Clinical Analysis of Lobular Keloid after Ear Piercing

BACKGROUND: Lobular keloid appears to be a consequence of hypertrophic inflammation secondary to ear piercings performed under unsterile conditions. We wish to understand the pathogenesis of lobular keloids and report operative outcomes with a literature review. METHODS: A retrospective review identified 40 cases of lobular keloids between January, 2005 and December, 2010. Patient records were reviewed for preclinical factors such as presence of inflammation after ear piercing prior to keloid development, surgical management, and histopathologic correlation to recurrence. RESULTS: The operation had been performed by surgical core extirpation or simple excision, postoperative lobular compression, and scar ointments. Perivascular infiltration was noted in intra- and extra-keloid tissue in 70% of patients. The postoperative recurrence rate was 10%, and most of the patients satisfied with treatment outcomes. CONCLUSION: Histological perivascular inflammation is a prominent feature of lobular keloids. Proper surgical treatment, adjuvant treatments, and persistent follow-up observation were sufficient in maintaining a relatively low rates of recurrence.

Reduction of Nasal Bone Fracture using Ultrasound Imaging during Surgery

BACKGROUND: Most nasal bone fractures are corrected using non-invasive methods. Often, patients are dissatisfied with surgical outcomes following such closed approach. In this study, we compare surgical outcomes following blind closed reduction to that of ultrasound-guided reduction. METHODS: A single-institutional prospective study was performed for all nasal fracture patients (n=28) presenting between May 2013 and November 2013. Upon research consent, patients were randomly assigned to either the control group (n=14, blind reduction) or the experimental group (n=14, ultrasound-guided reduction). Surgical outcomes were evaluated using preoperative and 3-month postoperative X-ray images by two independent surgeons. Patient satisfaction was evaluated using a questionnaire survey. RESULTS: The experimental group consisted of 4 patients with Plane I fracture and 10 patients with Plane II fracture. The control group consisted of 3 patients with Plane I fracture and 11 patients with Plane II fracture. The mean surgical outcomes score and the mean patient dissatisfaction score were found not to differ between the experimental and the control group in Plane I fracture (p=0.755, 0.578, respectively). In a subgroup analysis consisting of Plane II fractures only, surgeons graded outcomes for ultrasound-guided reduction higher than that for the control group (p=0.007). Likewise, among the Plane II fracture patients, those who underwent ultrasound-guided reduction were less dissatisfied than those who underwent blind reduction (p=0.043). CONCLUSION: Our study result suggests that ultrasound-guided closed reduction is superior to blind closed reduction in those patients with Plane II nasal fractures.

Cranioplasty with Methylmethacrylate in Plagiocephaly

No abstract available.

Improvement of Infraorbital Rim contour Using Medpor

BACKGROUND: Asymmetry of the infraorbital rim can be caused by trauma, congenital or acquired disease, or insufficient reduction during a previous operation. Such asymmetry needs to be corrected because the shape of the infraorbital rim or midfacial skeleton defines the overall midfacial contour. METHODS: The study included 5 cases of retruded infraorbital rim. All of the patient underwent restoration of the deficient volume using polyethylene implants between June 2005 and June 2011. The infraorbital rim was accessed through a subciliary approach, and the implants were placed in subperiosteal space. Surgical outcomes were evaluated using preoperative and postoperative computed tomography studies. RESULTS: Implant based augmentation was associated with a mean projection of 4.6 mm enhancement. No postoperative complications were noted during the 30-month follow-up period. CONCLUSION: Because of the safeness, short recovery time, effectiveness, reliability, and potential application to a wide range of facial disproportion problems, this surgical technique can be applied to midfacial retrusion from a variety of etiologies, such as fracture involving infraorbital rim, congenital midfacial hypoplasia, lid malposition after blepharoplasty, and skeletal changes due to aging.

Postaxial Polydactyly of the Hands and Feet in Monozygotic Twins

Polydactyly is the most common congenital difference of the hand and foot presenting as a range of defects from minor soft tissue duplications to major bony abnormalities. Although polydactyly of the hand is reported to occur among approximately 1 in 1,000 live births, the co-occurrence of hand polydactyly on hands and polydactyly on feet is as rare as one out of 100,000 persons. We report a case of hand and foot polydactyly in twins. One of the twins had polydactyly on both hands and feet, the other had polydactyly on the right hand and both feet. Postaxial polydactyly in monozygotic twins appears on both hands and feet in a different form shows that polydactyly is caused by multiple factors. It has been reported that the mother's infection and drug in addition to hereditary factors are the causes for polydactyly, but since they are unknown yet, it is necessary to conduct a study of them.

Reconstruction of Penile and Long Urethral Defect Using a Groin Flap

Urethral reconstruction is a problematic issue, thus its management can be challenging. Different methods using various materials were introduced for urethral reconstruction. The authors have made some changes in the groin flap surgery, affording more successful urethral reconstruction for defects of long urethra and penile soft tissue. A 45-year-old male requested both functional and cosmetic reconstruction of his defected penis, caused by an iatrogenic urethral injury and chronic infection following removal of paraffin self-injected on the penile shaft. The defect affected the full length of the penile urethra, corpus spongiosum, and prepuce. A groin flap was designed, measuring 28×10 cm. The most distal flap was utilized for the construction of the luminal surface of the neourethra; relaxed length measuring 8 cm, and the lumen wide enough. Competent external meatus and neourethra was confirmed by retrograde cystogram and the patient voided with sufficient urine caliber up to 2 years follow-up. This operative technique has advantages. Donor sites have non-hair bearing skin for the neourethra and minimal or almost not-recognizable donor site morbidity. After surgery, the patient was relieved from voiding difficulties combined with psychological stress. The author would like to introduce a unique approach for the urethral and ventral phalloplasty using the groin flap.

Soft Tissue Chondroma Presenting as a Dermal Mass in the Toe

No abstract available.

Erratum to: Prevention of Lower Eyelid Ectropion Using Nonincisional Suspension Sutures after Blepharoplasty

In this article, on page 173, the title has been spelled incorrectly.

Comparison of the Viability of Cryopreserved Fat Tissue in Accordance with the Thawing Temperature

BACKGROUND: Adipose tissue damage of cryopreserved fat after autologous fat transfer is inevitable in several processes of re-transplantation. This study aims to compare and analyze the survivability of adipocytes after thawing fat cryopreserved at -20degrees C by using thawing methods used in clinics. METHODS: The survival rates of adipocytes in the following thawing groups were measured: natural thawing at 25degrees C for 15 minutes; natural thawing at 25degrees C for 5 minutes, followed by rapid thawing at 37degrees C in a water bath for 5 minutes; and rapid thawing at 37degrees C for 10 minutes in a water bath. The survival rates of adipocytes were assessed by measuring the volume of the fat layer in the top layers separated after centrifugation, counting the number of live adipocytes after staining with trypan blue, and measuring the activity of mitochondria in the adipocytes. RESULTS: In the group with rapid thawing for 10 minutes in a water bath, it was observed that the cell count of live adipocytes and the activity of the adipocyte mitochondria were significantly higher than in the other two groups (P<0.05). The volume of the fat layer separated by centrifugation was also measured to be higher, which was, however, not statistically significant. CONCLUSIONS: It was shown that the survival rate of adipocytes was higher when the frozen fat tissue was thawed rapidly at 37degrees C. It can thus be concluded that if fats thawed with this method are re-transplanted, the survival rate of cryopreserved fats in transplantation will be improved, and thus, the effect of autologous fat transfer will increase.

Histological Changes in Levator Aponeurosis According to Blepharoptosis and Aging

BACKGROUND: Many studies about the levator aponeurosis complex of the blepharoptosis have already been presented. However, the studies about the changes of the levator aponeurosis are relatively insufficient. So, this study was performed to observe histological changes of levator aponeurosis that arise depending on the severity of blepharoptosis and the age. METHODS: Twenty patients who have undergone surgical treatment for blepharoptosis from 2013 to 2014 were analyzed in this study. Patients were categorized mild or severe group according to the severity of blepharoptosis, and the age. Through the blepharoplasty incision, we harvested the specimens of the levator aponeurosis on the upper border of tarsal plate. After staining the specimens with the Verhoeff-van Gieson technique, the changes of elastin was analyzed in a histopathological manner. RESULTS: Light microscopy of the levator aponeurosis stained positively for elastic fibers using the Verhoeff-van Gieson technique. Elastic fibers appear to have direct connections with the collagen fiber of the levator aponeurosis. The amount of the elastin was decreased in the old age group. And the amount of elastin was decreased markedly in severe blepharoptosis group. CONCLUSIONS: The elastin of the levator aponeurosis was decreased in old age and elastin tended to decreased markedly in severe levator function group. The levator aponeurosis plays a greater role in the eyelid ptosis. Therefore, knowledge about the histologic changes of the levator aponeurosis may give more help us to understand the high recurrence rate of the blepharoptosis in old age. Also, considering this information, will be helpful to the blepharoptosis surgery.

Erratum to: Prevention of Lower Eyelid Ectropion Using Nonincisional Suspension Sutures after Blepharoplasty

The name of author should be corrected as the following: from "Min Hwang" to "So Min Hwang".

The Usability of Medial Sural Artery Perforator Flap for Reconstruction of the Finger Defects

PURPOSE: Groin or abdominal flap, anterolateral thigh free flap, and radial forearm flap can typically be performed in large defects, however satisfactory results in functional recovery and aesthetic aspect have not been achieved using these methods. Medial sural artery perforator free flap is recommended as a complement to these disadvantages, therefore we report the functional and aesthetic results of this flap for reconstruction of large finger defects. METHODS: From January 2008 to December 2013, 10 patients with large soft tissue defect of the fingers were treated with medial sural artery perforator free flap. Six months after the final surgery, metacarpophalangeal joint and proximal interphalangeal joint range of motion was measured, and the circumference of the reconstructed finger was compared with that of the contralateral side. In addition, for assessment of the aesthetic satisfaction, the patients and three physicians compared the color of the reconstructed finger with that of adjacent skin on a five-point scale. RESULTS: The flaps survived without complications in all ten cases. Average flexion was 77 degrees in the metacarpophalangeal joint and 84 degrees in the proximal interphalangeal joints. The average circumference of the reconstructed finger was measured as 12 percent larger than contralateral. The patien's subjective satisfaction (4.1) and physicians' objective satisfaction (4.2) regarding aesthetic aspect were very good. CONCLUSION: Medial sural artery perforator free flap is a very thin, stable, fasciocutaneous flap which has a tendon gliding effect and produces aesthetically good results. Therefore we consider medial sural artery perforator free flap as the flap which can solve the drawbacks of other techniques associated with large finger defect reconstruction.

Moll's Cyst Occurring in the Orbital Septum

No abstract available.

Chondromyxoid Fibroma of the Finger

No abstract available.

Prevention of Lower Eyelid Ectropion Using Noninsional Suspension Sutures after Blepharoplasty

Blepharoplasty is one of the most common anti-aging operations. Although rare, complications such as ectropion may occur. Thus, we introduced an operative technique to prevent ectropion of the lower lid after blepharoplasty. From January 2012 to August 2013, we performed a nonincisional suspension suture (NISS) technique for 30 patients who visited our clinic for lower blepharoplasty. These patients had a distance of greater than 7 mm on the distraction test and were suspected of having horizontal lid laxity. We performed a slit incision 3 mm superior to the junction between the lateral epicanthus and the orbital bone during lower blepharoplasty. We passed a 7-0 nylon suture through the subcutaneous layer and the orbicularis oculi muscle. Then, we punctured the tarsal plate at the lateral limbus and fixed it to the lateral orbital rim by puncturing the periosteum. We tied a suspension knot through the slit incision. Thirty patients had satisfactory results without major complications, such as scleral exposure or ectropion. The NISS technique could be an effective method by which to prevent postoperative ectropion in cases with a mild to moderate degree lower lid laxity. The use of a NISS procedure is also a simple surgical technique, which saves time and is minimally invasive.

Clinical Characteristics of the Forehead Lipoma

BACKGROUND: Lipomas can be categorized into deep and superficial lipomas according to anatomical depth. Many cases of forehead lipomas are reported to be deep to the muscle layer. We analyze ultrasound in delineating depth of forehead lipomas. METHODS: A retrospective review was performed for all patients who underwent excision of forehead lipomas between January 2008 and March 2013 and for whom preoperative ultrasound study was available. Sensitivity and specificity of ultrasound imaging was evalauted against depth finding at the time of surgical excision. RESULTS: The review identified 42 patients who met the inclusion criteria. Preoperative ultrasound reading was 18 as deep lipomas and 24 as superficial. However, intraoperative finding revealed 2 of the 18 deep lipomas to be superficial and 13 of the 24 superficial lipomas to be deep lipomas. Overall, ultrasonography turned out to be 69% (29/42) accurate in correctly delineating superficial versus deep lipomas. CONCLUSION: Lipomas of the forehead tend to be located in deeper tissue plane compared to lipomas found elsewhere in the body. Preoperative ultrasonography of lipomas can be helpful, but was not accurate in identifying the depth of forehead lipomas in our patient population. Even if a forehead lipoma is found to be superficial on ultrasound, operative planning should include the possibility of deep lipomas.

The Usefulness of Retroauricular Full Thickness Skin Graft in Hand Reconstruction

PURPOSE: We used the retroauricular area skin as an alternative full-thickness skin donor site in the hand reconstruction surgery. METHODS: From January 2006 to March 2013, 55 patients observed more than 1 year, were recruited for the study. In case of requiring the skin graft on hand, we grafted skins were harvested from the retroauricular area on hand. To assess the subjective and objective satisfaction, the patients themselves and three doctors compared the skin graft area's color with adjacent skin and estimated the donor site scar on a five-point scale. RESULTS: A partial necrosis was seen in one case who received skin graft because of a burn scar contracture, but it was cured with conservative treatment. In other cases, the skin graft was well taken without any specific problems. The retroauricular skin graft showed good color match with adjacent skin and less pigmentation. Donor site scar was not noticeable. As a result, the patient's subjective satisfaction (4.07) and doctor's objective satisfaction (4.18) about skin graft were very good. And the patient's subjective satisfaction (4.93) and doctor's objective satisfaction (4.98) about donor site scar were also very good. CONCLUSION: We obtained the favorable result and the patients satisfaction by using the retroauricular area as a full thickness skin graft donor site in hand.

Transposition of Intravascular Lipid in Experimentally Induced Fat Embolism: A Preliminary Study

BACKGROUND: Liposuction is a procedure to reduce the volume of subcutaneous fat by physical force. Intracellular storage fat is composed of triglyceride, whereas circulating fat particles exist as cholesterol or triglycerol bound to carrier proteins. It is unavoidable that the storage form of fat particles enters the circulation system after these particles are physiologically destroyed. To date, however, no studies have clarified the fatal characteristics of fat embolism that occurs after the subclinical phase of free fat particles. METHODS: A mixture of human lipoaspirate and normal saline (1:100, 0.2 mL) was injected into the external jugular vein of rats, weighing 200 g on average. Biopsy specimens of the lung and kidney were examined at 12-hour intervals until postoperative 72 hours. The deposit location and transport of the injected free fat particles were confirmed histologically by an Oil Red O stain. RESULTS: Inconsistent with previous reports, free fat particles were transported from the intravascular space to the parenchyma. At 24 hours after infusion, free fat particles deposited in the vascular lumen were confirmed on the Oil Red O stain. At 72 hours after infusion, free fat particles were accumulated compactly within the parenchymal space near the perivascular area. CONCLUSIONS: Many surgeons are aware of the fatal results and undiscovered pathophysiologic mechanisms of free fat particles. Our results indicate that free fat particles, the storage form of fat that has been degraded through a physiological process, might be removed through a direct transport mechanism and phagocytotic uptake.

Vascular Variations in the Anterolateral Thigh Flap

PURPOSE: Although a fasciocutaneous perforator artery as a vascular pedicle has previously been shown to be predominant in the anterolateral thigh (ALT) flap, recent studies have shown that a myocutaneous perforator artery is predominant. We have attempted to attain a clinical understanding of the vascular variations in the ALT flap. MATERIALS AND METHODS: We confirmed the origin of a perforator artery in 11 cases of ALT flap. We then reviewed the variations of the descending branch of the lateral femoral circumflex artery, known as the major origin of the flap, and the overall variations associated with an ALT flap. RESULTS: In a total of 11 cases, there were 18 perforator arteries of the ALT flaps. In addition, there were 9 fasciocutaneous perforator arteries and another 9 myocutaneous ones. However, depending on the origin, there was great variability in the perforator artery. That is, there were unique variants in the descending branches of the lateral femoral circumflex artery, the major origin of the perforator artery, in 3 of the total 11 cases. CONCLUSION: Our results showed that (1) a perforator artery accounts for the high proportion of fasciocutaneous ones, (2) a perforator artery might not originate from the descending branch of the lateral femoral circumflex artery and (3) there might be unique variants in the descending branch. If considering this, surgeons would successfully elevate an ALT flap.

Reconstruction of Digits Injured by Punch Press Machine

PURPOSE: Digits injured by punch press machines show peculiar types with segmental loss of middle part of digits. Although the distal parts of finger survived, thr results is frequently unfavorable with respect to function and appearance after inappropriate reconstruction. METHODS: From August 2008 to February 2013, five digits injured by punch press machines in four patients were managed. Pinch strength, two-point discrimination and active range of motion were measured to evaluate finger function. RESULTS: Three digits with a preserved amputated segment underwent replantation. Partial necrosis occurred in one digit in which local flap was performed. Secondary tendon graft was performed in the other digits. Two digits without segment was reconstructed by arthrodesis after shortening the length. The patients were generally satisfied with function and appearance. CONCLUSION: Reconstruction of digits injured by punch machines are technically difficult. Replantation is the best method in cases of preserved segment, while arthrodesis with shortening is appropriate in cases without segment.