Case-control study of the treatment of postaxial polysyndactyly of the foot: Comparison of surgical results after removal of the fifth or sixth toe

Background@#In postaxial polysyndactyly of the foot, the choice of which toe to excise is controversial. It is often treated by resection of the fifth toe to save the lateral neurovascular bundles of the sixth toe. However, the sixth toe is often short and laterally deviated, which may require wedge osteotomy, potentially shortening the phalanx and compromising circulation. This study outlines an individualized method to spare the length and axis of the fifth toe in polysyndactyly with a short and deviated sixth toe. @*Methods@#We retrospectively analyzed 38 patients who underwent surgery between 2006 and 2019. The fifth toe was spared in 18 cases, and the sixth toe in 20 cases. The ratios of the forefoot width, angle difference, and toe length were compared between the affected and unaffected sides postoperatively. Complications and subjective judgments on cosmetic results were recorded and compared. @*Results@#No significant between-group differences were observed for sex, age at surgery, or the follow-up period. The forefoot width ratio did not significantly differ between the groups. However, the angle difference and toe length ratios showed significantly better results in the fifth toe-spared group than in the sixth toe-spared group (P<0.05 and P<0.01, respectively). There were no cases of impaired circulation, and subjective evaluations revealed satisfactory results in the fifth toe-spared group. @*Conclusions@#In cases with short and deviated sixth toes, sparing the fifth toe is an effective method of cosmetic treatment. The surgical results were satisfactory, with an improved appearance and no residual deformities.

Clinical analysis and review of literature on pilomatrixoma in pediatric patients

Background@#Pilomatrixoma is a benign tumor that originates from the hair follicle matrix. It usually presents as a hard, slow growing, solitary mass that can be easily misdiagnosed as other skin masses. The aim of this study was to clinically analyze a case series of pilomatrixoma in pediatric patients from Korea. @*Methods@#A total of 165 pediatric patients from 2011 to 2018 with a histological diagnosis of pilomatrixoma were included. A retrospective review was performed using the electronic medical records, including patient demographics, number and location of the mass, clinical and imaging presentation, and postoperative outcomes. @*Results@#There were 61 male and 104 female patients with 152 solitary and 13 multiple pilomatrixomas. Among solitary pilomatrixomas, the lesion commonly occurred in the head and neck (84.2%), followed by upper limbs (11.2%), lower limbs (3.3%), and trunk (1.3%). The pilomatrixoma lesion presented as the following types based on our clinical classification: mass (56.02%), pigmentation (25.31%), mixed (12.65%), ulceration (4.82%), and keloid-like (1.2%). Ultrasonography showed a high positive predictive value (95.56%). There were no specific complications observed except for two cases of recurrence. @*Conclusion@#Pilomatrixoma has various clinical feature presentations and commonly occurs in the head and neck. Ultrasonography is a helpful diagnostic tool. Surgical removal of the lesion is the main treatment method with a low recurrence rate.

Surgical Treatment of Axial Polysyndactyly and Postaxial Polydactyly of The Hand in Korean: A Clinical Analysis of 24 Cases

PURPOSE: Non-preaxial polydactyly of the hand refers to axial polysyndactyly involving the 2nd, 3rd, or 4th finger and postaxial polydactyly involving the 5th finger. It has a much lower incidence and a higher genetic penetrance than preaxial type. METHODS: Medical records of the patients who had operation for their polydactyly between July 1997 and July 2015 were retrospectively reviewed. The clinical data of the patients were investigated regarding demographics, clinical findings of the involved digits, foot involvement, and genetic penetrance. Through postoperative follow-up based on physical and radiologic examinations, we assessed functional and aesthetic outcomes, postoperative complications, and reoperation rate. RESULTS: Twenty-four patients (17 males and 7 females) underwent surgery for non-preaxial polydactyly of the hand. There were 15 postaxial type polydactyly, and 9 axial type polysyndactyly. Thirteen patients had bilateral involvement (54.2%), while 5 patients (20.8%) were right-sided and 6 patients (25%) were left-sided. In the axial type, 4th finger was the most frequently involved in 8 patients, followed by the 3rd finger in 1 patient. Thirteen patients (54.2%) had concurrent congenital foot anomalies. One patient (4.2%) had a family history of congenital hand anomaly. Patients with axial type polysyndactyly had poorer postoperative outcome than those with postaxial type, regarding reoperation rate. CONCLUSION: Non-preaxial polydactyly is a very rare congenital hand anomaly and the surgical outcome is not always promising especially in the axial type. Therefore, it is necessary to provide a sufficient preoperative counseling and to perform a meticulous surgery.

Three-Directional Reconstruction of a Massive Perineal Defect after Wide Local Excision of Extramammary Paget's Disease

Extramammary Paget's disease (EMPD) is a rare, slow-growing intraepithelial malignancy that mainly involves the genital region, including the vulva, penis, scrotum, perianal, and periurethral areas. Although several treatment options exist, wide local excision with a safe margin is considered the treatment of choice. After resection of the lesion, it is often challenging to reconstruct the defect because defects in the perineal region require adequate volume for protection and are susceptible to infections, which is a particularly significant risk for large defects. We report a case of perivulvar EMPD that was reconstructed with three-directional local flaps after wide excision of the tumor. We covered the defect sequentially using the following 3 flaps: a gracilis myocutaneous flap from the left thigh, a bipedicled V-Y advancement flap from the lower abdomen, and an internal pudendal artery perforator-based island flap from the right buttock. To the best of our knowledge, this report is the first to describe a three-directional approach to extensive perivulvar reconstruction.

Foot Syndactyly: A Clinical and Demographic Analysis

BACKGROUND: Syndactyly of the foot is the second most common congenital foot anomaly. In East Asia, however, no large case study has been reported regarding the clinical features of isolated foot syndactyly. In this study, we report a review of 118 patients during the last 25 years. METHODS: We conducted a chart review of patients who underwent surgical correction for foot syndactyly between January 1990 and December 2014. Operations were performed with a dorsal triangular flap and a full-thickness skin graft. The demographics of included patients and their clinical features were evaluated. Surgical outcomes and complications were analyzed. RESULTS: Among 118 patients with 194 webs (155 feet), 111 patients showed nonsyndromic cases and 7 patients showed syndromic cases. In 80 unilateral cases (72.1%), the second web was the most frequently involved (37.5%), followed by the fourth (30%), the first (15%), the third (15%), the first and second in combination (1.3%), and the second and third in combination (1.3%). Among 31 bilateral cases, 2 cases were asymmetric. Among the remaining 29 symmetric bilateral cases, the second web was the most frequently involved (45.2%), followed by the first (22.6%), and the fourth (6.5%). No specific postoperative complications were observed, except in the case of 1 patient (0.51%) who required a secondary operation to correct web creep. CONCLUSIONS: This retrospective clinical study of 118 patients with both unilateral and bilateral foot syndactyly revealed that the second web was the most frequently involved. In addition, complete division and tension-free wound closure with a full-thickness skin graft of sufficient size showed good postoperative results.

Porocarcinoma Arising in a Ganglion Cyst: A Case Report and Review of the Literature

Eccrine porocarcinoma is a rare malignant neoplasm of the eccrine sweat gland that often occurs in the lower extremities, and usually affects elderly individuals. Most cases of eccrine porocarcinoma arise de novo. We encountered a case of a large porocarcinoma arising in a pre-existing ganglion cyst in the knee. The malignant tumor was excised widely, and the defect was reconstructed using a free anterolateral thigh flap.

Acute Calcific Tendinitis in the Distal Interphalangeal Joint

No abstract available.

Basaloid Squamous Cell Carcinoma on the Skin of the Hand

No abstract available.

Plastic Surgery Training: A Privilege and Honor

No abstract available.

Medial and Lateral Canthal Reconstruction with an Orbicularis Oculi Myocutaneous Island Flap

BACKGROUND: The eyelid and canthal areas are common locations for cutaneous tumors. The medial canthus includes, among many other apparatuses, the canthal tendon and lacrimal canaliculi, and its characteristic thin and supple skin is hard to mimic and restore using tissue from other regions. Accordingly, reconstruction of the canthal area can prove challenging for surgeons. Although various methods, such as skin grafts and local flaps from adjacent regions, have been utilized for reconstructive purposes, they present known disadvantages. However, we were able to successfully reconstruct both lateral and medial canthal area defects by using orbicularis oculi myocutaneous island flaps. METHODS: Our study included seven patients who underwent medial or lateral canthal region reconstruction, using orbicularis oculi myocutaneous island flaps, between 2011 and 2014, following either cutaneous tumor excision or traumatic avulsion injury. RESULTS: Five patients had basal cell carcinoma, one had squamous cell carcinoma of the eyelid, and one had sustained a traumatic avulsion injury of the eyelid and canthal area. Entire flap loss was not observed in any patient, but one-a heavy smoker-showed partial flap loss, which healed with secondary intention and yielded acceptable results. Donor site morbidity was not observed, and all patients were satisfied with their surgical outcomes. CONCLUSIONS: The canthal regions can be successfully reconstructed with orbicularis oculi myocutaneous island flaps. These flaps offer several key advantages, including similarity in texture, color, and thickness to the recipient site and a negligible incidence of donor site morbidity.

Treatment of Chronic Osteomyelitis in the Hand with Anterolateral Thigh Free Flap and Autologous Iliac Bone Graft

Adequate debridement and flap operations are effective treatment methods for chronic osteomyelitis. Several flap operations have been described for treating chronic osteomyelitis in various regions. We performed anterolateral thigh fasciocutaneous free flap and iliac bone graft for treating posttraumatic chronic osteomyelitis in hand. The result was successful with satisfactory control of osteomyelitis and avoiding amputation of fingers.

Three-Dimensional Pre-Bent Titanium Implant for Concomitant Orbital Floor and Medial Wall Fractures in an East Asian Population

BACKGROUND: The objective of this article is to evaluate clinical outcomes of combined orbital floor and medial wall fracture repair using a three-dimensional pre-bent titanium implant in an East Asian population. METHODS: Clinical and radiologic data were analyzed for 11 patients with concomitant orbital floor and medial wall fractures. A combined transcaruncular and inferior fornix approach with lateral canthotomy was used for the exposure of fractures. An appropriate three-dimensional preformed titanium implant was selected and inserted according to the characteristics of a given defect. RESULTS: Follow-up time ranged from 2 to 6 months (median, 4.07 months). All patients had a successful treatment outcome without any complications. Clinically significant enophthalmos was not observed after treatment. CONCLUSIONS: Three-dimensional pre-bent titanium implants are appropriate for use in the East Asian population, with a high success rate of anatomic restoration of the orbital volume and prevention of enophthalmos in combined orbital floor and medial wall fracture cases.

New Classification of Polydactyly of the Foot on the Basis of Syndactylism, Axis Deviation, and Metatarsal Extent of Extra Digit

BACKGROUND: Polydactyly of the foot is one of the most frequent anomalies of the limbs. However, most classification systems are based solely on morphology and tend to be inaccurate and less relevant to surgical methods and results. The purpose of this study is to present our new classification of polydactyly of the foot, which can serve as a predictor of treatment and prognosis. METHODS: To find a correlation between the various morphologic traits of polydactyly of the foot and the treatment plan and outcomes, we reviewed 532 cases of polydactyly of the foot in 431 patients treated in our hospital, expanding on our previous study that described polydactyly based on the importance of metatarsal bone status and varus deformity. The records of patients were evaluated and compared with previous studies at other centers. RESULTS: Unsatisfactory results were seen in 36 cases, which included 5 cases of incomplete separation due to syndactylism, 23 cases of axis deviation, and 8 cases of remnants of extra-digit metatarsal bones. The locus of the polydactyly, or the digit which was involved, did not seem to affect the final postoperative outcomes in our study. Three factors-syndactylism, axis deviation, and metatarsal extension-are the major factors related to treatment strategy and prognosis. Therefore, we developed a new classification system using three characters (S, A, M) followed by three groups (0, 1, 2), to describe the complexity of polydactyly of the foot, such as S1A2M2. CONCLUSIONS: Our new classification could provide a communicable description to help determine the surgical plan and predict outcomes.

Surgical Options for Malignant Skin Tumors of the Hand

BACKGROUND: Primary malignant tumors of the hand, although unusual, may present varied and often complex clinical problems. The main treatment modality of skin cancer of the hand has changed. METHODS: We retrospectively reviewed the medical records of 43 patients who underwent surgery for malignant skin tumors of the hand during an 18-year period, from September 1994 to February 2012. The characteristics of the tumor, methods of reconstruction, and long-term results were reviewed. RESULTS: We had 43 patients with 27 melanomas, 14 squamous cell carcinomas, and 2 sarcomas. Their ages ranged from 19 to 74 years (mean, 53.4+/-14.5 years), from 46 to 79 years (mean, 59.7+/-9.6 years), and from 15 to 43 years (mean, 29+/-19.8 years), respectively. Thirty-four cases occurred on the fingertip (16 of those cases on the thumb), 5 cases occurred on the palm, and 4 cases on the dorsum of the hand. Amputation was most frequently used in early cases, but recently, tissue-sparing excision has been performed frequently. The incidence of local recurrence was 3 cases and distant metastasis was 1 case, and the 5-year survival rate was 100%, except in 4 cases due to follow-up loss. CONCLUSIONS: The principles of treatment-to be curative and to preserve function and appearance-are important points. "Preservative surgery" preserves function and cosmesis of the involved finger or hand dorsum or palm. Preservative surgery not only emphasizes less resection and surgery of a smaller scale, but also optimal reconstruction of the soft tissue defect of the digit.

A Retrospective Analysis of Eight Cases of Merkel Cell Carcinoma

BACKGROUND: Merkel cell carcinoma (MCC) is a rare locally aggressive cutaneous neuroendocrine carcinoma with a high incidence of local recurrence, regional lymph node metastasis, followed by distant metastasis. Because of shortage of the retrospective study, standard treatment has not been established. The purpose of this study was to present the surgical treatment and outcome of 8 patients with MCC. METHODS: We report our experiences with 8 patients who underwent treatment for MCC at our institution from 2000 through 2012. Two men and 6 women received treatment for MCC. The mean age was 76.4 years (range, 53 to 93 years). RESULTS: The follow-up period ranged from 7 to 26 months (mean, 22.9). During the follow-up period, three of 8 patients had a relapse (mean time before recurrence, 10 months; 1 month, 7 months, and 22 months). After primary surgery, 3 patients underwent radiotherapy, and 1 patient received chemotherapy. CONCLUSION: MCC is an aggressive skin cancer with a high rate of local recurrence. Complete surgical excision is the mainstay of local treatment, but adjuvant radiotherapy should be considered for better local control.

Absorbable Barbed Suture for the Repair of Tendo Calcaneus in Rabbits

PURPOSE: A barbed suture used in flexor tenorrhaphy can maintain prolonged strength despite absorption of the suture material and allows knotless repair with tendon-barb adherence along the suture's entire length. The purpose of this study was to evaluate the strength of the tendon and its histologic analysis after tenorrhaphy using barbed sutures. METHODS: Forty-two New Zealand rabbits were used in this study and were divided into experimental and control groups. In the experimental group, knotless repair of the tendons was performed using absorbable barbed sutures. In the control group, a 4-stranded double-modified Kessler tenorrhaphy was performed using non-absorbable monofilament sutures. The force to failure for each tendon was measured immediately after tendon repair and at 1 week, 4 weeks, and 8 weeks after the repair. Microscopic analysis of the tendons was performed at 1 week, 4 weeks, and 8 weeks after their repair. RESULTS: Eight weeks after tendon repair, the force to failure value of the rabbits in the experimental group (144.02+/-10.21 N) was significantly higher than that of the rabbits in the control group (125.26+/-8.75 N) (p=0.032). The difference in the value during the periods was not statistically significant. Histologic findings showed increased foreign body reaction in the tendons of the experimental group and sustained inflammation in those of the control group. CONCLUSION: With respect to load to failure and the degree of inflammation, the use of absorbable barbed suture resulted in better tendon repair than the conventional non-absorbable suture.

Effect of Platelet-rich Plasma(PRP) on Regeneration of Rat Sciatic Nerve in a Silicone Chamber

PURPOSE: The purpose of this study is to determine the effect of platelet-rich plasma(PRP) on rat sciatic nerve regeneration in a 10mm silicone chamber. METHODS: A total of 6 inbred Lewis rats were used in this study. Bilateral sciatic neurectomy was performed on each rat. On one side, silicone chambers containing PRP solutions were implanted; on the contralateral side, the chambers without PRP were implanted as a control. In 12 weeks post-implantation, chambers were retrieved and both gastrocnemius muscles were excised. Nerves biopsy samples were examined under a light microscope after Masson trichrome staining. RESULTS: Cross sections of the midpoints of PRP treated nerves were significantly larger and appeared more mature than those of controls. CONCLUSION: Based on morphological evidence, PRP has a positive effect on neural regeneration, and it may therefore be useful for treating peripheral nerve injuries.

Use of Stereoscopic Microscope for Practice of Microsurgical Skill

PURPOSE: Microsurgery is an essential technique in plastic and reconstructive surgery. However, microsurgical suturing and handling of the instrument are difficult for beginners, and who requires a steep learning curve. Therefore, methods for improving the technical skill are needed. The authors describe the value of a small stereoscopic microscope as a training tool. MATERIALS AND METHODS: A small stereoscopic microscope was used to help improve the microsurgical skill. Monofilament 10-0 Nylon and a surgical rubber globe were used as a suture material and education material, respectively RESULT: Stereoscopic view of the operation field was obtained and basic microsurgical suture was possible. CONCLUSION: The stereoscopic microscope is an effective training tool for beginners of microsurgery with benefits in cost and usefulness in small place.

Subungual Glomus Tumor Resection with Partial Detachment of Nail Plate

PURPOSE: A glomus tumor is a rare tumor with predilection for the hand. The curative treatment is complete surgical excision. Transungual approach is one of usual options for subungual glomus tumor, but the major complication of this method is nail deformity. The authors describe the different operation to avoid this complication. MATERIALS AND METHODS: From April, 2005 to May, 2009. 9 patients were diagnosed with digital glomus tumors. 8 patients were underwent excision with transungual open window exposing nail bed using partial detachment of nail plate. In all patients, preoperative clinical diagnosis was confirmed postoperatively with the biopsy result. RESULTS: All cases were followed up for average 4.2month(range 6 weeks to 13 months). Symptoms were improved after surgery. No complication and recurrence were occurred. There were no nail deformities by this altered approach. CONCLUSIONS: This altered technique with partial detached nail plate represent a safe and effective result to excise digital glomus tumors in subungual lesion.

Skill training in internal medicine student clerkship at a university hospital / 대한내과학회지

BACKGROUND/AIMS: This study evaluated medical students' experience performing basic clinical skills with real patients in a tertiary hospital and their response to clinical skill training in the Skills Center during their clerkship in internal medicine. METHODS: We surveyed 169 third-year students at the end of the internal medicine clerkship. The questionnaire included questions on their experience sampling blood and inserting intravenous (IV) catheters with real patients, success with their first patient, and the usefulness of the Skills Center during the clinical clerkship. RESULTS: Of the 169 students, 145 (86%) answered the questionnaire. Two (5%) of 39 students had not sampled blood and 22 (56%) had not inserted an IV catheter during the 8 weeks of the internal medicine clerkship. Two (6%) of 35 students had not sampled blood and 8 (23%) had not inserted an IV catheter during 32 weeks of the 3rd-year clinical clerkships. The partial or complete success rate for performing the skills with real patients was 93% for blood sampling and 79% for IV catheter insertion. Ninety (62%) students stated that skill training in the Skills Center during the clinical clerkship improved their basic clinical skills and 62 (43%) agreed that it increased their confidence to perform those skills on real patients. CONCLUSIONS: A significant number of medical students do not experience basic clinical skills with real patients during the clinical clerkship in a university hospital, although they had relatively high success rates performing those skills.