Early postoperative treatment of mastectomy scars using a fractional carbon dioxide laser: a randomized, controlled, split-scar, blinded study

Background@#Mastectomy leaves unsightly scarring, which can be distressing to patients. Laser therapy for scar prevention has been consistently emphasized in recent studies showing that several types of lasers, including fractional ablation lasers, are effective for reducing scar formation. Nonetheless, there are few studies evaluating the therapeutic efficacy of ablative CO2 fractional lasers (ACFLs). @*Methods@#This study had a randomized, comparative, prospective, split-scar design with blinded evaluation of mastectomy scars. Fifteen patients with mastectomy scars were treated using an ACFL. Half of each scar was randomized to “A,” while the other side was allocated to group “B.” Laser treatment was conducted randomly. Scars were assessed using digital photographs of the scar and Vancouver scar scale (VSS) scores. Histological assessments were also done. @*Results@#The mean VSS scores were 2.20±1.28 for the treatment side and 2.96±1.40 for the control side. There was a significant difference in the VSS score between the treatment side and the control side (P=0.002). The mean visual analog scale (VAS) scores were 4.13±1.36 for the treatment side and 4.67±1.53 for the control side. There was a significant difference in VAS score between the treatment side and the control side (P=0.02). @*Conclusions@#This study demonstrated that early scar treatment using an ACFL significantly improved the clinical results of the treatment compared to the untreated scar, and this difference was associated with patient satisfaction.

Early postoperative treatment of mastectomy scars using a fractional carbon dioxide laser: a randomized, controlled, split-scar, blinded study

Background@#Mastectomy leaves unsightly scarring, which can be distressing to patients. Laser therapy for scar prevention has been consistently emphasized in recent studies showing that several types of lasers, including fractional ablation lasers, are effective for reducing scar formation. Nonetheless, there are few studies evaluating the therapeutic efficacy of ablative CO2 fractional lasers (ACFLs). @*Methods@#This study had a randomized, comparative, prospective, split-scar design with blinded evaluation of mastectomy scars. Fifteen patients with mastectomy scars were treated using an ACFL. Half of each scar was randomized to “A,” while the other side was allocated to group “B.” Laser treatment was conducted randomly. Scars were assessed using digital photographs of the scar and Vancouver scar scale (VSS) scores. Histological assessments were also done. @*Results@#The mean VSS scores were 2.20±1.28 for the treatment side and 2.96±1.40 for the control side. There was a significant difference in the VSS score between the treatment side and the control side (P=0.002). The mean visual analog scale (VAS) scores were 4.13±1.36 for the treatment side and 4.67±1.53 for the control side. There was a significant difference in VAS score between the treatment side and the control side (P=0.02). @*Conclusions@#This study demonstrated that early scar treatment using an ACFL significantly improved the clinical results of the treatment compared to the untreated scar, and this difference was associated with patient satisfaction.

A case report of Madelung’s disease

Madelung’s disease (MD) otherwise known as Launois-Bensaude syndrome, multiple symmetrical lipomatosis, or benign symmetric lipomatosis, is a rare disease characterized by abnormal diffuse lipomatosis in proximal upper limbs and neck. Here, we report a rare case of MD. A 66-year-old man presented with massive growth of soft tissues in the cervico-occipital region of more than 2 years duration. Physical examination showed diffuse enlargement of the anterior neck (Madelung’s collar) and three huge humps at the posterior neck. Under a diagnosis of MD, lipectomy via a single anterior transverse incision and liposuction were performed. This rare case report may be helpful for assessing patients with abnormal diffuse lipomatosis in the neck and proximal upper limbs.

Aggressive cutaneous squamous cell carcinoma of the scalp

Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer, and its incidence is increasing globally. In Korea, there were 12,516 diagnosed cases of cSCC between 1999 and 2014. Surgical treatment, for which several options are available, is the standard of care for cSCC and securing a sufficient surgical resection margin is always important. cSCC of the scalp sometimes exhibits unusually aggressive behavior. In this article, we report a case of cSCC of the scalp with invasion into the skull and dura mater.

Aggressive cutaneous squamous cell carcinoma of the scalp

Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer, and its incidence is increasing globally. In Korea, there were 12,516 diagnosed cases of cSCC between 1999 and 2014. Surgical treatment, for which several options are available, is the standard of care for cSCC and securing a sufficient surgical resection margin is always important. cSCC of the scalp sometimes exhibits unusually aggressive behavior. In this article, we report a case of cSCC of the scalp with invasion into the skull and dura mater.

A case of Merkel cell carcinoma of the head and neck

Merkel cell carcinoma (MCC) is a relatively rare and aggressive cutaneous neuroendocrine malignancy. It is characterized by high rates of recurrence and metastasis, both to regional lymph nodes and to distant locations. Its characteristic clinical manifestation is a single, painless, hard, erythematous nodule on a sun-exposed area, particularly in older men. Surgical management of both the primary site and the sentinel lymph node is the standard of care. In this article, we describe the diagnosis and treatment of a case of MCC in the left cheek.

Preparation of harvested skin using the Versajet Hydrosurgery System in full-thickness skin grafts

During a full-thickness skin graft procedure, the thickness of the harvested donor skin is adjusted based on the location of the recipient site and the judgment of the surgeon. Conventionally, the thickness of the harvested skin is roughly adjusted using surgical instruments such as scalpels and scissors. However, this method is not only time-consuming, but also requires effort to obtain both the desired thickness of the harvested skin and a smooth surface of that skin. Moreover, there is a possibility of skin perforation. Hence, the authors devised a method of adjusting harvested skin thickness using the Versajet Hydrosurgery System. The Versajet device is a handheld hydrosurgical tool that delivers a high-speed jet stream of saline solution, which enables the precise debridement of tissue. This method makes it easier and faster for the surgeon to obtain the desired thickness of harvested skin. In addition, by obtaining a smooth surface and an even thickness of harvested donor skin, this technique may lead to improved graft viability.

Limited retromuscular fibrofatty tissue resection in upper blepharoplasty for senile patients

BACKGROUND: Studies of eyelid anatomy suggest an absence of supratarsal folds and a redundancy of retromuscular tissue in many Asians. Aggressive retromuscular tissue resection during senile blepharoplasty can lead to complications such as hematoma and extra fold formation. A thin fold is considered aesthetically pleasing, but upper eyelid hollowness is undesirable. Therefore, senile blepharoplasty allows relatively little room for retromuscular resection. METHODS: Between January 2016 and March 2019, blepharoplasty without a brow procedure was performed in 48 patients aged 55 years and older. In some patients with thin eyelids, the upper retromuscular tissue was explored, and the surgeon decided intraoperatively whether to perform resection. In total, 36 of 48 patients underwent retromuscular tissue resection, which was confined to the central and lateral aspects of the eyelid within 7–10 mm from the incision in the superior direction to create a crisp, thin fold without hollowness. The skin was closed, with the closure including the levator palpebrae superioris (levator) muscle, to create a weak, natural-looking, and dynamic fold instead of the buried dermo-levator suture typically created during double eyelid surgery. RESULTS: In the 72 eyelids that underwent resection, hematoma or extra fold formation was absent. In all cases, thin folds were achieved without an increase in the hollowness of the upper eyelid. Most patients were satisfied with their natural-looking postoperative appearance. CONCLUSIONS: When indicated, limited retromuscular resection is recommended in cases of senile blepharoplasty. The resection should be confined to the central and the lateral aspects of the eyelid, within 7–10 mm in the superior direction from the incision, to create a crisp thin fold without hollowness.

Treatment of post-traumatic hematoma and fibrosis using hyaluronidase injection

Patients complaining of swelling and hematoma caused by contusion of the face can be easily seen in the emergency room. Most of the treatments were conservative treatments such as ice bag application, mild compression dressing, and massage. During the follow-up, fibrosis progression due to hematoma was frequently observed in the contusion site. When hematoma or fibrosis is confirmed, hyaluronidase (H-lase) 1,500 IU and 2 mL of normal saline were mixed and subcutaneously injected in crisscross manner. To evaluate the improvement of hematoma before and after hyaluronidase injection, three plastic surgeons evaluated using the Vancouver scar scale and compared preoperative and postoperative images. Hematoma and fibrosis after facial trauma improved after hyaluronidase injection for early treatment.

Early Management of Scars Using a 532-nm Nd:YAG Laser

BACKGROUND: Laser therapy is generally postponed until scar maturation. We speculated that the use of laser therapy at the beginning of the wound healing process might minimize discomfort and problems at an early stage. METHODS: From January 2013 to May 2014, we conducted a study of 50 patients who underwent primary closure or scar revision procedures due to facial scarring. Within 1 to 2 weeks after the removal of all stitches, we performed laser treatments with a 532-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser. To assess the improvement of the scars, we evaluated the scars using the Vancouver Scar Scale (VSS) and conducted a photo analysis using a computer graphics program. RESULTS: The mean score on the VSS decreased from 5.99 to 1.49 after the laser treatment. The score for each evaluation item decreased, meaning that the scars improved. The differences showed statistical significance. In the photo analysis that was conducted using Adobe Photoshop, the mean brightness of the pixels located within the scar territory increased from 61.54% to 69.42% after laser treatment, and the mean chroma decreased from 50.65% to 43.12%. These changes were statistically significant. CONCLUSIONS: We used a 532-nm Nd:YAG laser at an early stage of scar formation and confirmed improvements in the redness, hyperpigmentation, and hypertrophy of the scars shortly after treatment.

Early Management of Scars Using a 532-nm Nd:YAG Laser

BACKGROUND: Laser therapy is generally postponed until scar maturation. We speculated that the use of laser therapy at the beginning of the wound healing process might minimize discomfort and problems at an early stage. METHODS: From January 2013 to May 2014, we conducted a study of 50 patients who underwent primary closure or scar revision procedures due to facial scarring. Within 1 to 2 weeks after the removal of all stitches, we performed laser treatments with a 532-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser. To assess the improvement of the scars, we evaluated the scars using the Vancouver Scar Scale (VSS) and conducted a photo analysis using a computer graphics program. RESULTS: The mean score on the VSS decreased from 5.99 to 1.49 after the laser treatment. The score for each evaluation item decreased, meaning that the scars improved. The differences showed statistical significance. In the photo analysis that was conducted using Adobe Photoshop, the mean brightness of the pixels located within the scar territory increased from 61.54% to 69.42% after laser treatment, and the mean chroma decreased from 50.65% to 43.12%. These changes were statistically significant. CONCLUSIONS: We used a 532-nm Nd:YAG laser at an early stage of scar formation and confirmed improvements in the redness, hyperpigmentation, and hypertrophy of the scars shortly after treatment.

Reconstruction of the Foot Using a Superficial Inferior Epigastric Artery Free Flap

When foot reconstruction is performed in the pretibial area, the ankle, or the dorsum of the foot, the need for a reliable flap remains a challenge. We found that the superficial inferior epigastric artery (SIEA) free flap can be used as an alternative tool for this purpose, as it helps to solve the problems associated with other flaps. We describe 2 cases in which we reconstructed the foot using an SIEA free flap, which was pliable enough to fit the contours of the area. Postoperatively, the flaps were intact and showed excellent aesthetic results. Thus, the SIEA free flap can be an alternative tool for patients with a low body mass index who undergo reconstructive surgery involving the pretibial area, ankle, knee, or dorsum of the foot, all of which require a soft and flexible flap.

Dear Members of the Association

No abstract available.

Dear Members of the Association

No abstract available.

Stability after Bimaxillary Orthognathic Surgery with Rigid Fixation

After bimaxillary orthognathic surgery for correction of facial deformity, the factors influencing stability of bone segment are the amount of bone segment, surgical technique, fixation technique, rotation of proximal segment. The aim of this study is to analyze the significance of the factors influencing skeletal relapse after bimaxillary orthognathic surgery. From March 1994 to march 2003, 11 patients who underwent bimaxillary procedures without genioplasty or any other orthognathic surgical procedures were included for sample. Lateral cephalograms were analyzed before surgery, 1 month and 12 months after surgery respectively. Vertical, horizontal, angular and dental measurements were obtained from each tracing using the horizontal and vertical reference lines. The mean amount of bone movement and relapse was 7.03mm, 2.44mm (35%) respectively at pogonion and 3.41mm, 0.6mm (18%) respectively at point A. After statistical analysis of collected data, the amount of skeletal movement, fixation technique were significantly related to relapse, but rotation of proximal segment, surgical procedures were not significantly related to relapse. Then we suggest that when operation is planned, 20-30% overcorrection was recommended at the time of bimaxillary surgery.

Avoidance of Injury to the Inferior Alveolar Nerve in Mandibular Angle Contouring; Maneuver of One Inch

Complications of mandibular angle contouring may include damage to the inferior alveolar nerve. This study was undertaken to quantify the path of the inferior alveolar nerve in the normal human mandible and in the mandibles of patients presenting for cosmetic reduction of the mandibular angles. The study was based upon the panorama radiography of 20 normal population (ten men, ten women) and 20 patients (ten men, ten women) complaining of square face. Using panorama radiographs and paper tracing, the distance from the "A" point (Fig. 1) to the inferior alveolar nerve was recorded within its mandibular osseous canal in the mandibular angle. The nerve was identifiable in each ramus. The average distance between A point and the other points along the osseous canal is 21.48mm. Therefore together with an additional margin of several millimeters, it is important to maintain a safe distance of at least an inch (25mm) between the saw and the anterior border of the ramus. From our clinical experiences, we are suggesting that this "1 inch maneuver" to be very helpful in avoiding injury to the inferior alveolar nerve, especially for the novice surgeon.

Stability after Surgical Correction of Mandibular Prognathism Using Bilateral Sagittal Split Ramus Osteotomy with Rigid Fixation

Sagittal split ramus osteotomy(SSRO) has become one of the most popular procedure for correction of mandibular prognathism. Rigid fixation is favored for its stability and patient comfort. But there were few data presented about skeletal stability and factors contributing to relapse for sagittal split ramus osteotomy with rigid fixation. From August 1997 to August 2002, eleven patients, who underwent sagittal split osteotomy with rigid fixation, were studied. Patients with genioplasty or any other orthognatic surgical procedures were excluded from sample. Lateral cephalograms were analyzed before surgery, 1 month after surgery, and 12 months after surgery. The mean amount of surgical setback was 6.29 mm at pogonion and the mean amount of skeletal relapse was 1.29 mm at pogonion. The mean postoperative horizontal change of soft tissue pogonion was 5.66 mm posteriorly, vertical change of menton was 1.83 mm superiorly, and angular change of ramus inclination was 5.88 degree increased. The mean amount of postoperative movement was 1.9 mm anteriorly at soft tissue pogonion, 2.13 mm superiorly at menton, 0.8 degree was decreases at ramus inclination. The amount of skeletal relapse is related to the amount of setback. The results of this study present that the bilateral sagittal split osteotomy with rigid fixation has many advantages and stable procedure for the correction of mandibular prognathism.

Stability and Relapse of Facial Asymmetry following Orthognathic Surgery in Patients with Asymmetric Prognathism

The purpose of this study is to evaluate the amount of correction and relapse after orthognathic surgery in patients with facial asymmetry and prognathism by means of the frontal cephalogram. Out of twenty prognathism patients who had been diagnosed as having skeletal facial asymmetry in need of orthognathic operation at our institute during last 6 years, only thirteen patients with pre-existing pre-operative(T0), immediate postoperative (T1) and long term follow up(T2) frontal cephalograms were included in the study. The population was divided according to the kind of surgical operation and severity of asymmetry. The midline sagittal reference line (MSR) was drawn and four basic landmarks were marked on the frontal T0, T1 and T2 cephalograms. Radiographic facial asymmetry was found most obviously in the lower jaw(Deviation from MSR: 2.21mm at ANS, 8.34mm at menton). Facial asymmetry was corrected to minimal degree(1.34 at menton) with orthognathic procedures. On long-term follow up, the correction of deviation was maintained as 1.98mm. The relapse rate was 24.1% at menton. The contributing factor was searched and the amount of asymmetry correction and the amount of prognathism correction proved to have statistical significance (p<0.05). In conclusion, asymmetry could be corrected with orthognathic procedures, which could be maintained with minimal degree of relapse. However, in preoperative planning, the degree of relapse should be considered to maximize the aesthetic outcome.

Microvasclar Free Tissue Transfer for Aesthetic Facial Contouring

The facial contour deformity can cause significant handicaps in social life and a psychological stress to the patient. From January 1991 to November 1998, ten patients were operated on for correction of facial contour deformities with three types of free flap: deepithelialized scapular (n = 6), deepithelialized groin (n = 3) and omental free flap (n = 1). The distribution of diseases were Romberg's disease (n = 3), hemifacial microsomia (n = 2), facial lipodystrophy (n = 1), sequelae after surgery (n = 3) and post-traumatic deformity (n = 1). The patient ages ranged from 12 to 42 years. An incision was made at preauricular (n = 3) or submandibular area (n = 7). After making a subcutaneous pocket just above SMAS, the flap was placed within the pocket. The microvascular anastomosis was performed using superficial temporal vessel (n = 3) or facial vessel (n = 6) as a recipient. The flap margin was sutured to the fascia or periosteum and fixed by bolster sutures to reduce gravitational migration. There were no flap loss. Flap revisions consisting of minor contour corrections were performed in eight patients. A stable restoration of facial contour was achieved in all patients. Microvascular free tissue transfer has the advantages that it can be used on the irradiated bed and restore a large defect of facial contour. The deepithelialized groin free flap is suitable for correction of generalized defect of facial contour such as hemifacial microsomia because of its abundance of fatty tissue. In the deepithelialized scapular free flap, the dorsal thoracic fascia can be folded and tailored into variable width and thickness to correct subtle deformity of facial contour such as Romberg's disease or facial lipodystrophy. The omental free flap is not considered the first choice in facial contouring surgery as it requires laparotomy and has a greater tendency to gravitational migration.

CORRECTION OF ORIENTAL EPIBLEPHARON BY HALF A-PLASTY AND HOTZ PROCEDURE

Epiblepharon is frequently encountered n oriental eyelid, especially in children. It is characterized by a horizontal fold of redundant skin and abundant orbicularis muscle near lid margin, which the lashes vertically, or posteriorly towards the eye. Surgical therapy of epiblepharon in correcting the trichiasis includes lid bracing sutures, burried sutures, skin resection, a Hotz procedure or its modification, and a Jones procedure. In our opinion, these procedures are not sufficient, because these procedures will not correct the epicanthal folds. Epicanthal folds have been a one of the characteristics of Asian over 50 percents of population in Japan and South Korea, and it either reduce the aesthetic result of the double-eyelid procedure or make the correction of the entropion and epiblepharon difficult. Although many surgical procedures are available to eliminate epicanthal folds, scarring on the medial canthus is in still and obstacle for surgeons to overcome. From January of 1998 to October of 1998, we used half z-plasty procedures in 5 cases to correct epicanthal folds in epiblepharon. There were few complications in our series. We believe that half z-plasty can get a good result in the correction of epibolepharon and oriental epicanthal folds.