibrosis (stage IIIb) and nonpitting edema, with leather-like skin, skin crypts, and ulcers with or without involvement of the toes (stage IVa and IVb, respectively). Recently, surgical treatment of advanced lymphedema has been a challenging reconstructive modality. Microvascular techniques such as lymphaticovenous anastomosis and vascularized lymph node flap transfer are effective for early stage lymphedema. In this study, we performed a two-stage operation in an advanced lymphedema patient. First, a debulking procedure was performed using liposuction. A vascularized free lymph node flap transfer was then conducted 10 weeks after the first operation. In this case, good results were obtained, with reduced circumferences in various parts of the upper extremity noted immediately postoperation.

Potential Use of Transferred Lymph Nodes as Metastasis Detectors after Tumor Excision

Due to the fact that it reliably results in positive outcomes, lymph node flap transfer is becoming an increasingly popular surgical procedure for the prevention and treatment of lymphedema. This technique has been shown to stimulate lymphoangiogenesis and restore lymphatic function, as well as decreasing infection rates, minimizing pain, and preventing the recurrence of lymphedema. In this article, we investigate possible additional benefits of lymph node flap transfer, primarily the possibility that sentinel lymph nodes may be used to detect micro-metastasis or in-transit metastasis and may function as an additional lymphatic station after the excision of advanced skin cancer.

Lymphedema Fat Graft: An Ideal Filler for Facial Rejuvenation

Lymphedema is a chronic disorder characterized by lymph stasis in the subcutaneous tissue. Lymphatic fluid contains several components including hyaluronic acid and has many important properties. Over the past few years, significant research has been performed to identify an ideal tissue to implant as a filler. Because of its unique composition, fat harvested from the lymphedema tissue is an interesting topic for investigation and has significant potential for application as a filler, particularly in facial rejuvenation. Over a 36-month period, we treated and assessed 8 patients with lymphedematous limbs who concurrently underwent facial rejuvenation with lymphedema fat (LF). We conducted a pre- and post-operative satisfaction questionnaire survey and a histological assessment of the harvested LF fat. The overall mean general appearance score at an average of 6 months after the procedure was 7.2+/-0.5, demonstrating great improvement. Patients reported significant improvement in their skin texture with a reading of 8.5+/-0.7 and an improvement in their self-esteem. This study demonstrates that LF as an ideal autologous injectable filler is clinically applicable and easily available in patients with lymphedema. We recommend the further study and clinical use of this tissue as it exhibits important properties and qualities for future applications and research.