Mondor's Disease after Bilateral Mastectomy in Both Breast Paraffinoma Patient

PURPOSE: Mondor's disease is a rare benign condition which involves thrombophlebitis of the superficial veins of the breast and anterior chest wall after breast surgery, breast tissue biopsy, inflammatory reaction, breast cancer, trauma. The affected veins include the lateral thoracic, axillary veins, thoracoepigastric veins and superior epigastric veins. METHODS: A 49-year-old woman presented to the outpatient department with complaints of the sudden appearance of a subcutaneous cord just under the skin at left lower lateral abdominal wall 1 month later of bilateral mastectomy due to both severe breast paraffinoma. The cord was initially red and tender and subsequently became a painless, tough, fibrous band that was accompanied by tension and skin retraction. RESULTS: On ultrasonographic findings, palpable threadlike structures at both lateral superficial abdominal wall after bilateral mastectomy were noted. Superficial short elongated hypoechoic tubular structures were noted just under the skin at palpable lower lateral abdominal wall. It was compatible to Mondor's disease of thoracoepigastric vein. CONCLUSION: The increase in breast surgery will give rise to the increase in the frequency of Mondor's disease clinically. Mondor's disease can be diagnosed with clinical symptoms and image findings and the disease has proved to be benign and self-limited.

Mondor's Disease after Bilateral Mastectomy in Both Breast Paraffinoma Patient

PURPOSE: Mondor's disease is a rare benign condition which involves thrombophlebitis of the superficial veins of the breast and anterior chest wall after breast surgery, breast tissue biopsy, inflammatory reaction, breast cancer, trauma. The affected veins include the lateral thoracic, axillary veins, thoracoepigastric veins and superior epigastric veins. METHODS: A 49-year-old woman presented to the outpatient department with complaints of the sudden appearance of a subcutaneous cord just under the skin at left lower lateral abdominal wall 1 month later of bilateral mastectomy due to both severe breast paraffinoma. The cord was initially red and tender and subsequently became a painless, tough, fibrous band that was accompanied by tension and skin retraction. RESULTS: On ultrasonographic findings, palpable threadlike structures at both lateral superficial abdominal wall after bilateral mastectomy were noted. Superficial short elongated hypoechoic tubular structures were noted just under the skin at palpable lower lateral abdominal wall. It was compatible to Mondor's disease of thoracoepigastric vein. CONCLUSION: The increase in breast surgery will give rise to the increase in the frequency of Mondor's disease clinically. Mondor's disease can be diagnosed with clinical symptoms and image findings and the disease has proved to be benign and self-limited.

Experience with use of Expanded Polytetrafluoroethylene(Gore-tex(R)) in Cosmetic Facial Surgery

To date, for facial soft tissue augmentation, numerous implant materials have been used, including autogenous, homogenous, and alloplastic grafts. Among these, the porous material, Gore-tex(R) has a pore (0.5-30 microns, average 22 microns) which allows sufficient but limited soft tissue ingrowth to anchor implants, but not so much to make removal difficult or destructive to adjacent structures. In addition, this material has some advantage: non-carcinogenic, non-allergic, less capsule formation and reduced chance of infection due to high vascularity. In the past years Gore-tex(R) has found multiple applications in facial plastic and reconstructive surgery. However this alloplastic material can be associated with potentially severe complications and side effects such as soft tissue reaction, infection, extrusion, exposure, etc. There have been also adverse criticism of Gore-tex(R) : relative difficulties in postoperative removal, in carving implant, higher infection and extrusion rates in scarred tissue and thicker implant as well as postoperative volume reduction. In order to analyze results depending on the implantation site, the presence of scar on recipient site, thickness and type of implant, a retrospective chart review of 56 patients(69 cases) was undertaken of all patients who underwent facial soft tissue augmentation with Gore-tex(R) graft from November 1998 to November 2001 in a wide variety of situations. All cases were categorized as either primary(normal recipient site) or secondary(scarred recipient site) cases and the thickness of each graft used in millimeters was recorded. Postoperative follow up revealed a stable implant material with no major complications relating to the graft material and no differences in developing complications according to the implantation site, the presence of scar, thickness and type of implant. All patients were highly satisfied with their results.

Treatment of Acute Sterno-Mediastinitis using Regional Muscle Flaps

Although the incidence of mediastinal wound infection after median sternotomy is relatively low, its associated devastating complications may be life-threatening. Treatment of sterno-mediastinal infection has evolved over the past several decades. Early treatment was wet soaking of debrided wound or irrigation through a closed indwelling catheter system and its mortality was quite high. Subsequent treatments focused on the debridement followed by muscle flaps such as pectoralis major and rectus abdominis muscle flap or by omental flap closure, which were considered as the ideal modalities for acute sterno-mediastinitis. Mortality rate was reduced significantly after application of this active treatment. However, to date, there has been no definite treatment strategy for sterno-mediastinitis and the choice of operations depends largely on the experience and personal preference of the surgeon. So we introduce our experience, including technique and outcome, with transposition of pectoralis major muscle and superiorly-based rectus abdominis muscle turn over flap for deep and extensive sterno-mediastinal wounds. Five patients(3 male and 2 female) had repair of an infected median sternotomy wound from July 2001 to september 2002. Complications after wound closure occured in 2 cases, 1 case of hematoma and 1 case of seroma, respectively. No other major complications have been noted. We treated MRSA or VRE- cultured acute sterno-mediastinitis successfully with early sternal wound debridement and immediate regional muscle flap coverage.