Nipple Reconstruction with a C-V Flap Overgrafted with AlloDerm®

BACKGROUND: Breast reconstruction involves several steps, culminating in the creation of the nipple-areolar complex. Numerous methods of nipple reconstruction have been attempted, and have all proven somewhat successful in providing tissue for projection. In this clinical study, we evaluated a new technique using an acellular dermal matrix (ADM; AlloDerm®) adjunct to a skin flap (C-V flap technique) in nipple reconstruction. METHODS: In 2016, 13 nipple reconstructions were performed using this technique. We designed the C-V flap in the proper position on the breast. After the skin flap was elevated, a 1.5 × 1.5-cm AlloDerm® section was grafted to the inner surface of the elevated C-V flap; the grafted area was then folded into a cylindrical shape. Nipple projection was measured with an electronic caliper at the time of surgery and at 3 weeks and 3 months postoperatively. RESULTS: Immediately postoperatively, nipple projection ranged from 5 to 11 mm (mean, 8.1 mm). The mean maintenance of nipple projection at 3 months postoperatively was 73.14% ± 16.39% (82% and 58% in the breast implant and autologous tissue flap groups, respectively), as compared with the immediate postoperative measurements. CONCLUSIONS: Our results demonstrated a good maintenance rate of ADM retention. Our method is easy to implement and focuses on the maximal retention of ADM to provide long-term projection of the reconstructed nipple.

Trichilemmal Carcinoma from Proliferating Trichilemmal Cyst on the Posterior Neck

Trichilemmal cysts are common fluid-filled growths that arise from the isthmus of the hair follicle. They can form rapidly multiplying trichilemmal tumors-, also called proliferating trichilemmal cysts, which are typically benign. Rarely, proliferating trichilemmal cysts can become cancerous. Here we report the case of a patient who experienced this series of changes. The 27-year-old male patient had been observed to have a 1×1 cm cyst 7 years ago. Eight months prior to presentation at our institution, incision and drainage was performed at his local clinic. However, the size of the mass had gradually increased. At our clinic, he presented with a 5×4 cm hard mass that had recurred on the posterior side of his neck. The tumor was removed without safety margin, and the skin defect was covered with a split-thickness skin graft. The pathologic diagnosis was a benign proliferating trichilemmal cyst. The mass recurred after 4months, at which point, a wide excision (1.3-cm safety margin) and split-thickness skin graft were performed. The biopsy revealed a trichilemmal carcinoma arising from a proliferating trichilemmal cyst. This clinical experience suggests that clinicians should consider the possibility of malignant changes when diagnosing and treating trichilemmal cysts.

Actinomycosis in a Mucosal Lesion on a Created Perioral Dimple: A Case Report

Facial dimple creation is a simple surgical procedure. Nonetheless, several complications can occur. Actinomycosis is a rare chronic granulomatous infection caused by Actinomyces species. Some conditions that can cause actinomycosis are trauma, oral surgery, and poor dental hygiene. We report a case of actinomycosis that developed on a created facial dimple. A 51-year-old woman presented with a palpable mass on her left cheek that was approximately 1 cm in size. She had undergone facial dimple-creating surgery on both perioral areas at a local clinic 12 years previously. She had not experienced any problems until she was diagnosed with rheumatoid arthritis and diabetes mellitus about 2 years previously, for which she took leflunomide and methotrexate. The mass was completely excised through an intraoral approach. The specimen was grossly described as a gray-yellow cystic mass containing non-absorbable suture material. The filamentous nature of the Actinomyces organisms was observed in dark-stained foci on a histologic examination, confirming the diagnosis of actinomycosis. Indwelling non-absorbable suture materials may increase the risk for opportunistic infections, such as actinomycosis, in immunocompromised patients. Therefore, plastic surgeons should be aware of a patient's general hygiene, immune condition, and medical history when using these materials.