Does the dominant hand’s use affect the complication rates in prosthetic breast reconstruction?

Background@#Numerous studies have investigated risk factors for unfavorable outcomes in prosthetic breast reconstruction, such as obesity, perioperative radiotherapy, and acellular dermal matrix use. However, no reports have explored whether the use of the dominant hand influences complications in breast reconstruction. To address this gap in the literature, analyzed complication rates between the dominant and non-dominant sides after reconstruction. @*Methods@#We retrospectively reviewed the charts of 160 patients (170 breasts) who underwent breast reconstruction from February 2017 to March 2022. We analyzed the complications between beasts on the dominant and non-dominant sides according to the reconstruction method. @*Results@#During prosthetic breast reconstruction, the drainage volume and duration on the dominant side exceeded those on the non-dominant side after reconstruction (duration: 9.79 days on the dominant side vs. 9.12 days on the non-dominant side, P=0.196; volume: 771.1 mL on the dominant side vs. 654.3 mL on the non-dominant side, P=0.027). The incidence of complications such as wound dehiscence, mastectomy flap necrosis, and infection was significantly higher in the dominant hand group (infection: 6 vs. 0, P=0.014; dehiscence: 15 vs. 4, P=0.009; flap necrosis: 13 vs. 4, P=0.024). @*Conclusions@#Complications including seroma, infection, and mastectomy skin flap necrosis following prosthetic reconstruction were common in breasts on the dominant-hand side. Therefore, meticulous management and restriction of shoulder movement can aid in preventing seroma-related complications in prosthetic breast reconstruction, especially on the side of the dominant hand.

The effects of curcumin on the fibrous envelope surrounding silicone implants in rats

Background@#Capsular contracture is the most common serious breast surgery complication. The cause of capsular formation remains unknown, but chronic inflammation is commonly considered to cause excessive fibrosis. Curcumin has anti-inflammatory effects and thus can relieve the symptoms of inflammatory diseases, as demonstrated in animal studies. This study aimed to evaluate the effects of curcumin on the fibrous envelope covering silicone implants in a rat model. @*Methods@#Two solid 1.8-cm oval-shaped silicone implants were placed beneath both sides of the back in 20 Sprague-Dawley rats. The control group included 10 rats that were fed a normal diet (group A), while the experimental group (group B) included the remaining 10 rats that were fed ground curcumin. En bloc excision was conducted at 8 postoperative weeks. Capsular thickness and inflammatory cell distribution were examined using a fixed tissue sample. @*Results@#Gross findings and histologic differences between the groups were observed. The experimental group had a significantly lower mean total capsular thickness than the control group (177.4±31.4 μm vs. 145.9±32.5 μm, P=0.007). A significant decreasing tendency was found in several inflammatory cells in the experimental group (7,070±744.3/mm2 vs. 2,640±301.7/mm2, P=0.001). @*Conclusions@#Curcumin significantly reduced the inflammatory reaction, and will help to lower the risk of capsular contracture. Long-term studies are required to determine whether this hypothesis can provide a basis for a viable therapeutic strategy to reduce capsular contracture.

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.

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.

The Effects of Vascular Endothelial Growth Factor on Capsule Formation around Silicone Implant in Rats

BACKGROUND: The purpose of this study was to examine the effects of a single administration of vascular endothelial growth factor (VEGF) in promoting the angiogenesis and thereby reducing the formation of capsular contracture. METHODS: We treated 24 female Sprague-Dawley rats with (1) 5 mM Tris Buffer and 150 mM NaCl 0.1 cc, (2) VEGF 15 µg/0.1 cc, (3) VEGF 150 µg/0.1 cc during placement of the implant, or (4) VEGF 150 µg/0.1 cc and VEGF 300 µg/0.2 cc. We histopathologically measured the thickness of the capsule and the number of blood vessels. RESULTS: All experimental groups had a significant difference in the thickness of the capsule compared to the control group (P<0.001). There was no significant difference between experimental group 2 and experimental group 3. The number of blood vessels formed around the capsule was significantly greater in all the experimental groups compared with the control group (P<0.05). There was no significant difference between the experimental groups. There was a significant negative correlation between the thickness of the capsule and the number of blood vessels (Spearman's correlation coefficient, 0.2732; P<0.0001). CONCLUSIONS: A single administration of VEGF reduced formation of the capsule and increased the vascularity around the implant, supporting the hypothesis that prevention of tissue ischemia can be a treatment strategy for capsular contracture.

Traumatic Oculomotor Nerve Palsy

No abstract available.

Giant Eccrine Hidradenoma Mimicking a Malignant Tumor of the Salivary Gland

No abstract available.

Primary Intraosseous Hemangioma in the Frontal Bone

No abstract available.

Primary Intraosseous Hemangioma in the Frontal Bone

No abstract available.

Analysis of Stromal Vascular Fraction from Lipoaspirates: Our Institute's Experiences

Today, adipose tissue derived mesenchymal stem cells (ADSC) have gained a great interest in various medical fields due to the characteristics of its self-renewal and multilineage differentiation capacity. The stromal vascular fraction (SVF) of adipose tissue is known to contain mesenchymal stem cells and it is obtained by processing the lipoaspirate which is usually collected from tumescent liposuction. In this study, we reviewed the records of patient epidemiology and results of SVF isolation. 30 patients (8 males and 22 females) had been underwent tumescent liposuction between April 2012 and January 2013, and the collected lipoaspirates were processed to isolate SVF in GMP facility in CHA Bundang Medical Center. The average stem cell count per 1 cc of lipoaspirate was 52,252 +/- 26,704 and cell count including red blood cells per 1cc of lipoaspirate was 970,607 +/- 873,436. The stem cell viability was proven to be 84 +/- 4%. Bacteria were not detected in all the SVF samples. Compared to previous reports concerning the yield of SVF, our results coincide well with the results of previous studies. Because there were no domestic report about the yield and viability of SVF, this report may provide a reference value of the Korean SVF for the clinicians who want to use SVF as a therapeutic purpose.

Epicanthoplasty Using Y-M Plasty

Lots of Koreans have relatively thick skin, small palpebral fissures and unfolded eyelids with a prominent epicanthal fold. Various methods have been developed to correct epicanthal fold. However, excessive or hypertrophic scar can be occurred, especially in the medial canthal and nasal area. And the recurrence may restrict the application of these methods. We developed a new epicanthoplasty using Y-M plasty to correct the epicanthal folds without obvious scar. From February 1999 to August 2010, all patients underwent Y-M plasty for the correction of epicanthal folds. Y-shaped incision line was designed not extending to the nasal area and the orbicularis oculi muscles were resected with skin. The dog ear deformities were corrected and sutured using nylon 7-0. The epicanthal folds were completely corrected. Prominent scar and recurrence were not observed. Most of the patients are satisfied with the results. Mean preoperative ICD(intercanthal distance) was 38.84 mm and average 2.24 mm ICD was reduced after the operation. Epicanthoplasty using Y-M plasty is relatively safe, easy and rapid method to design and apply even in the beginners with low risk of scars and recurrences. So, the authors propose this new versatile technique in the case of minimal to moderate epicanthal folds.

A Case of Right Side Ischemic Colitis Associated with Herbal Medication for Weight Reduction in a Young Woman

Ischemic colitis has a relatively high prevalence in the elderly population with underlying vascular disorders such as hypertension and usually occurs on the left side of the colon. However, ischemic colitis also rarely occurs in healthy young adults with no risk factors. Herbal medication use is increasing, particularly for weight loss. Ischemic colitis associated with herbal medication use has been rarely reported. Here, we describe a case of right-sided ischemic colitis in a young woman that was potentially linked to the use of herbal medication. An 18-year-old woman was admitted to our emergency department with abdominal pain and bloody diarrhea for 1 day. Her medical history was unremarkable for bowel ischemia risk factors. However, she had taken herbal medication for weight loss for the past 2 weeks. Abdominopelvic CT showed diffuse wall thickening with decreased mucosal enhancement from the ascending to the transverse colon. A colonoscopic biopsy specimen showed coagulative necrosis of the mucosa, hemorrhage, and inflammatory cell infiltration. The abdominopelvic CT, colonoscopy, and biopsy findings were compatible with ischemic colitis. Her abdominal pain and bloody diarrhea improved completely with conservative management, and she was advised to discontinue the use of herbal medications.

Flank Reconstruction of Large Soft Tissue Defect with Reverse Pedicled Latissimus Dorsi Myocutaneous Flap: A Case Report

PURPOSE: Coverage of full-thickness large flank defect is a challenging procedure for plastic surgeons. Some authors have reported external oblique turnover muscle flap with skin grafting, inferiorly based rectus abdominis musculocutaneous flap, and two independent pedicled perforator flaps for flank reconstruction. But these flaps can cover only certain portions of the flank and may not be helpful for larger or more lateral defects. We report a case of large flank defect after resection of extraskeletal Ewing's sarcoma which is successfully reconstructed with reverse latissimus dorsi myocutaneous flap. METHODS: A 24-year-old male patient had 13.0x7.0x14.0cm sized Ewing's sarcoma on his right flank area. Department of chest surgery and general surgery operation team resected the mass with 5.0cm safety margin. Tenth, eleventh and twelfth ribs, latissimus dorsi muscle, internal and external oblique muscles and peritoneum were partially resected. The peritoneal defect was repaired with double layer of Prolene mesh by general surgeons. 24x25cm sized soft tissue defect was noted and the authors designed reverse latissimus dorsi myocutaneous flap with 2110cm sized skin island on right back area. To achieve sufficient arc of rotation, the cephalic border of the origin of latissimus dorsi muscle was divided, and during this procedure, ninth intercostal vessels were also divided. The thoracodorsal vessels were ligated for 15 minutes before divided to validate sufficient vascular supply of the flap by intercostal arteries. RESULTS: Mild congestion was found on distal portion of the skin island on the next day of operation but improved in two days with conservative management. Stitches were removed in postoperative 3 weeks. The flap was totally viable. CONCLUSION: The authors reconstructed large soft tissue defect on right flank area successfully with reverse latissimus dorsi myocutaneous flap even though ninth intercostal vessel that partially nourishes the flap was divided. The reverse latissimus dorsi myocutaneous flap can be used for coverage of large soft tissue defects on flank area as well as lower back area.

The Shape and the Location of Forehead Hairline of Korean Males in Their 20s & 30s

PURPOSE: It is generally believed that alopecia is caused by various factors such as scars, stress, genetical factors, androgens, etc. Androgenic alopecia is one of the most common cause of alopecia and found mainly in males. Propecia(Merck & Co., USA) and Minoxidil(McNEIL-PPC, Inc, USA) were the drugs approved from FDA for treatment of androgenic alopecia. Surgical treatments such as flap, tissue expansion, scalp reduction and hair transplantation can be considered if necessary. Hair micrograft techniques were developed for natural hair shapes and minimal adverse effect. There were attempts to measure the length of the forehead of the Korean young adults. However attempts to classify the shape and location of forehead hairline were rare. This study attempted to find out standard hairlines of young adults in their 20s & 30s and the result would be the guideline of the hairline in hair replacement surgery of male patients in their 40s & 50s. METHODS: 200 male adults in 20s and 30s were photographed and measured the length of 11 vertical index lines to determine hairline. The indexes are the distances from hairline to intercanthal midpoint(A), to medial canthus (B), to upper eyelid fissure(C), to lower eyelid fissure(D), to lateral canthus(E) and distance from lateral highest point to medial lowest point, if the hairline is M-shape(F). Additionally, we classified the hairlines into 4 groups, M, horizontal, inverted U and irregular shapes. RESULTS: The most common hairline of male adults in their 20s is inverted U-shape(53.3%), followed by horizontal-shape, M-shape, irregular-shape. In their 30s, inverted U-shape(59%) is followed by irregular-shape, M-shape, horizontal-shape. The M-shape is more frequently found in males in 30s than those in 20s. The mean values of the indexes in their 20s are as follows: A(76.14mm), B(Rt: 75.78mm, Lt:76.41mm), C(Rt: 69.43mm, Lt: 69.92mm), D(Rt: 76.92mm, Lt:77.46mm), E(Rt: 64.16mm, Lt: 64.73 mm), F(4.09mm). Those in their 30s are as follows: A(76.13mm), B(Rt: 76.114mm, Lt: 76.02mm), C(Rt: 69.87 mm, Lt: 70.37mm), D(Rt: 77.37 mm, Lt: 77.58mm), E(Rt: 69.63mm, Lt: 69.85mm), F(6.14 mm). CONCLUSION: The knowledge about human body measurement is indispensable to plastic surgeons. In this study, inverted U shape is the most common type of hairline in 30s, and similar distribution is found in 20s. The percentage of M shape in their 30s is elevated more than 10% compared to that in their 20s. The study of hairline shapes and 11 indexes of hairlines can be useful for planning of the hair transplantation and postoperative evaluation. This study being based on photogrammetry, there may be differences between actual distance of curved face and projected distance on flat photographs.

Experience of Reconstruction of an Extensive Chest Wall Defect with Extended External Oblique Musculocutaneous Flap

PURPOSE: The resection of locally advanced or recurred breast cancers frequently result in large chest wall defects and it leads to a great challenges to cover. Generally simple skin grafts are not a practical option for patients because of their poor cosmetic appearance and prognosis. The latissimus dorsi and rectus abdominis musculocutaneous flap have traditionally been recommended for closure of these large defects. Though the cosmetic result of reconstruction using these flaps is often excellent, but has significant drawbacks. Therefore, we thought that chest wall reconstruction using the external oblique musculocutaneous flap can be an alternative method for extensive chest wall defect related to large, locally advanced breast carcinoma. METHODS & RESULTS: We present a case of a 50-year-old Korean female, refered to our department with a left breast tumor for 10 months. CT demonstrate a large tumor on the left anterior chest wall and multiple nodules of varying size in the cervical areas and liver. FDG-PET showed areas of hot uptake throughout the left chest wall, mediastinum and liver. Biopsy was consistent with invasive ductal carcinoma (Grade III). The initial tumor was considered inoperable, so a series of chemotherapy was initiated. Though the size of the breast mass was slightly decreased, the patient continued to suffer from purulent discharge, unpleasant odor and contact bleeding of the mass, the salvage mastectomy was performed. CONCLUSION: We could reconstruct 23x16cm sized large chest wall defect, resulting from the resection of a locally advanced breast carcinoma, using an external oblique musculocutaneous flap successfully. Immediate postoperatively checked flap was healthy. Overall result was good without any significant complications and discharged 3 weeks after operation.

A Case Report of Treatment of Heterotrophic Calcification in Pseudohypoparathyroidism

PURPOSE: Pseudohypoparathyroidism is a hereditary disorder characterized by symptoms and signs of hypoparathyroidism, typically in association with distinctive skeletal and developmental defects. Hypoparathyroidism is caused by a insufficient end-organ response to PTH (parathyroid hormone). Hypoparathyroidism consists of four types in which the most common form, pseudohypoparathyroidism-Ia, accompany with Albright's hereditary osteodystrophy. We experienced a case of a woman who had been suffering from calcified mass on left foot, diagnosed Albright's hereditary osteodystrophy. METHODS: We present a case of a 24-year-old Korean female who visited plastic surgery department with a painful mass on dorsum of the left foot. On the physical exam, bony hard and painful mass, fixed to dermis, was noted. Plain X-ray films demonstrate suspicious calcification on subcutaneous tissue of dorsum of the left foot. The patient was diagnosed pseudohypoparathyroidism 2 years ago at the plastic surgery department. At the visiting time, the laboratory results were within normal range even though the patient actually had a disease. The reason is because the patient has been treated with Vit.D, calcium replacement therapy and thyroid hormone therapy. Moreover, the patient has been treated with anticonvulsant agents due to epilepsy. On the brain computer tomography (CT), calcification was noted on the basal ganglia and dentate nucleus. So we decided the total excision of entire mass from the left foot. RESULTS: We excised main mass with numerous pinhead sized masses which were scattered around the main mass. The 6.0x4.0x0.5 cm sized main mass was bony hard, and its surface was flat and margin was irregular. The permanent biopsy was confirmed that the main mass and all the scattered tiny masses were heterotopic calcification. The patient did not suffer from the pain after the mass excision. The wound has been healed without any problem. CONCLUSIONS: Heterotrophic calcification is often accompanied with pseudohypoparathyroidism, but such a huge one is uncommon. We report a case of pseudohypoparathyroidism with heterotrophic calcification developed in dorsum of left foot who was diagnosed by excisional biopsy.

Magnetic Resonance Guided Focused Ultrasound Induced Dermal Burn, Case Report

PURPOSE: Authors experienced a case of burn induced by magnetic resonance guided focused ultrasound (MRgFUS) which is performed for treatment of uterine myoma. The patient presented unusual progress from that of usual burns and did not cured by conservative treatment. At last the patient underwent surgical treatment. Authors report this rare case of burn induced by focused ultrasound. METHODS: A 26-year-old woman visited the department of gynecology with a abdominal mass. A 9.0x7.9x8.4 cm sized uterine myoma was found after evaluation. The patient was treated with MRgFUS after hormone therapy. Burn was noted on her lower abdomen immediately after MRgFUS and the patient was send to our department. Authors found 3.7x3.3 cm sized superficial second degree burn on her lower abdomen. The wound was treated with conservative methods but the depth extended to subcutaneous layer. 35 days after burn, debridement and primary repair was performed. RESULTS: The wound was healed clearly without any complication. There was no specific complaints or long-term complications during 6 months of follow-up. CONCLUSION: MRgFUS is known as a safe and reliable method for treatment of soft tissue tumors. Ultrasound is concentrated at inner body and generates high thermal energy. It might induce burn. The burn induced by ultrasound seems to have different progress and traits from usual burn wound. It is hard to make a precise diagnosis with external wound only.

The Treatment of Gynecomastia using XPS(R) Microresector (Shaver)

PURPOSE: Gynecomastia is an abnormal increase in the volume of the male breast. Subcutaneous mastectomy was the first surgical treatment for gynecomastia. But because of the complications such as nerve injury and scar formation, subcutaneous mastectomy has been substituted with liposuction. Recently various techniques including ultrasound-assisted liposuction has been used for treatment of gynecomastia. The purpose of this study is to evaluate the results of XPS(R) microresector (Shaver) for treatment of gynecomastia. METHODS: 17 patients, 33 breasts of gynecomastia, Simon grade I or II have been treated with XPS(R) microresector (Shaver). The mean age was 24.5. The subcutaneous tissue and glandular tissue were removed with XPS(R) microresector (Shaver). The operation time, the weight of removed tissue and patients' satisfaction score were accessed. RESULTS: The mean operation time was 78.2 minutes. The mean weight of removed tissue was 113.8 g. There were no significant complications such as necrosis, hematoma, infection or scar contracture. Patients' satisfactory score of scar, shape and confidence were 8.4, 8.2 and 8.4 respectively. As the average score was 8.3, most of the patients were satisfied with their breasts. CONCLUSION: The authors have treated 17 patients suffering from gynecomastia with XPS(R) microresector (Shaver). We obtained short operation time, early recovery, minimal operative scar and less complications with XPS(R) microresector (Shaver) for the treatment of gynecomastia, and patients were satisfied with the results of our method. We concluded that XPS(R) microresector (Shaver) is an alternative option for the treatment of gynecomastia.

Nipple Reconstruction using the C-V Flap Technique after Breast Reconstruction with the Only Breast Expander

PURPOSE: Breast cancer is second most common cancer in women. Most of the patients with breast cancer treated with mastectomy take breast reconstruction. Nipple reconstruction is an important step in breast reconstruction. Many surgeons have investigated of nipple reconstruction using the flap technique after breast reconstruction with the autologous tissue. The objective of this study is to evaluate the results of nipple reconstruction using the C-V flap technique after breast reconstruction only with the breast expander. METHODS: From April 2006 to May 2008, the authors treated 17 patients of nipple reconstruction using C-V flap technique, who received breast reconstruction only with the breast expander. As we have predicted decrease in the size of reconstructed nipple, we designed flap a little larger than wanted nipple size. Nipple splint was applied for 4-6 months for minimizing decrease of the size of reconstructed nipple. The diameter and height of the reconstructed nipple were measured and patient's satisfaction score was assessed. RESULTS: Mean follow-up duration was 12.5 months. Among the 17 patients, the average absorption rate by height of nipple was 47.0%. Partial necrosis was noted in 1 case, and treated well with conservative management. There were no other significant complications noted. Patient's satisfactory score was assessed by the height, design and location of the nipple. The average of satisfaction score was 85%, 68%, 62% and total average was 83%. CONCLUSION: The authors experienced 17 patients of nipple reconstruction using the C-V flap technique after breast reconstruction only with the breast expander. The absorption rate of the size of the nipple, complications and patient's satisfactory score of this study were similar to those of nipple reconstruction after breast reconstruction with the autologous tissue. It is expected that nipple reconstruction after breast reconstruction only with the breast expander is safe and reliable. It is considered that a long-term study is necessary.

XPS(R) Microresector for Treatment of Axillary

PURPOSE: Surgical excision of the subcutaneous tissues, with or without skin excision in the axillary hair-bearing area, has been the treatment of choice in treating osmidrosis for several decades. However, long periods of postoperative immobilization of a shoulder joint, partial necrosis of skin flaps or the possibility of hematoma and scars have occurred frequently. So we used XPS(R) microresector(Shaver) in procedure which requires removal of soft tissue for comparing results between surgical excision and the laters. METHODS: From January 2007 to February 2008, a total of 20 patients(8 male and 12 female) underwent XPS(R) microresector(Shaver) assisted aspiration for treating osmidrosis. The mean age of the subjects was 21.9, and we tried to analyze some advantages of XPS(R) microresector(Shaver). RESULTS: The average operation time was 61.6 minutes. This results can show that the patients who received XPS(R) microresector(Shaver) assisted aspiration can accomplish better outcomes than any other procedures in terms of operation time at least. Moreover, no significant postoperative complications occurred in our studies. Subjects have been followed up from 2 months to 1 year and among these patients, no one suffered from critical complications. CONCLUSION: In brief, XPS(R) microresector(Shaver) is able to shorten the time of operation and simplify the procedures relatively and this device has more superiorities in wound healing by maintaining of vascularized dermal skin flaps. It means that XPS(R) microresector (Shaver) can prevent flap necrosis, axillary hair loss and minimalize scarring and bleeding. Thus, we expect that these advantages can lead to better patient's comfort and self-confidence than several previous procedures.