Reconstruction of Hand Using Peroneal Perforator Free Flap in High-Voltage Electrical Burn Patients

PURPOSE: The hand is frequently affected area in high voltage electrical burn injury as an input or output sites. Electrical burn affecting the hand may produce full thickness necrosis of the skin and damage deep structures beneath the eschar, affecting the tendon, nerve, vessel, even bone which result in serious dysfunction of the hand. As promising methods for the reconstruction of the hand defects in electrical burn patients, we have used the peroneal perforator free flaps. METHODS: From March 2005 to June 2006, we applied peroneal perforator free flap to five patients with high tension electrical burn in the hand. Vascular pedicle ranged from 4cm to 5cm and flap size was from 4x2.5cm to 7x4cm. Donor site was closed primarily. RESULTS: All flaps survived completely. There was no need to sacrifice any main artery in the lower leg, and there was minimal morbidity at donor site. During the follow-ups, we got satisfactory results both in hand function and in aesthetic aspects. CONCLUSION: The peroneal perforator flap is a very thin, pliable flap with minimal donor site morbidity and is suitable for the reconstruction of small and medium sized wound defect, especially hand with electrical burn injury.

Perforator-Based Fasciocutaneous Island Rotation Flap in Treatment of Pressure sore

The reconstruction of deep soft tissue defect such as pressure sore has difficult problems. Myocutaneous flaps have been used commonly as the best coverage method for pressure sore. But, they have several drawbacks such as sacrifice of functional muscle, high morbidity of the donor sites and bulkiness at the recipient site. The concepts of perforator flap has recently developed and widely used to overcome these disadvantages. Between March 2005 to July 2006, we have treated 9 patients who had pressure sore using perforator based fasciocutaneous island rotation flap. Preoperative unidirectional Doppler was used in all cases. Mean number of perforator vessels was 3.8 and flap sizes were from 7x5 cm to 14x13 cm. Rotation angles of flap were from 90 degree to 180 degree. In all cases, donor sites were closed primarily. All flap survived completely and postoperative complications were wound dehiscence in 1 case, wound infection in 3 cases. The mean postoperative follow up period was 15.7 months and recurrence was not reported. We could decrease donor site morbidity and cover wound sites easily by using flap rotation and get robust blood supply without sacrifice of functional muscle. Fasciocutaneous perforator island rotation flap would be very useful for various pressure sore treatment.

The Usability of Perforator-based Fasciocutaneous Flap for Trochanteric Pressure Sore

PURPOSE: Myocutaneous flap was widely used for trochanteric pressure sore but it had many drawbacks such as donor site morbidity, dog-ear deformity and functional muscle sacrifice. We have performed fasciocutaneous flap based on perforating vessels and succeeded in overcoming its drawbacks. METHODS: We experienced 11 cases of perforator-based fasciocutaneous flap for the coverage of trochanteric pressure sore in 9 patients, 2 cases of which were bilateral. The ambulatory status of patient group is as follows: 6 of them used a wheelchair, 2 of them are free walking, 1 of them use a wheelchair or crutches. Flap was supplied by cutaneous perforating vessel of descending branch of the lateral circumflex femoral artery and the third perforating artery of the deep femoral artery. The size of wounds were from 4x6.5cm to 10x13cm. RESULTS: We did not find any flap loss or congestion except 2 partial wound dehiscences and 1 wound infection. Donor site morbidity was not found. We observed no recurrence of the pressure sore during the 2.5 year follow-up period. CONCLUSION: We considered that perforator-based fasciocutaneous flap could overcome the traditional drawbacks of the conventional myocutaneous flap and its modified flap for trochanteric pressure sore. And this flap has many advantages for covering trochanteric pressure sore without any donor site deformity and morbidity, which would greatly improve the aesthetic result.

Primary Cutaneous Anaplastic Large Cell Lymphoma: A Case Report

PURPOSE: Anaplastic large cell lymphoma, has the following three characteristics of a malignant lymphoma; 1) An irregular large nucleus, called pathologic atypical cells, 2) Eosinophilic cytoplasm, 3) Immunologically positive for Ki-1. Anaplastic large cell lymphoma occurs mostly in the lymph nodes, but about 40% has been observed to occur in other tissues. Skin is the one of the main sources of origin and it is called 'primary cutaneous anaplastic large cell lymphoma'. METHODS: A 69-year-old male patient with an erythematous nodule, sized 1.5 X 1.7 cm on his right hand dorsum was excised under local anesthesia and on biopsy was diagnosed as 'Dermatofibrosarcoma Protuberans'. Three months after the local excision and biopsy, same natured mass reoccurred in the same region, and then spontaneous regressed after three weeks. However, metastatic large mass of 4.0 X 5.0 cm, of same nature was observed on the elbow. The large mass was operated with wide excision and biopsy. RESULTS: On final diagnosis, with an immunofluorescent stain with CD30(Ki-1), 'Primary cutaneous large cell lymphoma' was made. After follow up for three years, we did not observed recurrence and metastasis. CONCLUSION: We have reported that we have diagnosed primary cutaneous large cell lymphoma and treated without recurrence and metastasis.

Inverted Nipple Correction through Modified Broadbent-Woolf Method

Inverted nipple can be a cause of great distress, leading to potential breast feeding problems, and repeated irritation and inflammation. Many surgical and non-surgical procedures have been described for reshaping the nipple and areola so that it once again projects out from the breast. The aim of the study presented here is to show a reliable and effective method for treating inverted nipple particularly the more serious cases of Grade II and III as classified in the Han and Hong classification of nipple inversion. We added to vertical Z-plasty based on the Broadbent- Woolf method to the correction of inverted nipple This is a simple procedure with very few recurrence of inversion after treatment particularly for women no longer breast feeding. We saw good results with patients during the 6 to 18 months follow up period. 5 patients(9 inverted nipples) were treated. All patients had congenital nipple inversion. Each patient had no plans to breast feed in the future. There was no recurrence and sensory change, no postoperative hematoma or any seroma complications. All patients had good aesthetic results and their overall satisfaction was high. We considered that this method was effective and simple for correction of the inverted nipple.