Cervicofacial Flap: Can We Save Patient's Sideburns?

BACKGROUND: The conventional cervicofacial flap may cause the aesthetic problem of sideburns with a mismatched shape and arrangement. We developed a modified method with the goals of minimizing the destruction of the shape and arrangement of the sideburns and minimizing complications in comparison with the conventional method. METHODS: The incision line was designed to descend just in front of the sideburns, without passing through them, and then to ascend with the sideburns posteriorly when a cervicofacial flap is performed, unlike the conventional method. Patients in whom this method was applied (group B) and patients who underwent surgery using the conventional method (group A) were investigated in a retrospective study. The method was evaluated by assessing changes in the arrangement of the sideburns and patients' satisfaction, and differences in the complication rate. RESULTS: In group A, 23 of the 31 patients experienced changes in the arrangement of their sideburns. Most patients who experienced a change in the arrangement of their sideburns were dissatisfied with the change. The patients in group B did not experience such changes, and the defects were well reconstructed. Most of them were satisfied with the final sideburn arrangement. CONCLUSION: A novel method was used to preserve the sideburns while performing a cervicofacial flap. As a result, the appearance of the sideburns was well preserved and the satisfaction of patients was also high. Moreover, this technique could also prove useful for reconstruction without any increase in complications compared to the conventional method.

Investigation of Risk Acceptance and Expectations in Hand and Foot Allotransplantations

PURPOSE: Composite tissue allotransplantation is a new therapeutic modality to reconstruct major tissue defects of the head and neck region and extremities. However, there is a serious ethical debate about whether the risks posed by the life-long immunosuppression that a recipient would have to take justify the benefits of receiving this non-life saving procedure. The purpose of this study is to examine differences between expert and non-expert groups in risk acceptance and expectations regarding hand and foot allotransplantations. METHODS: The author conducted a survey of 345 subjects in total (lay public n=110; medical students, n=120; doctors, n=115), using a questionnaire-based instrument, the Louisville Instrument for Transplantation (translated to Korean). RESULTS: Of the three groups studied, risk acceptance was found to be lowest in the doctor group and highest in the non-expert group, and the difference was significant (p < 0.05). The expectations of aesthetic and functional improvement from the procedure, however, were found to be highest in the non-expert group and lowest in the doctor group, and the differences were also significant (p < 0.05). CONCLUSION: The results of this study shows that the three populations have noticeable differences in risk acceptance and expectations regarding hand and foot allotransplantations. Therefore, accurate and sufficient information on these procedures should be provided to patients from both medical and ethical perspectives.

Treatment of Lymphedema of the Scrotum and Penis Using Scrotal Flaps

PURPOSE: Lymphedema of the scrotum and penis is a functionally and emotionally incapacitating problem for patients. Patients suffer pain from swelling, chronic irritation, repeated infections, drainage, and sexual dysfunction. Although there are various methods for the treatment of scrotal and penial lymphedema, achieving a satisfactory reconstruction in severe cases still remains a challenge due to the lack of locally available tissue. METHODS: A 33-year-old man sustained severe lymphedema of the scrotum and penis. He reported a history of swelling since 25 years, which had been intensified during the past few months. There was no history of irritation, surgery, trauma, infection or travel to endemic countries. The authors reconstructed the scrotum and penis using 4 scrotal flaps made by incising the enlarged scrotum crucially. RESULTS: The postoperative course was uneventful. Histopathologic examination showed nonspecific chronic inflammation. The patient was followed up for 18 months and a good reconstructive result was obtained with no recurrence. CONCLUSION: The authors' method is safe and easy to perform. This method may be a convenient and reliable alternative for the treatment of severe lymphedema of the scrotum and penis.