Extralesional cryotherapy combined with intralesional triamcinolone injections after keloid excision

Background@#Keloid treatment is challenging because of the high likelihood of recurrence and a lack of definitive treatment combinations. The treatment of bulky and recurrent keloids is particularly difficult. We investigated the administration of extralesional cryotherapy (EL) in conjunction with intralesional (IL) triamcinolone (TA) injections as adjuvant therapy after surgical excision for the management of keloids. @*Methods@#Among all patients who visited our scar laser center between January 2016 and August 2017, 54 patients who underwent IL keloid excision with EL cryotherapy and IL TA injection as adjuvant therapy were included in this retrospective study. We examined sex, site, the number of cryotherapy sessions and TA injections, symptoms after surgery, and recurrence. The Vancouver Scar Scale (VSS) was used as to quantify treatment outcomes. @*Results@#Among 54 cases of IL keloid excision, after an average of 6.26 cryotherapy sessions and IL TA injections as combined adjuvant treatment, the lesion was controlled without recurrence in 49 cases. Relapse occurred in five patients, requiring additional treatment and reoperation. For 49 patients with photographic data, the average VSS score before and after treatment improved from 10.1 to 5.0. In 17 patients in whom symptoms recurred after surgery, all symptoms were controlled and maintained with adjuvant therapy. @*Conclusions@#Initial direct surgical excision, followed by a combination of EL cryotherapy and IL TA injections, was shown to be effective in challenging cases of large and recurring keloids.

Correction of a brow ridge deformity in a comminuted depressed skull fracture using a multiple-layered pericranial flap: the Persian carpet method

Frontal sinus fractures are common traumatic injuries of the head and neck, accounting for 8% of facial fractures. When a severe frontal sinus fracture and a naso-ethmoid-orbital fracture occur together, a postoperative contour deformity is highly likely. A pericranial flap is a reliable and versatile tool for craniofacial reconstruction. The authors fabricated an anteriorly-based pericranial flap in multiple layers to camouflage the fracture site and augment the brow ridge for volumization. Open reduction and pericranial flap coverage using this method (dubbed the “Persian carpet” method) were successfully performed in a 26-year-old male patient with a comminuted frontal bone fracture and a naso-ethmoid-orbital fracture.

The perforator-centralizing technique for super-thin anterolateral thigh perforator flaps: Minimizing the partial necrosis rate

Background@#Despite the wide demand for thin flaps for various types of extremity reconstruction, the thin elevation technique for anterolateral thigh (ALT) flaps is not very popular because of its technical difficulty and safety concerns. This study proposes a novel perforatorcentralizing technique for super-thin ALT flaps and analyzes its effects in comparison with a skewed-perforator group. @*Methods@#From June 2018 to January 2020, 41 patients who required coverage of various types of defects with a single perforator-based super-thin ALT free flap were enrolled. The incidence of partial necrosis and proportion of the necrotic area were analyzed on postoperative day 20 according to the location of superficial penetrating perforators along the flap. The centralized-perforator group was defined as having a perforator anchored to the middle third of the x- and y-axes of the flap, while the skewed-perforator group was defined as having a perforator anchored outside of the middle third of the x- and y-axes of the flap. @*Results@#No statistically significant difference in flap thickness and dimension was found between the two groups. The arterial and venous anastomosis patterns of patients in both groups were not significantly different. Only the mean partial necrotic area showed a statistically significant difference between the two groups (centralized-perforator group, 3.4%±2.2%; skewed-perforator group, 15.8%±8.6%; P=0.022). @*Conclusions@#The present study demonstrated that super-thin ALT perforator flaps can be elevated safely, with minimal partial necrosis, using the perforator-centralizing technique.

Penicillamine-induced virginal mammary hypertrophy

Virginal mammary hypertrophy (VMH), also known as juvenile mammary hypertrophy, is characterized by excessive enlargement of the breasts. Especially in adolescent patients, this condition can cause a negative body image to develop and result in significant psychological stress. Furthermore, social problems can arise from difficulties in finding appropriately-fitting attire and having trouble exercising. Although the mechanism of VMH has not been fully elucidated, several associated drugs have been identified. In this report, we present a 15-year-old female patient with Wilson disease who developed macromastia after administration of penicillamine for 8 months. Despite cessation of penicillamine for 3 months, the condition remained stable; thus, reduction mammoplasty was performed. After surgery, the patient was able to return to activities of daily living. Although rare, physicians should be aware of the fact that penicillamine can cause VHM. Therefore, patients with Wilson disease should be checked regularly for changes in breast volume in order to minimize possible complications.

A solution for revision rhinoplasty with thinned nasal tip skin: An extended dermofat graft

The emphasis on tip plasty in Asian rhinoplasty has led to heightened concerns about complications regarding nasal tip skin. Although uncommon, these complications can cause tremendous frustration to surgeons when encountered. Conventional methods such as skin graft or healing by secondary intention cause an unpleasant scar. Instead, an extended dermofat graft in revision rhinoplasty enables both replacement of the dorsal implant and adequate coverage of the nasal tip without modifying the previous tip plasty. A patient who experienced nasal tip skin thinning after augmentation rhinoplasty was treated successfully with an extended dermofat graft. The authors believe that this is a solid method for managing patients with nasal tip skin complications.

Correction of a brow ridge deformity in a comminuted depressed skull fracture using a multiple-layered pericranial flap: the Persian carpet method

Frontal sinus fractures are common traumatic injuries of the head and neck, accounting for 8% of facial fractures. When a severe frontal sinus fracture and a naso-ethmoid-orbital fracture occur together, a postoperative contour deformity is highly likely. A pericranial flap is a reliable and versatile tool for craniofacial reconstruction. The authors fabricated an anteriorly-based pericranial flap in multiple layers to camouflage the fracture site and augment the brow ridge for volumization. Open reduction and pericranial flap coverage using this method (dubbed the “Persian carpet” method) were successfully performed in a 26-year-old male patient with a comminuted frontal bone fracture and a naso-ethmoid-orbital fracture.

Feasibility of a de-epithelialized orbicularis oculi musculocutaneous flap for subbrow blepharoplasty

BACKGROUND: Subbrow blepharoplasty (SBB) has advantages over traditional blepharoplasty in that it results in more natural-looking creases and contours and is more effective for lateral periorbital rejuvenation. However, in older patients with sunken upper eyelid, this procedure might make the superior eyelid sulcus appear worse because the thicker upper eyelid tissue in the subbrow area is replaced by thinner tissue. To overcome this limitation, we developed a de-epithelialized musculocutaneous flap for SBB. METHODS: From August 2016 to January 2018, 13 patients with sunken upper eyelid deformity underwent SBB. For each of these patients, a typical SBB incision was made, but the tissue usually removed in SBB was dissected as a flap based on the branch of the ophthalmic vessel. After elevation, the flap was transposed or folded to correct the sunken deformity. The results were assessed by the patients themselves and by three plastic surgeons at 6 months postoperatively. RESULTS: The mean age of the patients was 63 years (range, 47–81 years). There were no postoperative complications related to wound dehiscence, hypertrophic scarring, or sensory changes. All patients and plastic surgeons provided scores indicating good to excellent results and were satisfied with the cosmetic outcomes. All patients reported improved functional visual acuity after surgery. CONCLUSIONS: Our technique is simple and effectively addresses both sunken upper eyelid deformity and dermatochalasis. Unlike fat or dermofat grafting, our new technique does not require an additional donor site, and it is more reliable in terms of vascularity.

Massive Hemopneumothorax during Breast Augmentation

Although it is very rare, hemopneumothorax can occur during breast augmentation. This potentially fatal surgical complication can be experienced by any plastic surgeon who performs breast augmentation surgery. In this article, we present a case from our institution and review the related literature in order to explore the etiological mechanism of hemopneumothorax, as well as preventive measures and treatments. In addition, we have tried to emphasize the importance of a thorough knowledge of anatomical variations and proper surgical techniques as ways to minimize the likelihood of this complication.