Novel surgical use of electrosurgical tip cleaners in subdermal excision for axillary osmidrosis

Background@#Axillary osmidrosis is a disease characterized by axillary malodor. The conventional treatment method of subdermal excision uses Metzenbaum scissors. Recently, subdermal excision using the Versajet system was introduced. However, it is an expensive surgical tool, and a recent study demonstrated a higher frequency of axillary skin necrosis with the Versajet. We propose a novel, cost-effective, and safe subdermal excision method that utilizes an electrosurgical tip cleaner (ETC). @*Methods@#Our retrospective cohort study included 27 patients who underwent subdermal excision from June 2012 to November 2021. The patients were classified into three groups according to the surgical method: Metzenbaum scissors, Versajet, and ETC. The operation time, hospitalization cost, and postoperative complications were investigated. @*Results@#The number of patients in the Metzenbaum scissors, Versajet, and ETC groups was seven, eleven, and nine, respectively. The mean operation time and hospitalization cost were significantly different among the three groups (P<0.05). The longest mean operation time was observed in the Metzenbaum scissors group (112.9±23.6 minutes), followed by the ETC and Versajet groups (76.4±27.1 and 64.2±24.8 minutes, respectively). The most expensive method was the Versajet ($2,346.1±517.7), followed by the ETC and Metzenbaum scissors ($1,391.8±317.7 and $1,279.6±287.5, respectively). No postoperative complications were observed. @*Conclusions@#The ETC is a novel method of subdermal excision, comparable to Metzenbaum scissors or Versajet. Therefore, it is recommended for situations where it is necessary to consider both the time and cost of surgery.

Rapidly growing juvenile xanthogranuloma in an adult: a case report

Juvenile xanthogranuloma is a benign tumor made up of non-Langerhans histiocytes that predominantly occurs in infancy and early childhood. Juvenile xanthogranuloma can be differentiated from xanthoma by the distribution of the lesions and the absence of lipid abnormalities. It usually develops on the trunk and upper and lower extremities. Histologically, xanthogranulomas show a mixed cellular dermal infiltration with histiocytes, lymphocytes, eosinophils and Touton-type multinucleated giant cells. Classically, juvenile xanthogranuloma is a disease that largely affects infants and children. We describe a rare case of juvenile xanthogranuloma that suddenly developed in the axillary region of a male adult.

Iatrogenic Spark Burn Injury to the Chest From a Transcutaneous Pacing Patch

Iatrogenic electrical burns that occur from the use of a defibrillator, a paddle-type cardiac shock device, have been reported in various forms. Electrical burns are usually conducted directly through the skin and are more damaging than scald burns or contact burns. A transcutaneous cardiac pacing device is a patch-type cardiac shock device that automatically delivers a shock when an abnormal heart rhythm is detected. We introduce a unique case of iatrogenic electrical burns caused by the transcutaneous pacing patch of a cardiac shock device. Electrical energy was converted into a spark due to foreign bodies deposited around the patch, resulting in damage to the peripheral area of the skin.

Chondrocutaneous posterior auricular artery perforator free flap for single-stage reconstruction of the nasal tip: a case report

Full-thickness nasal tip reconstruction is a challenging process that requires provision of ample skin and soft tissue, and intricate cartilage structure that maintains its architecture in the long term. In this report, we describe reconstruction of a full-thickness nasal tip and ala defect using a posterior auricular artery perforator based chondrocutaneous free flap. The flap consisted of two lay ers of skin covering conchal cartilage, and was based on a perforating branch of the posterior auricular artery. A superficial vein was secured at the posterior margin. The donor perforator was anastomosed to a perforating branch of the lateral nasal artery. The superficial vein was connected to a superficial vein of the surrounding soft tissue. The donor healed well after primary closure. The flap survived without complications, and the contour of the nasal rim was sustained at follow-up 6 months later. As opposed to combined composite reconstructions using a free cartilage graft together with a small free flap or pedicled nasolabial flap, the posterior auricular artery perforator free flap encompasses all required tissue types, and is similar in contour to the alar area. This flap is a useful option in single-stage reconstruction of nasal composite defects.

A propeller superficial transverse cervical artery perforator flap for defect coverage of the submental area: a case report

Reconstruction of submental defects is a challenge that needs to be approached carefully, since many important anatomical structures are located in this small space. Both aesthetic and functional outcomes should be considered during reconstruction. In this report, we describe a case where a superficial branch of the transverse cervical artery (STCA) perforator propeller flap was applied for coverage of the submental area. An 85-year-old woman presented with a 3-cm ovoid mass on her submental area. We covered the large submental defect with a STCA rotational flap in a 180° propeller pattern. The flap survived well without any complications at 1 year of follow-up. A STCA propeller flap is a useful surgical option in reconstruction for defect coverage of the submental area.

Angiolymphoid hyperplasia with eosinophilia attached to the masseter muscle

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign vascular tumor. The pathogenesis of ALHE is unknown; however, it may be linked to local trauma. ALHE predominantly occurs in areas of the preauricular region, forehead, and scalp; the masseter area is rarely involved. A 49-year-old man was referred for a mass in the right cheek region that was felt 2 months prior. Physical and imaging examination results suggested the presence of a benign tumor. Thus, surgical excision was performed. Pathologic findings confirmed an unexpected diagnosis of ALHE. This case was interesting, since the mass occurred at an unusual site with a misdiagnosis of an epidermal inclusion cyst.

A giant solitary vellus hair cyst on the nasal root

Eruptive vellus hair cyst is a rare lesion of the vellus hair follicles as a result of developmental abnormality. This cyst is usually found in children, adolescents, and young adults most commonly involving the chest, upper and lower extremities, and abdomen. Herein, we introduce a 22-year-old male patient with a mass of nasal root, growing since childhood. The mass has grown over the years, causing the protruding of the nasal root contours, leading to decline in the patient’s aesthetic and mental quality of life. In response, we performed complete resection of the mass, which pathologically was a vellus hair cyst. The patient is now satisfied with his appearance and there was no local recurrence during follow up.

Feasibility of TRPM8 Agonist Agent for Management of Skin Graft Donor Site

Feasibility of Cultured Allogenic Keratinocyte Treatment for Third Degree Burns

Necrotizing fasciitis of the masticator space with osteomyelitis of the mandible in an edentulous patient

Necrotizing fasciitis (NF) is a rapidly progressive necrosis of the subcutaneous tissue and fascia, caused by bacterial infection. Usually presenting in the extremities, trunk, or perineum, it is uncommon in the craniofacial or cervical area. Cervicofacial NF is a potentially fatal infection, which should be managed with early detection and intervention. Most cases have a primary odontogenic source of infection, especially when the masticator space is involved. We report a case of masticator space NF that developed without odontogenic origin in a 78-year old female who was treated with prompt surgical drainage and intravenous antibiotics.

Acellular dermal matrix (Insuregraf) in the prevention of Frey’s syndrome and surgical site depression after parotidectomy

BACKGROUND: Parotidectomy is the treatment of choice in many parotid tumors. Due to the extensive nature of the procedure, unfavorable complications such as gustatory sweating, surgical site depression are common. Various techniques using fascia, muscle or AlloDerm have been developed but debate still remains regarding its availability and affordability. We applied a newly developed acellular dermal matrix (Insuregraf) to the parotidectomy field to act as a physical barrier and to provide adequate filling effect for prevention of functional and aesthetic complications. METHODS: From March 2010 to March 2017, 30 patients with parotid tumors underwent superficial parotidectomy. Twenty patients underwent only superficial parotidectomy. Ten patients had Insuregraf applied to the surgical site after superficial parotidectomy. We evaluated the incidence of Frey’s syndrome, surgical site depression, and patient satisfaction rate in both groups. RESULTS: The incidence of Frey’s syndrome was lower in the Insuregraf group (0 vs. 2). Surgical site depression was also lower in the Insuregraf group (2 vs. 20). Satisfaction score for facial contour in Insuregraf group was 9.2 out of 10, which was comparable to 6.2 out of 10 in the control group. CONCLUSION: Application of Insuregraf after superficial parotidectomy is an effective surgical procedure to prevent complications such as Frey’s syndrome and surgical site depression. This technique is affordable and safe with no immune reactions. Above all this surgical method should be considered as an option for patients who are concerned about the contour of the face after surgery.

Eccrine porocarcinoma on the cheek

Eccrine porocarcinoma is a rare malignant tumor arising from the intraepidermal ductal portion of the eccrine sweat gland. It develops either spontaneously or from a long standing benign eccrine poroma. This entity usually affects older people and is commonly located on the lower extremities, the trunk, and the head. We report a case of eccrine porocarcinoma on the left cheek in an 85-year-old male. In our case, the tumor was treated with wide excision and postoperative adjuvant radiation therapy. The patient recovered well without local recurrence and distant metastasis during the 14-month follow-up period. Wide excision and postoperative adjuvant radiation therapy can be considered as a safe and effective treatment option in treating patients with eccrine porocarcinoma.

Intraparotid facial nerve schwannomas

Schwannoma is a benign tumor rarely found in the head and neck and much less commonly found in the intraparotid facial nerve. It is a slow-growing encapsulated tumor originating from the Schwann cells or axonal nerve sheath. It can occur anywhere along the course of the facial nerve. Patients may present with symptoms of facial palsy, but the most common presenting symptom is an asymptomatic swelling. Diagnosis is usually difficult before surgical removal and histopathological examination. We report a rare case of intraparotid facial nerve schwannoma in a 57-year-old female who had sustained a mass of the right preauricular area for 3 years. She reported no pain or facial muscle weakness. Enhanced computed tomography findings revealed the impression of pleomorphic adenoma. However, intraoperative gross findings were not characteristic of pleomorphic adenoma, and a frozen biopsy was performed resulting in the impression of a nerve sheath tumor. We performed an extracapsular surgical excision without parotidectomy. Permanent histopathology and immunohistochemistry reports diagnosed the mass as schwannoma. There were no complications including facial palsy after surgery. No recurrence was found at 6 months after surgery

Successful replantation of an amputated helical rim with microvascular anastomosis

Replantation using microvascular anastomosis is considered to be the optimal method in treating the amputated ear in terms of resulting color, texture, and shape. Only a few cases of ear replantation have been reported because it is anatomically difficult to identify suitable vessels for anastomosis. We successfully replanted the amputated helical rim of the ear using single arterial anastomosis. A 37-year-old man had his helical rim amputated by a human bite. The amputee was about 4 × 1 cm in dimension, composed of skin and soft tissue including auricular cartilage. Replantation was performed anastomosing a small artery of the amputee with a terminal branch of the posterior auricular artery. After replantation, intravenous heparinization was performed and prostaglandin E1 and aspirin were administered. Venous congestion was decompressed by stab incisions applied with heparin solution soaked gauze. Venous congestion of the amputee slowly began to resolve at 4 days after the operation. The amputated segment of the helical rim survived completely with good aesthetic shape and color. The authors propose that performing microvascular anastomosis should be attempted especially if it is possible to detect vessels on cut surfaces of ear amputee and stump. Proper postoperative care for venous congestion, arterial insufficiency, and infection should be followed for amputee survival.

The Efficacy of Midline Barbed Absorbable Sutures in Progressive Tension Closure of Abdominal Flap Donor Sites

BACKGROUND: The donor site of abdominal flaps for breast reconstruction consists of a wide suprafascial cavity that poses a risk of seroma formation. The authors evaluated the efficacy of continuous progressive tension sutures (PTS) using unidirectional barbed absorbable sutures for decreasing the volume of fluid collection and the risk of seroma at the abdominal donor site. METHODS: Between March 2013 and February 2015, 37 consecutive patients underwent breast reconstruction using a deep inferior epigastric artery perforator flap. Two patients who underwent salvage operations were excluded. Ten patients underwent standard abdominal flap donor site closure without PTS. Seven received donor site closure with interrupted Vicryl PTS between the abdominal flap and abdominal muscle fascia. Eighteen patients underwent closure with continuous PTS using unilateral barbed absorbable sutures. Body mass index, the approximate flap area, the duration of drain maintenance, the total drained volume, and the incidence of seroma were compared across these 3 groups. The operative time and subjective difficulty perceived by the surgeon was compared between the 2 PTS groups. RESULTS: The total drained volume was lower and the duration of drain maintenance was shorter in both PTS groups than in the standard closure group. There were no cases of seroma in the PTS groups, and 2 that resolved with conservative care in the standard closure group. More time was required and the subjective difficulty score was significantly higher for interrupted PTS than for continuous PTS. CONCLUSIONS: Continuous PTS effectively reduced the duration of drain insertion, the total volume of drained fluid, and was swifter and easier to perform than interrupted PTS.

Skeletal cavernous hemangiomas of the frontal bone with orbital roof and rim involvement

Skeletal cavernous hemangiomas are rare, benign tumors that may involve the supraorbital rim and orbital roof. However, such involvement is extremely rare. We report a case of skeletal cavernous hemangioma of the frontal bone involving the orbital roof and rim. En bloc excision and reconstruction, using a calvarial bone graft for the orbital roof and rim defect, was performed. It is important not only to perform total excision of skeletal cavernous hemangiomas, but to properly reconstruct the defects after the total excision since several complications can arise from an orbital roof and rim defect.

A New Method of Umbilical Transposition

BACKGROUND: Creating a natural-looking umbilicus during closure of the donor-site in abdominally based free flap breast reconstruction is a factor of satisfaction for both the patient and surgeon. We present a simple method of umbilical transposition that results in an aesthetic, natural-looking umbilicus. METHODS: From March 2011 to November 2014, fifty three consecutive female patients received abdominal flap breast reconstruction. Twenty patients (from March 2011 to February 2013) underwent umbilical transposition through a cross like incision in the abdominal flap, with fascial fixation sutures but no dermal flaps. Thirty three patients (March 2013 to November 2014) received umbilical transposition in the following method. An oval-shaped incision is made at the location of the new umbilicus on the abdominal flap. This oval is deepithelialized, and full-thickness incisions are made at the 2, 6, and 10 o'clock directions to create three triangular dermal flaps. These are pulled down to the abdominal fascia using sutures that pass through the umbilical stalk and the abdominal fascia at the 3, 9, and 12 o'clock directions. This results in an umbilical stalk lined with dermal flaps, creates a natural periumbilical concavity, and anchors the abdominal flap inward to minimize tension. The cranial flap enhances superior hooding. RESULTS: Patient and surgeon satisfaction, surveyed 2 months after surgery with a satisfaction scoring system, were higher in the dermal flap group. CONCLUSIONS: The technique using three dermal flaps in an oval skin incision is simple, relatively easy to learn, and results in an aesthetic, natural-looking umbilicus.

V-Y Advancement Flap: Aesthetic Reconstruction for Auriculotemporal Keloid Excision

Keloid scars are commonly found on the ears. Treatment modalities include compression, intralesional steroid injection, and surgical excision with or without radiotherapy, depending on the size and location of the keloid scar. Excision may be a curative solution, but it always requires the immediate reconstruction of the excised defect. Herein, we report the case of a keloid scar located at the helical base of the auriculotemporal sulcus that was treated by excision and a V-Y temporal advancement flap.

Extravasation of a Percutaneous Femoral Hepatic Infusion Device

No abstract available.

Warthin's Tumor of the Parotid Enlarged by a Facelift Suture

No abstract available.