Peroneal Flap: Clinical Application and Cadaveric Study

BACKGROUND: The goal of this study was to investigate the anatomy of the peroneal artery and its perforators, and to report the clinical results of reconstruction with peroneal artery perforator flaps. METHODS: The authors dissected 4 cadaver legs and investigated the distribution, course, origin, number, type, and length of the perforators. Peroneal artery perforator flap surgery was performed on 29 patients. RESULTS: We identified 19 perforators in 4 legs. The mean number of perforators was 4.8 per leg, and the mean length was 4.8 cm. Five perforators were found proximally, 9 medially, and 5 distally. We found 12 true septocutaneous perforators and 7 musculocutaneous perforators. Four emerged from the posterior tibia artery, and 15 were from the peroneal artery. The peroneal artery perforator flap was used in 29 patients. Retrograde island peroneal flaps were used in 8 cases, anterograde island peroneal flaps in 5 cases, and free peroneal flaps in 16 cases. The mean age was 59.9 years, and the defect size ranged from 2.0 cm×4.5 cm to 8.0 cm×8.0 cm. All the flaps survived. Five flaps developed partial skin necrosis. In 2 cases, a split-thickness skin graft was performed, and the other 3 cases were treated without any additional procedures. CONCLUSIONS: The peroneal artery perforator flap is a good alternative for the reconstruction of soft tissue defects, with a constant and reliable vascular pedicle, thin and pliable skin, and the possibility of creating a composite tissue flap.

Treatment of Foreign Body Granuloma of the Hand Associated with Unregulated Material Injection for Aesthetic Purpose

Recently, rejuvenation of the aging hand has gained popularity. Various medical fillers have recently become popular, and patients have more options to rejuvenate their aging hands. However, in our country, unregulated material injections by unlicensed practitioners are still wide spread and its related complications have been considered as a serious problem. The aim of this retrospective study is to introduce our experiences regarding 17 cases of foreign body granuloma following hand rejuvenation using unregulated material. A retrospective review from December 2002 to October 2012 was performed. We analyzed data for 17 patients who underwent perilesional surgical excision for treatment of a foreign body granuloma of the hand associated with unregulated material injection by unlicensed practitioners. Injected materials include paraffin, silicone oil, and other unknown materials. Four patients were injected with paraffin, 3 patients with silicone oil, and remaining 10 patients with unknown materials. The main symptom was palpable mass and contour deformity. The patients were asked to rate their overall satisfaction following treatment. The average patient satisfaction score was 3.7. To prevent foreign body granuloma following unregulated medical practice, it is very important to inform the public about the disastrous consequence of unregulated material injections by unlicensed practitioners.

Dermatofibroma of the Lower Lip: A Case Report

PURPOSE: Dermatofibroma is a common benign dermal tumor characterized by a proliferation of fibroblast-like spindle cells. It is commonly localized on the skin of extremities and presents as a slow growing solitary nodule. To our knowledge, the occurrence of dermatofibroma in the oral cavity is rare. Herein, we report a rare case of dermatofibroma on the lower lip. METHODS: A 60-year-old woman presented with a slow growing mass that measured 1 x 0.8 cm in diameter on the lower lip. The mass was surgically excised with clear margins. RESULTS: Histologically, the mass was characterized by a nodular tumor composed of collagen bundles, fibroblasts, and histiocytes, which were findings consistent with dermatofibroma. The postoperative course was uneventful without any complications. CONCLUSION: When evaluating nodular tumors of the oral area, dermatofibroma should be considered in the differential diagnosis.

Dermatofibroma of the Lower Lip: A Case Report

PURPOSE: Dermatofibroma is a common benign dermal tumor characterized by a proliferation of fibroblast-like spindle cells. It is commonly localized on the skin of extremities and presents as a slow growing solitary nodule. To our knowledge, the occurrence of dermatofibroma in the oral cavity is rare. Herein, we report a rare case of dermatofibroma on the lower lip. METHODS: A 60-year-old woman presented with a slow growing mass that measured 1 x 0.8 cm in diameter on the lower lip. The mass was surgically excised with clear margins. RESULTS: Histologically, the mass was characterized by a nodular tumor composed of collagen bundles, fibroblasts, and histiocytes, which were findings consistent with dermatofibroma. The postoperative course was uneventful without any complications. CONCLUSION: When evaluating nodular tumors of the oral area, dermatofibroma should be considered in the differential diagnosis.

Staged Scar Revision of Angulated Facial Scar

Scar revision techniques are chief among the most important skills for facial plastic and reconstructive surgeons. In order to achieve the least amount of scarring following a surgical procedure, it is crucial that the surgeon always consider skin tension. In our hospital, staged scar revision was conducted on patients with angulated facial scars in order to reduce skin tension. We conducted a retrospective chart review of patients undergoing staged scar revision for angulated facial scars at our hospital from July 2002 to September 2010. The follow-up period was at least six months. All pre-and post-operative photographs were analyzed by two independent plastic surgeons. And the patients were asked to rate their overall satisfaction with their scar revision as very satisfied(5), satisfied(4), neutral(3), dissatisfied(2) or completely dissatisfied(1). Staged scar revision was used in 51 patients with angulated facial scars. Overall, a significantly improved scar and above(score > or =4), graded by an independent plastic surgerns, was notes in 47 patients(92.1%). And, 45 patients(88.2%) were satisfied with their scar revisions. In all cases, the postoperative clinical course was uneventful without any complications. In conclusion, staged scar revision is considered a good option for the treatment of angulated facial scar.

Cellular Blue Nevus of the Finger: A Case Report

We experienced an unusual case of the cellular nevus on the dorsal surface of the second metacarpophalangeal joint. We performed a local excision followed by immunohistochemical analysis. Cellular blue nevus should be considered in the differential diagnosis when a characteristic blue-black mass is found in the finger. Accurate diagnosis based on immunohistochemical analysis, appropriate surgical treatment and vigilant follow-up are mandatory to prevent any malignant transformation.

Absence of Linea Alba in Breast Reconstruction with Pedicled TRAM Flap: A Case Report

PURPOSE: The anatomical anomaly of the rectus abdominis muscle and it's fascia is very rare. No case of the absence of the linea alba below the umbilicus has yet been reported. During breast reconstruction with pedicled TRAM flap, we experienced one case of absence of linea alba. METHODS: The patient was a 38-years old female who underwent immediate breast reconstruction with pedicled TRAM flap after Right modified radical mastectomy in June 2010. While the TRAM flap was being elevated, bilateral twitching of the rectus abdominis muscle occurred when electrocautery was applied, and we found the absence of the linea alba below the umbilicus. RESULTS: When the rectus abdominis muscle was exposed, the linea alba below the umbilicus was not observed, and the bilateral rectus abdominis muscle was indistinguishably fused in a gross observation. In addition, bilateral twitching of rectus abdominis muscle was simultaneously observed as one muscle unit when electrocautery was applied. As with both rectus abdominis muscles was bluntly dissected with scissors, the scanty fatty tissues were observed between the both rectus muscles, and the bilateral rectus abdominis muscle was easily separated. The flap was transposed into the corresponding defect to make breast mound. Midline fascia was fixed to the posterior rectus sheath to reconstruct smilar anatomic linea alba. Abdominal defect was reinforced by suturing between remaining anterior rectus sheath. CONCLUSION: As the unexpected anatomical anomaly may affect the operation outcome, surgeons should be careful when they unexpectedly encounter the anatomical anomaly during an operation. Here, we report a rare case of absence of the linea alba seen at the time of pedicled TRAM flap elevation for breast reconstruction.