Optimal Initial Dose of Chloral Hydrate in Management of Pediatric Facial Laceration

BACKGROUND: Chloral hydrate (CH) is the primary agent most commonly used for pediatric sedation prior to diagnostic, therapeutic procedures. In the management of pediatric facial laceration, the initial dose of CH has to balance the need for adequate sedation against the need to minimize sedative complications. METHODS: A retrospective review of medical records of 834 children who visited our emergency room for facial lacerations from August 2010 to September 2012 was conducted. They were divided into six groups on the basis of the initial dose of CH administered. Further, each group was compared with the standard group (70 to < or =80 mg/kg) with respect to sedation success, augmentation dose, failed sedation, time to procedure, and time of stay. RESULTS: With respect to the complication rate, only group 1 (range, 40 to < or =50 mg/kg) showed a significantly lower complication rate. In the case of all the other variables considered, there were no significant differences among any of the groups. CONCLUSIONS: An initial CH dose of 48+/-2 mg/kg does not negatively affect the success rate of sedation or the need for additional sedative during the primary closure of facial lacerations in pediatric patients. Further, lower doses reduce the incidences of adverse effects and do not delay procedure readiness. Therefore, 48+/-2 mg/kg of CH can be considered the optimal initial dose for pediatric sedation.

Usefulness of V-Y Advancement Flap for Defects after Skin Tumor Excision

BACKGROUND: After skin tumor excision on the face, extremities, or trunk, the choice of treatment for a skin defect is highly variable. Many surgeons prefer to use a local flap rather than a skin graft or free flap for small- or moderately-sized circular defects. We have used unilateral or bilateral V-Y advancement flaps, especially on the face. Here we evaluated the functional and aesthetic results of this technique. METHODS: All of the patients were pathologically diagnosed with squamous cell carcinoma (SCC), basal cell carcinoma (BCC), or malignant melanoma or premalignant lesion (Bowen's disease). Thirty-two patients underwent V-Y advancement flap repair (11 unilateral and 21 bilateral) from January 2007 to June 2011. We analyzed the patients' age and satisfaction, and location and size of defect. The patients were followed up for 6 months or more. RESULTS: There were 22 women and 10 men. The ages ranged from 47 to 93 years with a mean age of 66 years. The causes were SCC in 15 cases, BCC in 13 cases, malignant melanoma in 1 case, Bowen's disease in 2 cases, and another cause in 1 case. The tumor locations were the face in 28 patients, and the scalp, upper limb, and flank each in one patient. All of the flaps survived and the aesthetic results were good. Postoperative recovery was usually rapid, and no complication or tumor recurrence was observed. CONCLUSIONS: The V-Y advancement flap is often used not only for facial circular defects but also for defects of the trunk and extremities. Its advantages are less scarring and superior aesthetic results as compared with other local flap methods, because of less scarification of adjacent tissue and because it is an easy surgical technique.

Breast Reconstruction Make Use of Contralateral Breast Tissue after Mastectomy

PURPOSE: Unilateral breast reconstruction after mastectomy confront the challenges of recreating a natural appearing breast mound and achieving symmetricalness of the breasts. If the patient's remaining breast is large compared to reconstructed breast, the most common procedure is reduction mammoplasty of the large breast side. The authors experienced a new method of breast reconstruction using the excess breast tissue from the contralateral breast after breast reduction. METHODS: The excess tissue from the contralateral breast after vertical reduction mammoplasty with superior pedicle and remaining lower breast tissue were transferred to the mastectomy site breast through the subcutaneous tunnel on the chest wall. The main blood supplies of the flap are perforator branches of the 4th, 5th and 6th anterior intercostal artery. After elevating and detaching the flap on the lower lateral area of the breast, the turned over flap is fixed on the upper portion of the chest wall of the mastectomy site. RESULTS: On two cases of the breast reconstructions, remaining excess breast tissue from reduction mammoplasty was transferred to the contralateral breast side as pedicles. Both patient and operator were satisfied with the outcome of the reconstruction as the breasts were symmetrical and in natural shape. CONCLUSION: We have performed unilateral breast reconstruction using the excess breast tissue after reduction mammoplasty of the contralateral breast. As Oriental women's breasts are relatively smaller than those of Caucasian women, delayed breast reconstruction cases of Oriental women with large breasts(macromastia) seem to be ideal for this procedure.

A Case Report of Lymphangioma Circumscriptum on Scalp

PURPOSE: Lymphangioma circumscriptum is a rare, congenital benign hamartous malformation, caused by the saccular dilatation of lymph channels lines by normal, single cell, lymphatic endothelia that present as local eruptions of persistent, grouped, translucent vesicles. The lymphangioma circumscriptum lesions may occur on axillary fold shoulder, neck proximal limbs and buccal mucosa. We reported a rare case of lymphangioma circumscriptum on the scalp. METHODS: A 15-year-old girl with a 5x3cm sized lymphangioma circumscriptum on scalp was examined. It was defined a boundry by ultrasound. And then, a tissue crescent type expander with 120cc normal saline was inserted on occipital area for a month. After confirmed safety margin of the excised lymphangioma circumscriptum on frozen biopsy and the scalp flap was elevated and covered with empty space. RESULTS: A histopathologic finding revealed that lymphangioma circumscriptum. During 11 months follow up, no relapse was found. CONCLUSION: We described a rare case of lymphangioma circumscriptum on scalp. By using a tissue expander and excision, we achieved no recurrence and aesthetically satisfactory outcome.