Reconstructive Modalities According to Aesthetic Consideration of Subunits of the Cheek after Wide Excision of Skin Cancer

BACKGROUND: Defects of the cheek present a reconstructive challenge because of the visibility of the site, as well as the limited local tissue supply. In addition, the cheek abuts several structures with expressive function, such as the eye, mouth, and surrounding facial musculature. This report describes a system of classifying cheek defects according to tumor size and location and present corresponding reconstruction techniques used to accomplish three-dimensional restoration of all missing components and adequate texture matching. METHODS: From 2008 to 2013, 27 patients with cheek defects resulting from skin cancer excision were treated. According to the size of the defect, location on the cheek, and relationships to adjacent structures and existing skin tension lines, different surgical methods were applied. RESULTS: The procedures used for cheek reconstruction included direct closure, Limberg flap, V-Y advancement flap, slide-swing flap, cheek rotation flap, and full-thickness skin graft. All flaps healed well without major complications, and no cancer recurrence was detected during follow-up. CONCLUSIONS: The anatomic classification of skin cancers and surgical protocols described in this report is simple and appropriate for reconstruction involving the cheek. Wide excision of skin cancer and appropriate, relatively easy-to-perform flaps based on this classification system can successfully produce safe and aesthetically-pleasing surgical outcomes.

Nasal Anthropometry on Facial Computed Tomography Scans for Rhinoplasty in Koreans

BACKGROUND: Cephalometric analysis is essential for planning treatment in maxillofacial and aesthetic facial surgery. Although photometric analysis of the Korean nose has been attempted in the past, anthropometry of the deeper nasal structures in the same population based on computerized tomography (CT) has not been published. We therefore measured three anthropometric parameters of the nose on CT scans in our clinical series of patients. METHODS: We conducted the current retrospective study of a total of 100 patients (n=100) who underwent a CT-guided radiological measurement at our institution during a period ranging from January of 2008 to August of 2010. In these patients, we took three anthropometric measurements: the nasofrontal angle, the pyramidal angle, and the linear distance between the nasion and the tip of the nasal bone. RESULTS: The mean nasofrontal angle was 131.14degrees in the male patients and 140.70degrees in the female patients. The mean linear distance between the nasion and the tip of the nasal bone was 21.28 mm and 18.02 mm, respectively. The mean nasal pyramidal angle was 112.89degrees and 103.25degrees at the level of the nasal root, 117.49degrees and 115.60degrees at the middle level of the nasal bone, and 127.99degrees and 125.04degrees at the level of the tip of the nasal bone, respectively. CONCLUSIONS: In conclusion, our data will be helpful in the preparation of silicone implants for augmentation and/or corrective rhinoplasty in ethnic Korean people.

Case Reports of Adipose-derived Stem Cell Therapy for Nasal Skin Necrosis after Filler Injection

With the gradual increase of cases using fillers, cases of patients treated by non-medical professionals or inexperienced physicians resulting in complications are also increasing. We herein report 2 patients who experienced acute complications after receiving filler injections and were successfully treated with adipose-derived stem cell (ADSCs) therapy. Case 1 was a 23-year-old female patient who received a filler (Restylane) injection in her forehead, glabella, and nose by a non-medical professional. The day after her injection, inflammation was observed with a 3x3 cm skin necrosis. Case 2 was a 30-year-old woman who received a filler injection of hyaluronic acid gel (Juvederm) on her nasal dorsum and tip at a private clinic. She developed erythema and swelling in the filler-injected area A solution containing ADSCs harvested from each patient's abdominal subcutaneous tissue was injected into the lesion at the subcutaneous and dermis levels. The wounds healed without additional treatment. With continuous follow-up, both patients experienced only fine linear scars 6 months postoperatively. By using adipose-derived stem cells, we successfully treated the acute complications of skin necrosis after the filler injection, resulting in much less scarring, and more satisfactory results were achieved not only in wound healing, but also in esthetics.

Reconstruction of Soft Tissue Defect on Scleroderma Using STSG & Artificial Dermis (Terudermis(R))

Scleroderma is a rare disease characterized by hard and thick skin, due to fibrosis of tissue with excessive deposition of collagen and extracellular matrix. It is well known that sclerodermatous skin does not heal well after trauma and also difficult to select proper reconstruction method. This article presents a treatment of skin and soft tissue defect with tendon exposure in a scleroderma patient using artificial dermis and STSG. A 67-year old woman, diagnosed as localized scleroderma in 2001, had contact thermal burn on her right hand 2 months ago. She was referred due to 9x5 cm sized skin and soft tissue defect with inflammation and necrosis on the dorsum of her right hand. Necrotic and inflammated tissues were excised under local anesthesia and, on postoperative day 13, debridement & artificial dermis (Terudermis(R)) was applied under general anesthesia. Her cutaneous lesion was spread so widely that we couldn't find appropriate donor site. After 16 days, wound was covered with STSG donated from sclerodermatous skin on right thigh. Artificial dermis was taken without inflammation or other specific complications, and she had uneventful post-operative course after STSG.

Consideration on Application of Modified Monitored Anesthetic Care in Plastic Surgery

PURPOSE: Many patients have fear for surgery owing to the injection of lidocaine and the possible pain in the course of the operation. To resolve such a problem the cases to do plastic surgery with monitored anesthetic care are increasing, in which something like sedatives is injected into vein without endotracheal intubation and under voluntary respiration, but the usage is now under the controversy. METHODS: There were 25 patients who had surgery with local anesthesia, and another 25 patients who had surgery with monitored anesthetic care which belongs to ASA class 1 and 2 from January to April, 2009. Their anesthesia records were collected and surveys were given before and after the surgery and the surgery staff recorded OAA/S during the surgery. The postoperative surveys included the awakening during the surgery, pain, anxiety, and the degree of patient's satisfaction through visual analogue scale to identify the difference between the two methods. RESULTS: The OAA/S results according to time lapse show that it is possible to lead a fast effective sedation and recovery with monitored anesthetic care, and monitored anesthetic care enhances both surgeon's convenience level and patient's satisfaction level, and reduces awakening, pain, and anxiety, compared to local anesthesia. CONCLUSION: The current paper shows about the plastic surgery, particularly the outpatient surgery, when monitored anesthetic care method is applied, it could gain a fast sedation and recovery or an effective sedation of patients. The method also has some affirmative effects in regard with surgeon's convenience and the patients' satisfaction degree and the reduction of their awakening, pain, and anxiety. With careful and adequate watch on the measures about vital signs like electrocardiogram, the degree of oxygen saturation, and blood pressure, it could clinically be very useful.

Abdominoplasty Combined with Wide Excision in Marjolin's Ulcer: Report of 2 Cases

Advances in medical science have produced significant progress in the area of wound healing. Yet, despite proper administration of initial medical treatment, burns or radiation induced wounds often develop into chronic wounds or develop other complications such as scar contractures. In these type of patients, chronic wounds and the potential accompanied ulcers are difficult to heal as malignant changes may occur to the wounds especially in the absence of or in the delay in timely medical treatment. In our beauty oriented society today people have shown great interest in improving their image and many obese patients want to undergo suction-assisted lipectomies or abdominoplasties. Abdominoplasty is an effective procedure to remove locally accumulated fat and to reshape abdominal contours by tightening the muscles of the relaxed abdominal wall. Our medical research conducted on two patients, one with contact burn injuries accompanied by upper abdominal ulcers suffered for fifty years and another with radiation impaired wounds accompanied by lower abdominal ulcers due to cancer treatment for seven years, has shown that through the proper use of abdominoplasty. We have eliminated all possibilities that may trigger the re-occurrence of Marjolin's ulcers which may become malignant. Additionally, we have been able to heal chronic wounds and functionally improve our patient's restrictions of movement caused by the scar contractures by completely removing the lesions, erythemas and discharges from the ulcer areas by performing upper and lower abdominoplasties while still obtaining cosmetically satisfactory results.

A Case of Chemical Burn due to Indomethacin Cream (Vigel Cream(R)): A Case Report

A 81-year-old female patient was experiencing a second degree burn. The vesicobullous lesion and skin necrosis was accompanied by erythema with a size of 8x11 cm and severe pain. Three days earlier, the patient had bumped her forehead against the wall, her forehead was swelled and hurted. The patient spread ground indomethacin cream (Vigel cream(R)) on her forehead constantly. She was treated with potadine soaked gauze every day. As soon as the erythema had worn out, she was treated by foam dressing using Episurge(R) (Erweis). Epithelialization of the injured area began from the 7th day since the burn. Complete epithelialization took 14th days, and the outpatient's progress is currently being observed.

Primary Parotid Non-Hodgkin's Lymphoma: A Case Report

PURPOSE: Primary malignant lymphomas of the salivary glands are uncommon, representing only 1.7% to 3.1% of all salivary neoplasms and 0.6% to 5% of all tumors and tumor-like lesions of the parotid gland. Lymphomas of the parotid glands are usually manifestations of a systemic disease process but primary lymphomas of the parotid glands are rare. Most of these lesions are classified as extranodal non-Hodgkin's lymphoma. We report the clinicopathological features of primary malignant lymphoma of the parotid gland based on an analysis of our cases. METHODS: The subject was a 48-year-old male patient with a malignant lymphoma originating in the parotid gland, which had been slowly increasing in size over previous 6 months. The diagnosis was established by MRI and a superficial lobectomy. After diagnosis, the patient was referred to an oncologist for staging and medical treatment. RESULTS: The stage was IIIA. The patient was treated with chemotherapy following surgery with rituximab and CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisolone). The tumor was controlled successfully by chemotherapy. The patient was followed up for 1 year with no relapse. CONCLUSION: A case of primary non-Hodgkin's lymphoma of the parotid gland was treated with a superficial parotidectomy and chemotherapy. The disease was well controlled after a 1 year follow-up.

Usefulness of High-Resolution Ultrasonography after Foreign Body Injection on Aesthetic Plastic Surgery

PURPOSE: The purpose of this study is to demonstrate the usefulness of the high resolutional ultrasonographic features in patients with foreign body. METHODS: From September 2007 to August 2009, we retrospectively reviewed high resolutional ultrasonogram using 5~12MHz linear transducer of 13 patients presenting with inflammation after foreign body injection. They were referred for complications after foreign body injection. Injected foreign bodies were 4 silicone, 4 paraffin, 2 artecoll, and 3 unknown. We treated them with foreign body removal(7), foreign body removal and corrective plastic surgery(4), and conservative treatment with antibiotics and steroid injection(2). RESULTS: High resolutional ultrasonography well demonstrated the existence of foreign body and it's overall size, location within the tissue layer, and vascularity. Comparison between preoperative and postoperative ultrasonographic findings was useful not only to evaluate the prognosis but also to plan the treatment. These ultrasonographic findings aided in precise assessment of the contour and location of the foreign body and led to an accurate surgery. We were able to acquire various information in order to set a detailed plan for the operation which in turn, led to a precise, successful surgery. After the treatment, complication did not occur in 12 patients, except 1 patient. But this patient was also treated after reoperation. Postoperative high resolutional ultrasonography shows almost foreign body removed and inflammation disappeared. CONCLUSION: Considering the usefulness of high-resolution ultrasonography in foreign body injection, high-resolution ultrasonography would be necessary for both the patient and the doctor. Preoperative and postoperative high resolutional ultrasonography is highly accurate, safe, inexpensive and easy. It can be a useful modality in foreign body after plastic surgery.

Intraoperative Expansion Technique for Soft Tissue Necrosis after Liposuction

PURPOSE: The liposuction has been generalized & undergone in the field of plastic surgery and it has had a great influence on fat graft. But despite of liposuction and fat injection being performed widely, we did not focus on complication associated with donor site. So we reported satisfactory result with the intraoperative sustained limited expansion & direct closure to donor site tissue necrosis after liposuction and analyzed the cause & measures of donor site necrosis with the literature investigation METHODS: From November 2007 to June 2008, we treated four cases of tissue necrosis and infection surrounding the thigh and forearm. Necrosis after liposuction was 1 case, donor site necrosis after fat injection were 3 cases and MRSA was detected in 2 cases. first, we debrided the necrotic tissue and treated with potadine gauze soaking dressing & susceptible antibiotics. After confirmation of healthy granulation tissue, we used intraoperative sustained limited expansion and closed directly of defect & observed the results. RESULTS: The patient was displeased and worried with the unexpected damage concerning the donor site and the procedure concerning time and financial exhaustion, but after confirming no contracture of the scar tissues and only a thin or slightly widened line of scar, showed satisfaction. CONCLUSION: Because it is fastidious to avoid donor site complication after liposuction & fat injection, enough explanation and understanding on possible complication to donor site are necessary and careful surgery procedure & materials are required. But if donor site necrosis occurred despite close consideration of possible causes of necrosis, we should think about not only wound healing process but also the sequela like scar contracture & cosmetic effect and treat the most adequate method to resolve both concerns.

Chemical Burn due to Garlic: A Case Report

PURPOSE: Garlic (Garlic: Allium sativum), throughout history, has long been used as a method to cure various diseases in different cultures. Although the intake or local application of garlic in order to treat skin disease and antibacterial effects is gradually increasing, its possible side effects cannot be neglected. As a chemical burn case due to local application of garlic has never been reported in Korea up to now, the following paper will present a case in which who suffered a partial layer second degree burn due to the local application of garlic. METHODS: A 53 year-old female patient was experiencing a partial layer second degree burn. The vesicobullous lesion was accompanied by erythema with a size of 20x7 cm and severe pain. Two days earlier, the patient spread ground garlics on her left arm and had wrapped it in order to remove the black spots. Unfortunately, due to her carelessness, the garlic had stayed there for 12 hours. She was treated with potadine soaked gauze every day. As soon as the erythema had worn out, she was treated by wet dressing using Hydrocolloid (Comfeel plus transplant dressing(R), Coloplast A/S and Denmark). RESULTS: Epithelialization of the injured area began from the 5th day since the burn. Complete epithelialization took seven days, and the outpatient's progress is currently being observed. CONCLUSION: Local application of garlic as a folk remedy is widely known, and the side effect such as contagious skin disease is also known to some extent. Patients today tend to rely more on organic remedies, let alone garlic. Moreover, they seek traditional methods or alternative medicine rather than conventional treatment. Thus, it is crucial to acknowledge the side effects of such folk remedies and to be aware whether they have been preceded.

Sudoriferous Cyst Adhered to Levator Aponeurosis: A Case Report

PURPOSE: Sudoriferous cyst usually occurs on the face, and especially on the ear and scalp as a solitary cystic mass. It is derived from the sweat glands of Moll and results from the obstruction of excretory ducts with the retention of fluid. In the eyelid, it is usually seen as small and firm vesicle arising at the eyelid margin. If it rarely occurs on the orbit, it develops from orbital ectopic epithelial cells predetermined to form glands of Moll. We experienced a case of sudoriferous cyst on eyelid which was adhered to levator aponeurosis and it disappeared when patient closed eyes. METHODS: A 55-year-old women suffered palpable mass on left upper eyelid without pain that had been present for 25 years. Orbital computed tomographic finding showed a oval mass(2.1x0.6x0.6cm size) inside upper eyelid and it invaded the orbit. The mass was completely excised under general anesthesia and histopathological examination was followed. RESULTS: Cystic mass was purple color and it was located in superiorly to tarsal plate. The mass was adhered to levator aponeurosis and levator palpabrae superioris muscle between the fat layer of post-orbital septum and the Whitnall ligament. The mass was completely excised without injury of aponeurosis and muscle. Microscopically, the lesion was a solitary cyst lined by two layers of cuboidal epithelial cells and innermost cells displaying eosinophilic cytoplasm with apical expansions. CONCLUSION: Sudoriferous cyst usually occurs on eyelid margin. But in this case, cystic mass occurred on upper eyelid and disappeared when patient closed the eyes because it was partially adhered to levator aponeurosis and levator palpebrae superioris muscle. Therefore, if sudoriferous cyst occurs on eyelid, it is necessary to excised the mass carefully.

Multiple Cutaneous Leiomyoma Derived from the Mutation in Fumarate Hydratase Gene: A Case Report

PURPOSE: Multiple skin leiomyoma and uterine myoma bearing autosomal dominant traits are benign smooth muscle tumors which originate in skin or female uterus. Skin leiomyoma occurs after gene mutation originating from arrector pili muscle of hair follicle where its clinical manifestations vary significantly from person to person. Our department hereby reports the histological findings and genetic evaluations of this very rare disease. METHODS: A 57-year-old woman presented in our institute with multiple tumors in the left and central parts of her back that started to appear since 19 years ago. The patient was diagnosed as having uterine myoma 15 years ago and underwent hysterectomy. Biopsy has been done on the specimen, and genomic DNA was separated from Fumarate hydratase gene for it to go through PCR amplification. The results of PCR amplification were aligned by sequencer. RESULTS: According to the results of biopsy, tumor cells were spindle-shaped and were aligned in a bundle where there was no dysplasia or mitosis. Moreover, these cells had abundant eosinophilic cytoplasm with elongated nucleus, and benign leiomyoma that showed positive reactions to SMA stain were found. In genetic examination, mutations such as heterozygous single nucleotide substitutions were found in alignments of amplified DNA. CONCLUSION: Multiple skin leiomyoma and uterine myoma are relatively uncommon diseases that are transmitted through autosomally dominant traits from genetic mutations. When a patient's chief complaint lies upon skin-colored or brown masses that occur in multiples appearing in the trunk or extremities with characteristic clinical symptoms and histological findings, and when the patient's family history is acknowledged such as skin or uterine leiomyoma or renal tumor, necessary genetic examination on multiple skin leiomyoma and uterine myoma could be done, and thereby precise diagnosis could also be made.

Surgical Correction of Pneumosinus Dilatans of the Frontal Sinus

Pneumosinus dilatans is a rare condition of paranasal sinus, which is most commonly found in males of the age between 20 to 40. That is defined hypersinus as the enlargement of a paranasal sinus beyond the upper limits of normal. The deformity is caused by an abnormal enlargement of the paranasal sinus by hyperpneumatization. A valve mechanism raising the pressure inside the sinus is regarded to be responsible for this condition. A preoperative computed tomography scan is used to illustrate the anatomical condition and possible etiologic mechanisms and the most commonly affected sinus is the frontal sinus. Numerous methods have been suggested to repair the anatomical deformities of frontal sinus and we represent a method of correction for pneumosinus dilatans, too. We approached the frontal sinus by using a bicoronal incision and exposed total frontal sinus to remove total outer wall at one piece. We remodeled outer wall of fontal sinus by one piece and fixed with absorbable plates and screws. Ten months after the successful operation, the patient was satisfied with a good cosmetic result without recurrence. The latest, this comsmetic surgery is attractive and we wanted to improve frontal sinus bossing commonly, but it is not usual. Here, we present a case of pneumosinus dilatans of the frontal sinus of the repair method.