Acute Osteomyelitis in the Hand Due to Dog Bite Injury: A Report of 3 Cases

As many people keep small dogs as pets, dog bites are common injuries, accounting for approximately 80%–90% of all animal bite injuries. These injuries usually occur on the upper extremities, most commonly on the fingers. Most of these injuries appear as simple lacerations or abrasions of the skin. Common symptoms include inflammatory reactions of the soft tissue, such as pain, swelling, erythema, and cellulitis. However, the complications of small dog bites may include joint or cartilage injuries, including acute osteomyelitis. Once osteomyelitis develops, it is difficult to diagnose since it has a latency period of approximately 2 weeks. Plain radiography, magnetic resonance imaging, and 3-phase bone scans should be performed when acute osteomyelitis is suspected, and broad-spectrum empiric antibiotic treatment should be administered for approximately 8–12 weeks. We report 3 very rare cases of acute osteomyelitis that occurred after a dog bite injury.

Acute Osteomyelitis in the Hand Due to Dog Bite Injury: A Report of 3 Cases

As many people keep small dogs as pets, dog bites are common injuries, accounting for approximately 80%–90% of all animal bite injuries. These injuries usually occur on the upper extremities, most commonly on the fingers. Most of these injuries appear as simple lacerations or abrasions of the skin. Common symptoms include inflammatory reactions of the soft tissue, such as pain, swelling, erythema, and cellulitis. However, the complications of small dog bites may include joint or cartilage injuries, including acute osteomyelitis. Once osteomyelitis develops, it is difficult to diagnose since it has a latency period of approximately 2 weeks. Plain radiography, magnetic resonance imaging, and 3-phase bone scans should be performed when acute osteomyelitis is suspected, and broad-spectrum empiric antibiotic treatment should be administered for approximately 8–12 weeks. We report 3 very rare cases of acute osteomyelitis that occurred after a dog bite injury.

Fingertip Reconstruction with Perionychial Flaps

PURPOSE: Out of nail components, nail plate, nail fold, paronychium, hyponychium, nail bed, and matrices are referred to as the perionychium. The authors report the outcomes of perionychial flap for reconstruction of fingertip injuries with nail bed injuries. METHODS: We performed 8 cases of perionychial flap for fingertip injuries with nail bed injuries between January 2012 and December 2015, and analyzed the outcomes of the reconstruction surgery. The patients evaluated the aesthetic results on a four-point scale, and we measured and evaluated the ratio of axis length of the nail plate compared with collateral side of normal nail plate. RESULTS: The mean follow up period was 8.4 months, and range of motion of distal interphalangeal joints and sensation of the reconstructed pulp were normal in all patients. After reconstructive surgery the nail plates regrew up to 80% in average compared to the normal side, and the satisfactory score were good to excellent as 3.8 point in average. CONCLUSION: The reconstruction of fingertip injuries with nail bed injuries using perionychial flap including paronychium and hyponychium is safe and easy procedure and aesthetic outcomes were excellent. The authors consider the perionychial flap as a useful technique for fingertip reconstruction.

Modified Y-V Flaps for Treatment of Postburn Scar Contractures and Scar Reduction in Extremity

PURPOSE: Reconstruction of postburn scar contractures is one of difficult tasks in burn plastic surgery. A linear scar contracture is usually repaired by using skin grafts, traditional or modified Z-plasty. However, the scar itself remains even if the contracture is released. Therefore, it should be suggested to reduce scars at the time of release of scar contractures. For this purpose, we have designed the Y-V flap method. This paper is presents our clinical experiences for reconstruction of postburn linear scar contractures and scar reduction by newly designed the Y-V flap. METHODS: We had 3 cases of postburn scar contractures with depressed deformities in extremities, buttock using the newly designed the Y-V flaps. The Y-V flap is made by the V shaped flap at a right angle to the scar band and it is advanced to Y incision site of opposite edge of the scar band, and this flap can correct the linear contracted scar band with moderate scar reductiontion. RESULTS: 2 cases of the postburn scar contractures were treated using the Y-V flaps. 1 case of scar contractures of extremities was reconstructed using Y-V flap and multiple Z-plasties. After postoperative follow up, relatively satisfactory results were obtained in all cases. CONCLUSION: We have had successful reconstruction of postburn scar contractures with depressed deformities by newly designed Y-V flap. The design of Y-V flap and its reliability have been introduced. The Y-V flap can be used effectively for the correction of linear scar contractures with depressed contour deformities and scar reduction.

Epidemiology of Burns in Korea from 2010 to 2014

PURPOSE: The epidemiology of burns in Korea has been sporadically reported in the treatis based on data from one burn center or hospital. The nationwide epidemiological study for burns in the Korea is scarce. It is necessary to establish the national medical plan for providing the specialized burn care for burn victims, burn prevention and burn safety for publics. METHODS: This study is done based on the burn patients data receiving medical treatment, from the Korea National Health Insurance Service during 2010~2014. We reviewed the following issues; the average annual burn incidence, and tendency of burn occurrence in every year, sex distribution of burn patients, the yearly numbers of pediatric burn patients, incidence of specific-age pediatric burn patients, incidence of burns by specific-age group, and prevalent sites of burns. RESULTS: 1) The average annual burn patient is 545,462 in 2010~2014. The average annual incidence of burn patients per 100,000 population is 1,091. The total annual numbers of burn patient is gradually increasing in tendency. 2) Male and female sex ratio is 39 (the mean 214,832 male burn patients per year): 61 (the mean 330,630 female burn patients per year). 3) The average pediatric burn patient (1~15 age) is 123,934 and it consists of 22.7% of the average annual burn patients during 2010~2014. 4) The most prevalent age of pediatric burns revealed at the age of 1 (21.7%). The incidence of burn patients of 1~2 age occupy 38.4% of the total pediatric burn patients. 5) The four age group-specific burn incidence are classified as pediatric group (0~15 age) 22.7% (123,934 patients), adolescence-middle age group (16~39 age) 32.3% (176,288 patients), middle-old age group (40~74 age) 41.9% (228,427 patients), super old age group (over 75) 3.1% (16,813 patients). 6) The mean yearly burn sites was 567,200. Among them, the most prevalent site of burn was hand (32.8%), and followed by upper extremities (13.5%), lower extremities (13.4%), face (10.5%), foot (10.1%), trunk (6.6%). the unspecified area and etc (13%), respiratory tract (0.1%). CONCLUSION: Based on the data from the Korea National Health Insurance Service, the average annual burn incidence is mean 545,462 burn patients during 2010~2014 in Korea, and revealed increasing in tendency. This epidemiological data can be attribute to providing the specialized burn care to domestic burn victims, and to establish the plans for burn prediction and prevention, and burn safety.

Effect of Endogenous Bone Marrow Derived Stem Cells Induced by AMD-3100 on Expanded Ischemic Flap

The purpose of this study was to devise an expanded ischemic flap model and to investigate the role of AMD-3100 (Plerixafor, chemokine receptor 4 inhibitor) in this model by confirming its effect on mobilization of stem cells from the bone marrow. Male Sprague-Dawley rats were used as an animal research model. The mobilization of stem cells from the bone marrow was confirmed in the AMD-3100-treated group. The fractions of endothelial progenitor cells (EPC) and the vascular endothelial growth factor receptor (VEGFR) 2+ cells in the peripheral blood were increased in groups treated with AMD-3100. The expression of vascular endothelial growth factor (VEGF) was increased in response to expansion or AMD injection. The expression of stromal cell derived factor (SDF)-1 and VEGFR2 were increased only in unexpanded flap treated with AMD-3100. Treatment with AMD-3100 increased both the number and area of blood vessels. However, there were no statistically significant differences in the survival area or physiologic microcirculation in rats from the other groups. This endogenous neovascularization induced by AMD-3100 may be a result of the increase in both the area and number of vessels, as well as paracrine augmentation of the expression of VEGF and EPCs. However, the presence of a tissue expander under the flap could block the neovascularization between the flap and the recipient regardless of AMD-3100 treatment and expansion.

Glomus Tumors: Symptom Variations and Magnetic Resonance Imaging for Diagnosis

BACKGROUND: The typical clinical symptoms of glomus tumors are pain, tenderness, and sensitivity to temperature change, and the presence of these clinical findings is helpful in diagnosis. However, the tumors often pose diagnostic difficulty because of variations in presentation and the nonspecific symptoms of glomus tumors. To the best of our knowledge, few studies have reported on the usefulness of magnetic resonance imaging (MRI) in diagnosing glomus tumors in patients with unspecific symptoms. METHODS: The inclusion criteria of this study were: having undergone surgery for subungual glomus tumor of the hand, histopathologic confirmation of glomus tumor, and having undergone preoperative MRI. Twenty-one patients were enrolled. The characteristics of the tumors and the presenting symptoms including pain, tenderness, and sensitivity to temperature change were retrospectively reviewed. RESULTS: Five out of 21 patients (23%) did not show the typical glomus tumor symptom triad because they did not complain of pain provoked by coldness. Nevertheless, preoperative MRI showed well-defined small soft-tissue lesions on T1- and T2-weighted images, which are typical findings of glomus tumors. The tumors were completely resected and confirmed as glomus tumor histopathologically. CONCLUSIONS: Early occult lesions of glomus tumor in the hand may not be revealed by physical examination because of their barely detectable symptoms. Moreover, subungual lesions may be particularly difficult to evaluate on physical examination. Our cases showed that MRI offers excellent diagnostic information in clinically undiagnosed or misdiagnosed patients. Preoperative MRI can accurately define the character and extent of glomus tumor, even though it is impalpable and invisible.

Current Status of Face Transplantation: Where Do We Stand in Korea?

The world's first face transplantation was performed in France, in 2005. Since then, 21 cases of face transplantation have been performed. Face transplantation is one of the most prominent part of composite tissue allotransplantation (CTA) along with hand transplantation. Since these fields are not deal with life-saving organs, there are many arguments about immunosuppression therapy. Recent paradigm of face transplantation shows that surgical ranges are expanded from partial face transplantation to full face transplantation. Most immunosuppression protocols are triple therapy, which consists of tacrolimus (FK-506), mycophenolate mofetil and prednisolone. Anatomical researches, immunosuppression, and immunotolerance take great parts in the researches of CTA. The medical fields directly related to face transplantation are microsurgery, immunology, and transplantation. Nowadays, each field is performed widely. Therefore people, even medical teams think face transplantation could be easily realized, sooner or later. But there are lots of things that should be prepared for not only practice and immunosuppression therapy but also for the cooperation with relevant fields. That's the reason why only 21 cases of face transplantation have been done, while more than 70 cases of hand transplantation have been done in the past years. Especially in Korea, brain death patients are not enough even for organ transplantation and furthermore there are some troubles in taking part in the society of transplantation. Face transplantation has lots of problems concerning variable medical fields, administration, society, ethics, and laws. Therefore, for the realization of face transplantation in Korea, not only medical skills but also political powers are needed.

Treatment of Complex Open Wounds Using AlloDerm(R) in Hand and Foot

PURPOSE: The purpose of this study is to evaluate the functional and aesthetic outcomes of the reconstruction of complicated open wounds with exposure of the bone, periosteum, or tendon using AlloDerm(R) and skin graft in hand and foot. MATERIALS AND METHODS: Seven cases of hand and 4 cases of foot were treated with combined AlloDerm(R) graft and split thickness skin graft in a single stage for managing the soft tissue defect of extremities where bone, periosteum, or tendon were exposed but flap operation was not feasible. The mean postoperative follow-up period was 30 months (range: 14-48 month). Postoperatively, we assessed graft taking rate, wound healing process, and the recovery of motion of hand and foot. RESULTS: AlloDerm(R) and skin graft were readily assimilated into the wound in all cases. The mean postoperative range of motions of the 5 fingers with exposed digital tendons were 89.2% of the normal side. Reconstructions of wound in the foot were successfully settled without unstable scar or ulcer in all cases. CONCLUSION: Composite grafting with AlloDerm(R) and autologous skin graft for reconstruction of complex open wound in hand and foot where deep structures are exposed provides stable reconstruction of the wound with high taking rate, successful recovery of tendon gliding motion by preventing adhesion.

Schwannoma of the Hand: Importance of Differential Diagnosis & Microsurgical Dissection

PURPOSE: The schwannoma is a benign peripheral nerve tumor arising from the Schwann cell of the nerve sheath. Only 2-8% of schwannomas arise in the hand and wrist. Misdiagnosis is frequent such as ganglion and neurofibroma. This article documents and clarifies the clinical features of schwannomas arising in the hand and wrist, and emphasizes importance of differential diagnosis and meticulous surgical extirpation under magnification. METHODS: The author reviewed clinical features of 15 patients with pathologic final diagnosis of schwannoma developed in hand and wrist during the last 12 years from 1998 through 2009. The review included the sex, age of onset, duration, preoperative diagnosis, location, involved nerve, preoperative symptoms and. Postoperative sequelae after surgical extirpation of the lesion with magnification, or without magnification of the surgical fields. RESULTS: The chief complaints were slow growing firm mass in all patients, and followed by pain in 40%, and paresthesia in 40% respectively. The lesions were developed solitarily in 14 patients(93%). The postoperative pathologic diagnosis and preoperative diagnosis were coincided with only in 6 patients(40%). Other preoperative diagnosis were soft tissue tumor in 4 patient(26.6%), and ganglion in 3 patients(20%), and neurofibroma in 2 patients(13%). In all patients who were undergone surgical excision under the fields of magnification, all symptoms were subsided without any sequelae. Meanwhile muscle weakness, paresthesia, hypoesthesia and/or accidental nerve resection developed after surgical excision with naked eye. CONCLUSION: Schwannoma in hand most commonly appears as a slow growing solitary mass with pain or paresthesia. The chance of preoperative misdiagnosis was 60% in this series. To provide good prognosis and less sequelae, careful and elaborate diagnostic efforts and meticulous surgical excision under the magnification are necessary in management of schwannoma.

Effect of Recombinant Human Epidermal Growth Factor Against Cutaneous Scar Formation in Murine Full-thickness Wound Healing

A visible cutaneous scar develops from the excess formation of immature collagen in response to an inflammatory reaction. This study examined the role of epidermal growth factor (EGF) in the formation of cutaneous scars. Twenty Crl:CD-1 (ICR) mice were used and 2 full-thickness skin wounds were made on the dorsum of each mouse. One of the wounds was treated with recombinant human EGF by local application and the other was treated with saline for control until complete healing was achieved. The EGF-treated group's wounds healed faster than the control group's. The width of the scar was smaller by 30% and the area was smaller by 26% in the EGF-treated group. Inflammatory cell numbers were significantly lower in the EGF-treated group. The expression of transforming growth factor (TGF)-beta1 in the EGF-treated group was increased. It was observed that the amount of collagen in the EGF-treated group was larger than the control group. In the EGF-treated group, the visible external scars were less noticeable than that in the control group. These results suggest that EGF can reduce cutaneous scars by suppressing inflammatory reactions, decreasing expression of TGF-beta1, and mediating the formation of collagen.

A Modified MACS Lift Combined with Composite Flap Elevation

Composite face lift has been accepted as the best technique for getting satisfactory outcome in surgical rejuvenation. As operations that ensure fast recovery and minimal complication were favored, MACS lift has been regarded as one of the innovative solutions. We experienced that nasolabial fold and neck wrinkle was hardly improved with conventional MACS lift. Therefore, we devised a new modification of composite face lift and MACS lift to achieve both outstanding improvement and fast recovery. From May, 2004 to April, 2008, we operated 49 cases with our technique. They were between 35 and 67 years old. Follow up ranged from 3 to 26 months. Fifteen of 49 patients had longer than 1 year follow up were evaluated with photos and patients interview. Eleven patients were satisfied with the results 12 months after operation. However, two patients complained of unimproved marionette line and remaining two patients had irregularity on the skin. We experienced one hematoma immediately after operation, however most of the patients went to their usual daily lives in one or two weeks after operation. Our operation had several outstanding advantages and long lasting outcome. We, therefore, concluded that this technique is an effective surgery to improve aged face.

Prognosis of Malignant Melanoma on Lower Extremity

PURPOSE: Malignant melanoma is recognized as the most serious skin cancer. We examined anatomical distribution and 5-year survival rate of each stage of malignant melanoma on lower leg. METHODS: We retrospectively analyzed the medical records of 91 patients(46 males and 45 females) with malignant melanoma on lower leg from 1985 to 2008. Age, sex, anatomical distribution and 5-year survival rates of each stage of malignant melanoma on lower leg were investigated. Also, 5-year survival rates of each stage and invasion depth of malignant melanoma on heel pad were investigated. RESULTS: On lower leg, most frequently 32 cases (35.1%) occurred on heel pad, 27 cases(29.7%) occurred on dorsum of foot, 18 cases(19.8%) in toe, and 14 cases(15.4%) on others in lower leg. We used the excision margin as 3-5cm. After wide excision, in stage III, IV, the patients underwent the immunologic / chemo-therapy. The incidences of each stage were 22 cases(24.2%) in stage I, 47(51.6%) in II, 17(18.7%) in III and 5(5.5%) in IV. The 5-year survival rates of each stage were 85%, 53.2%, 47.1% and 40%. On heel pad, the incidences of each stage were 5 cases(15.6%) in stage I, 19 cases(59.4%) in II, 7 cases(21.9%) in III and 1 case(3.1%) in IV. The 5-year survival rates of each stage were 80%, 63.2%, 42.9% and 100%, respectively. On heel pad, incidence of local recurrence was 2 and 5-year survival rate of this case was 100%. And systemic recurrence was 9 and 5-year survival rate of this case was 55.6%. CONCLUSION: The 5-year survival rate of malignant melanoma on heel pad was higher than previous study. To maintain the weight-bearing function of foot, we recommend the active reconstructive surgery for heel pad reconstruction after wide excision of heel pad malignant melanoma.

Treatment of Glabellar frown Lines Using Selective Nerve Block with Radiofrequency Ablation

PURPOSE: Corrugator supercilii muscle pulls eyebrow to inferomedial direction and produces the vertical component of the glabellar line formation. Current techniques for eliminating of glabellar frown include direct resection of corrugators and botulinum toxin injection. Muscle resection in endoscopic face lift procedure is relatively complex and has many disadvantages such as possible nerve injury, postoperative edema, pain and a long recovery period. The Botox treatment on the other hand is much more simple in technique but has a short duration of action. The authors have attempted new ways of finding improved treatment of the glabellar frown by selectively blocking of motor nerves innervating the corrugator supercili muscle by using radiofrequency ablation technique. METHODS: A total of 80 patients were recruited in our study during the period from Feb. 2007 to June 2008. A probe was introduced from the supraorbital ridge and advanced to the corrugator supercilii muscle. Nerve stimulator was then used to locate the nerve innervating the corrugator and radiofrequency ablation of the nerve was done. RESULTS: In all patients, there were marked improvement in glabellar frown after treatment. There were no reported cases of any relapses during the follow up period. No complication was noted such as facial nerve injury. No patient complained of any adverse symptoms other than slight discomfort due to swelling of the operation site. CONCLUSION: The treatment of glabellar frown lines using selective nerve block with radiofrequency ablation was not only less invasive but also excellent in surgical outcomes.

Acceleration of Wound Regeneration by Implantation of CD34-Mononuclear Cell from Human Cord Blood

PURPOSE: Cord blood stem cells are easily obtainable and have characteristics of higher proliferative potential and lower immunogenicity and with benefits in allogenic transplantation for wound treatment. To provide treatment evidence of cord blood stem cell on burn injury, CD34+ (hematopoietic lineage) and CD34- cells (mesenchymal stem cells lineage) were isolated and applied to full thickness skin wounds for evaluation of their effect. METHODS: Mononuclear cell layer was separated by Ficoll- Paque from human cord blood, followed by selection of CD34+, - cells. Two full-thickness wounds were made on dorsal area of ICR mice with 8 mm punch. CD 34+, - cell suspension was injected into the wound sites and wound healing rate was measured every 3 days with analysis of neo- vascularization. Immunohistochemical study for stem cell survival and TGF-beta1 was performed. RESULTS: The wound healing rate of CD34- , CD34 + and control group was 34.73%, 9.24%, 5.132% on day 3 and 82.60%, 64.45% 76.20% on day 9 respectively. The CD34- group showed a significantly higher wound healing rate (p<0.01). The CD34- group revealed a relatively well organized epidermis and showed a remarkably increased neo-vascularization. Anti-human nuclei was detected on CD 34- group. TGF-beta 1 was stained all groups with no differences. CONCLUSION: CD34- mononuclear cells group showed increased wound healing than the control and CD34+ mononuclear cells treated group. CD34- mononuclear cells enhanced epithelization and neo-vascularization by means of differentiation into endothelial cells, myofibroblast and so on. We can conclude that isolated CD34- mononuclear cells can be helpful for burn wound.

Surgical Correction of Hexadactyly: Innovation of New Technique and Its Application

PURPOSE: Hexadactyly without thumb is a rare congenital anomaly of the hand where six triphalangeal digits are symmetrically distributed without thumb. Contrary to mirror hands, triphalangeal six digits are symmetrically distributed on each side at the midline with well-differentiated carpal bones, extensor tendons, one ulna and one radius. The authors developed a new surgical technique based on a three-dimensional concept to correct the hexadactyly and applied to 2 cases of hexadactyly with good functional and aesthetic results. Here we document the surgical technique and its result. METHODS: A 16 month old male patient visited our clinic with chief complaints of bilateral hexadactyly deformity. On physical examination most radial first and second digits showed no opposition and adduction motion on both side hands. Radiography showed 6 triphalangeal digits with normal development of carpal, radial and ulnar bone. Right side abnormality was corrected by removal of most radial side extra-digit, rotation and migration of 2nd ray to thumb position and creation of 1st web by transposing a mid-palm based rectangular palmar flap as in Snow & Littler procedure which has been being applied for correction of 1st web syndactyly in cleft hand deformity. Seven months later, left side abnormality was also corrected with the same procedure. RESULTS: Postoperative appearances of the both hands were satisfactory. Flexion, extension, opposition and grasping were possible with the pollicized 2nd ray. Pinching power was 3.0kg 15 months after the surgery and 2.5kg 22 months after in right hand respectively. CONCLUSION: In correction of hexadactyly deformity, satisfactory aesthetic and relevant functional results can be expected with authors' newly developed technique: removal of most radial digit, rotation and migration of 2nd digit to thumb position as well as creation of the 1st web space by transposition of mid-palm based rectangular flap.

Correction of Lower Face Asymmetry using Dermofat Graft

PURPOSE: To correct the facial asymmetry and to achieve symmetry and balance, not only the soft tissue restoration of deficits but also creation and facial contour line such as mandible border and angle is important. Micro fat graft has limitation such as high resorption rate and somewhat limited ability to emphasize the rigid bony characteristics of the mandible angle due to its innate soft consistency. We have investigated the advantages of dermal fat graft over micro fat graft to correct asymmetry of the lower face in patients who had undergone mandibular reconstruction or distraction, using comparative analysis. METHODS: Total of 12 patients were enrolled in our study: 6 micro fat graft and 6 dermal fat graft. Postoperative results were compared and analyzed at immediate postoperative period and more than 1 year later in each group with photographs, and analysised with image J program. RESULTS: No complications were noted both in the micro fat type and the dermal fat type of procedures such as fat necrosis or micro calcifications. All of the patients who received micro fat graft, however had considerable amount of fat resorption after the procedure which led to two additional fat graft procedures. Although minor contour obliteration due to contracture was seen in patients who had undergone dermal fat graft procedure, no definite resorption was found even after more than one year follow-up. Results of dermal fat graft patients were satisfactory in terms of mandible angle symmetry. Secondary revision was necessary in one case due to overcorrection using dermal fat graft. CONCLUSION: The dermal fat graft has many advantages over the conventionally more popular micro fat graft to correct asymmetry of the lower face following mandible reconstruction owing to its lower resoption rate, more effective in emphasizing the natural curvilinear anatomical contours of the mandible angle and body and lower complication rates such as fat necrosis or micro calcifications.

Nipple Reconstruction with Modified C-V Flap: C-U Flap

For ideal breast reconstruction, final nipple reconstruction with good projection, symmetrical position, shape, and texture is very important. Nowadays, C-V flap is popularly used because of its simple procedure and less donor site morbidity. But, it also has problems of maintaining good perpendicular nipple projection. Furthermore, the flap could be injured by ischemia from the overloaded tension, when it contains too much subcutaneous fat. We modified the traditional C-V flap to overcome these drawbacks and obtained satisfactory results. From April 2006 to February 2007, we applied modified C-V flap to 46 patients who underwent NAC(Nipple-Areola Complex) reconstruction for breast reconstruction. First, we modified the flap design. The tip of horizontal V-flap was changed to rectangular shape as U-flap. Secondly, we discarded the subcutaneous fat in U-flap except the base to minimize the tension after flap insetting. Thirdly, following the flap elevation, we performed donor site closure of the C-flap. Thus the donor site of U-flap could be repaired without dog ear. Finally, de-epithelization was done on the base of nipple according to the diameter of new nipple. Then a small triangular flap was made, and insetted between the junction of bilateral U-flap to minimize the contracture and inversion of new nipple. The result were followed up for an average of 8 months. There was no complication such as flap loss or infection in all 46 patients. During the follow-up periods(3-13 months), new nipple maintained symmetry and perpendicular projection to be compared with traditional C-V flap. This modification of C-U flap could overcome some drawback of traditional C-V flap and improved results were obtained.

Microcystic Adnexal Carcinoma of the Lower lip: A Case Report

PURPOSE: Microcystic adnexal carcinoma is a rare malignant appendage tumor, first described by Goldstein et al in 1982. Here, we present our experience in treatment of a case on the lower lip. METHODS: A 52-year-old female with an asymptomatic nodule on the chin, previously misdiagnosed as trichoadenoma by needle aspiration biopsy, was treated by wide excision combined with multiple circumferential frozen biopsies. RESULTS: Pathological examination revealed typical features of microcystic adnexal carcinoma, such as basaloid and squamous cells forming nests and cord-like patterns, horn cysts, and minimal cytologic atypia. The patient has been followed up for 6 months. No sign of recurrence is noted to date. CONCLUSION: Differentiation from other benign adnexal neoplasms is important for its appropriate treatment. Differentiation can be difficult histologically because it is difficult to acquire an adequate biopsy due to its invasiveness, and clinically due to its asymptomatic and slow growing features. Complete excision is the key treatment, but it may not always be the best solution considering the huge defect that may result and the low incidence of metastasis & deaths owing to the tumor. We add this case to the approximately 300 cases reported worldwide with a review of literature.

Analysis of Factors for Satisfying Functional Outcomes in Tongue Reconstruction

PURPOSE: Tongue cancer is the most common malignant tumor of the oral cavity and the ultimate goal in treatment of the cancer is not only complete excision and meticulous closure of the wound, but also, reconstruction of a demensional and functional tongue. Our study focuses on various factors, such as defect size, extent of tumor, age, application of mandibulectomy or radiotherapy, and their influences on postoperative speech and swallowing function. METHODS: Our study was based on 59 patients who underwent tongue cancer operation and reconstruction of the tongue. Speech and swallowing were evaluated according to categories documented by Sultan and Teichgraeber. Patients were classified into 3 groups as partial glossectomy, hemiglossectomy and total glossectomy groups for evaluation. The average age of the patients were 51, and the mean follow-up period was 4 years 2 months. RESULTS: The partial glossectomy group showed statistically relevant results for speech articulation and swallowing abilities compared to the total glossectomy group. In cases of defects involving the mouth floor, the group showed decreased results compared to the group without mouth floor involvement. Increased age showed decreased postoperative results with statistical significance, while mandibulectomy and radiotherapy revealed no statistically significant data. Analysis according to TNM staging resulted in decreased functional result with advanced staging without statistical significance. CONCLUSION: To summarize the factors influencing the functional outcome in tongue reconstruction, younger patients and early stage cancer with minimal surgical extent revealed more satisfying results while mandibulectomy and radiation did not have influence on our analysis. Addition of various influencing factors and studies with longer follow up periods on our patient groups may provide effective data for more satisfying functional outcomes in the future.