A Case of Intramuscular Abscess in the Sternocleidomastoid Muscle after Intramuscular Stimulation(IMS)

PURPOSE: Intramuscular stimulation(IMS) shows good results in the treatment of chronic pain patients who did not respond to other treatments such as oral analgesics, trigger point injection, nerve block and epidural steroid injection. But, IMS procedure especially, patients with diabetes mellitus(DM) has sometimes serious problem. So, we present a very rare case of intramuscular abscess in the sternocleiomastoid muscle after IMS with literature review. METHODS: A 66 year old male visited our department 7 days after IMS in the neck. His premorbid conditions and risk factors of deep neck infection was DM and old age. Computed tomographic scans of the head and neck region were performed in this patient: signs of deep neck infection, were seen enhanced abscess in the sternocleidomastoid muscle, cellulitis overlying tissue of the neck, and air bubbles involved muscle. Necrotic wound was excised serially and we treated this with the Vacuum-assisted closure(VAC, Kinetics Concepts International, San Antonio, Texas) system device. After appropriately shaping the sponge in the pockets, continuous negative pressure of 125mmHg was applied. The VAC therapy was utilized for a period of 12 days. RESULTS: We obtained satisfactory results from wide excision, drainage of the abscess with the VAC system, and then primary closure. The postoperative course was uneventful. CONCLUSION: We suggest that many of the infectious complications may be preventable by strict adherence to aseptic techniques and that some of the other complications may be minimized by refining the techniques with a clear understanding of the medical disorders of patients. And, the refined technique using the VAC system can provide a means of simple and effective management for the cervical intramuscular abscess, with better cosmetic and functional results.

Nipple Reduction Preserving C-V Flap Tissue in Male Nipple Hypertrophy: Idea Innovation

PURPOSE: Male nipple hypertrophy is a rare condition but is a social embarrassment for individual. The currently available techniques of nipple reduction already described in the literature for female patients are discussed, but the goal of treatment is different in male patients. In male patient, the diameter as well as vertical height should be reduced simultaneously to achieve better aesthetic results. Our new technique can reduce the diameter of the hypertrophic nipple as well as the vertical height efficiently and simply. METHODS: A 19-years-old man with nipple hypertrophy on the right chest presented. The flap is designed based on the site of left nipple, symmetry, the diameter, and the projection desired. The widths of the V flaps determine projection, whereas the diameter of the C flap determines the diameter of the nipple and top of the new nipple. Unnecessary hypertrophic tissues are extirpated and the V flaps are elevated. The nipple base is reduced by purse-string suture technique. The V flaps are wrapped around, and C flap is used as a cap. RESULTS: No complication including nipple necrosis or sensory loss were found during follow-up period. The normal symmetry of the nipple contour was restored. CONCLUSION: We describe a simple technique for male nipple reduction using a C-V flap with purse-string suture. In our experience, this technique has provided good aesthetic result and patient satisfaction.

Case Report of Avulsion Amputation of Multiple Digits: Use of Rerouting the Transverse Digital Palmar Arch

PURPOSE: Avulsion injuries of digits have been presented for a long time as complex management problems. Despite of microsurgical advances, it is difficult to achieve good functional results and their management remains somewhat controversial. However, in a finger there are three transverse digital palmar arches. The middle and distal transverse digital palmar arches are consistently large(almost 1 mm) and may be used for arterial vessel repairs either proximally or distally, depending on the length and direction needed. 39-year-old man presented with avulsion amputation of the ulnar three digits, was operated using only arterial anastomosis with rerouting the transverse digital palmar arches. METHODS: Replantation was performed using the artery-only technique. Because the digital arteries had been damaged, we did that the transverse digital palmar arches were transposed in an inverted Y to I configuration and were lengthened with rerouting them for the purpose of direct anastomosis of the digital artery. Venous drainage was provided by an external bleeding method with partial nail excision and external heparin irrigation. RESULTS: The authors conclude that complete avulsion amputations with only soft tissue at the distal to insertion of the flexor digitorum superficialis tendon were salvageable with acceptable functional results. All three fingers survived. CONCLUSION: With technical advancements, the transverse digital palmar arches play an important role for finger amputation. Three digital palmar arches give us additional treatment option for the finger amputation. In this case, replantation with only-arterial anastomosis was successful and we obtained good aesthetic and functional outcome.