Recurrent Chondroid Syringoma of the Alar Rim

Chondroid synringoma (CS), pleomorphic adenoma of skin, is a benign tumor found in the head and neck region. CS was first reported in 1859 by Billorth for the salivary gland tumor. The usual presentation is an slowly growing, asymptomatic mass. A 53-year-old female with a history of chondroid synringoma had presented with multiple firm, nodular masses found in the left nostril area. The lesion had been excised 8 years prior and was diagnosed histopathologically, but had gradually recurred. Excision of the mass located in subcutaneous layer revealed four whitish, firm tumors surrounded with capsular tissue. Neither recurrence nor complications occurred during the 18 months follow-up period. In the head and neck region, chondroid syringoma should always be considered in differential diagnosis of soft tissue masses despite its rare incidence. For that reason, excisional biopsy with clear margin is the optimal diagnostic as well as therapeutic choice. We report a case of recurred chondroid syringoma on the nose in female patient.

A Case of Isolated Collagenoma on the Finger

PURPOSE: Collagenoma is an intradermal harmatomatous collagen proliferation among connective tissue nevi of the skin. Although there are some reports of isolated collagenomas that occurred on the sole and the palm, collagenoms at the finger has not been reported in Korea. METHODS: An 11-year-old girl presented with a growing mass on the distal interphalangeal joint of the left 5th finger. It was a skin-colored, oval and mild tender mass. There were no associated cutaneous or systemic abnormal findings. RESULTS: The nodule, at the subcutaneous level on the distal phalanx, was completely removed by excision. Grossly it was covered with normal skin, and its surface was smooth having a definite margin with a size of 1.5x1.2cm. Histopathological examination, the epidermis showed to be normal, increased thickness of collagens arranged with a whirl formation was found in the dermis. No signs of cellular component increase were observed. CONCLUSION: Isolated collagenoma can be aroused as a solitary nodule in at any place of the body. We report a rare case of a female patient with an isolated finger collagenoma.

Treatment of Intraoperative Thrombosis and Spasm in Free Tissue Transfers Using the Fogarty Catheter

PURPOSE: Microvascular free tissue transfer has become a reliable technique for the reconstruction of complex wounds. Occasionally, unexpected intraoperative thrombosis and/or spasm of recipient artery might be annoying problems even for the technically competent microvascular surgeons. If such problems are not treated properly, they will inevitably cause to flap failure. METHODS: From January 2006 to February 2007, soft tissue reconstructions by free tissue transfers were performed on 21 patients having complex defects in the lower extremity. Although segmental revision and various pharmacologic agents were repeatedly applied, arterial occlusions were not managed in 6 cases. For removal of thrombi and release of spasm, Fogarty No. 2 or No. 3 catheters were inserted into the lumen to the proximal recipient artery. Its balloon was then inflated after passing through a resistant area. Next, the catheter was gently withdrawn backward. RESULTS: After the Fogarty catheter was inserted two or three times, the pulsatile arterial flow was restored. When the catheter was inserted into the lumen, a feeling of resistance existed in a 5-10cm more proximal portion that could not be easily accessed from the vascular end. After the reestablishment of blood flow, successful anastomoses were achieved and immediate rethrombosis or spasm did not occur. No long-term sequelae associated with balloon trauma to the arterial wall were observed. CONCLUSION: The use of the Fogarty catheter can be an effective method in treating pedicle thrombosis and spasm. This is a very simple and rapid technique that offers microvascular surgeons another option to increase the success rate of microvascular anastomosis in free tissue transfers.

Effects of Cross-Linking Agents on the Stability of Human Acellular Dermal Matrix

PURPOSE: Human acellular dermal matrix(ADM) is widely used in the treatment of congenital anomalies and soft tissue deficiencies. But it is rapidly degraded in the body and does not provide satisfactory results. There is a need to improve collagen fiber stability through various methods and ultimately regulate the speed of degradation. METHODS: The ADMs were added with various cross- linking agents called glutaraldehyde, dimethyl 3,3'-dithiobispropionimidate to produce cross-linked acellular dermal matrices. 1,4-butanediol diglycidyl ether solution was applied with a pH of 4.5 and 9.0, respectively. The stability of cross-linked dermal matrix was observed by measuring the shrinkage temperature and the degradation rates. The cross- and non-cross linked dermis were placed in the rat abdomen and obtained after 8, 12 and 16 weeks. RESULTS: The shrinkage temperature significantly increased and the degradation rate significantly decreased, compared to the control(p<0.05). All of cross- linked dermises were observed grossly in 16 weeks, but most of non-cross linked dermis were absorbed in 8 weeks. Histologically, the control group ADM was found to have been infiltrated with fibroblasts and most of dermal stroma were transformed into the host collagen fibers. However, infiltration of fibroblasts in the experiment was insignificant and the original collagen structure was intact. CONCLUSION: Collagen cross-linking increases the structural stability and decreases degradation of acellular dermis. Therefore, decrease in body absorption and increase in duration can be expected.

Comparison Study of Physical Properties between Two Silicone Gel Sheets

PURPOSE: Silicone gel sheet(SGS) is used for preventing and treating keloid or hypertrophic scars. Because the product is weak in tear strength and adherence, it requires several replacements, which requires high cost. As a solution for this problem, we developed a new silicone gel sheet, named as Scar Clinic, and confirmed its physical properties. METHODS: Tensile strength, elongation rate, adhesiveness, and water vapor transmission rate were experimentally compared between the most commonly used SGS product and the Scar Clinic. RESULTS: The newly developed SGS showed better results compared to the existed SGS in regards to tensile strength, elongation rate, adhesiveness, and water vapor transmission rate. CONCLUSION: The Scar Clinic showed higher durability and flexibility. It will be a useful product for treating scars clinically.