Treatment of chest wall osteoradionecrosis with a contralateral breast Y-V flap: a case report

Chest wall osteoradionecrosis, one of the most serious complications of radiation therapy for breast cancer treatment, is usually treated by wide debridement followed by coverage with a well-vascularized flap. However, the extent of radiation-induced injury and limits in performing wide resection of the injured bones often present challenges in treatment. Herein, we present our experience treating chest wall osteoradionecrosis with a contralateral breast Y-V flap in an 81-year-old woman. She was diagnosed with chest wall osteoradionecrosis and had grade 3 ptotic breasts. Redundant contralateral breast tissue was used for reconstruction to cover the wound. The flap was elevated in the subfascial plane after an inverted-T incision was made in the lower pole and inframammary fold of the contralateral breast, while preserving the perforators of the left lateral thoracic artery. The flap was spread using the Y-V advancement fashion to cover the wound. The patient was discharged 2 weeks after surgery. At 19 months postoperation, there were no complications or recurrence. The patient was satisfied with the short recovery time and surgical results. The contralateral breast Y-V flap allows simple and quick reconstruction, potentially expanding the available treatment options and therefore increasing flexibility in choosing a treatment plan for patients.

Extensive calcific myonecrosis of the lower leg treated with free tissue transfer

Calcific myonecrosis is a rare condition in which hypoperfusion due to compartment syndrome causes soft tissue and muscle to become calcified. As calcific myonecrosis gradually deteriorates, secretions steadily accumulate inside the affected area, forming a cavity that is vulnerable to infection. Most such cases progress to chronic wounds that are unlikely to heal spontaneously. After removing the calcified tissue, the wound can be treated by primary closure, flap coverage, or a skin graft. In this case, a 72-year-old man had extensive calcific myonecrosis on his left lower leg, and experienced swelling and increasing tenderness. After removing the muscle calcification, we combined two anterolateral thigh free flaps, which were harvested from the patient’s right and left thigh, respectively, to reconstruct the wound with a dead-space filler and skin-defect cover at the same time. The patient recovered without revision surgery or major complications.

Extensive calcific myonecrosis of the lower leg treated with free tissue transfer

Calcific myonecrosis is a rare condition in which hypoperfusion due to compartment syndrome causes soft tissue and muscle to become calcified. As calcific myonecrosis gradually deteriorates, secretions steadily accumulate inside the affected area, forming a cavity that is vulnerable to infection. Most such cases progress to chronic wounds that are unlikely to heal spontaneously. After removing the calcified tissue, the wound can be treated by primary closure, flap coverage, or a skin graft. In this case, a 72-year-old man had extensive calcific myonecrosis on his left lower leg, and experienced swelling and increasing tenderness. After removing the muscle calcification, we combined two anterolateral thigh free flaps, which were harvested from the patient’s right and left thigh, respectively, to reconstruct the wound with a dead-space filler and skin-defect cover at the same time. The patient recovered without revision surgery or major complications.

Big Data Statistical Analysis of Facial Fractures in Korea

BACKGROUND@#The big data provided by Health Insurance Review and Assessment (HIRA) contains data from nearly all Korean populations enrolled in the National Health Insurance Service. We aimed to identify the incidence of facial fractures and its trends in Korea using this big data from HIRA.@*METHODS@#We used the Korean Standard Classification of Disease and Cause of Death 6, 7 for diagnosis codes. A total of 582,318 patients were included in the final analysis. All statistical analyses were performed using SAS software and SPSS software.@*RESULTS@#The incidence of facial fractures consistently declined, from 107,695 cases in 2011 to 87,306 cases in 2016. The incidence of facial fractures was the highest in June 2011 (n = 26,423) and lowest in January 2014 (n = 10,282). Nasal bone fractures were the most common, followed by orbit and frontal sinus fractures. The percentage of nasal bone fractures declined, whereas those of orbital fractures increased from 2011 to 2016 (P < 0.001). Among orbital fractures, inferior wall fractures were the most common, followed by medial wall fractures. Among mandibular fractures, angle fractures were the most common, followed by condylar process and symphysis fractures. Although it was difficult to predict the most common type of zygomatic and maxilla fractures, their incidence consistently declined since 2011.@*CONCLUSION@#We observed trends in facial fractures in Korea using big data including information for nearly all nations in Korea. Therefore, it is possible to predict the incidence of facial fractures. This study is meaningful in that it is the first study that investigated the incidence of facial fractures by specific type.

Big Data Statistical Analysis of Facial Fractures in Korea

BACKGROUND: The big data provided by Health Insurance Review and Assessment (HIRA) contains data from nearly all Korean populations enrolled in the National Health Insurance Service. We aimed to identify the incidence of facial fractures and its trends in Korea using this big data from HIRA.METHODS: We used the Korean Standard Classification of Disease and Cause of Death 6, 7 for diagnosis codes. A total of 582,318 patients were included in the final analysis. All statistical analyses were performed using SAS software and SPSS software.RESULTS: The incidence of facial fractures consistently declined, from 107,695 cases in 2011 to 87,306 cases in 2016. The incidence of facial fractures was the highest in June 2011 (n = 26,423) and lowest in January 2014 (n = 10,282). Nasal bone fractures were the most common, followed by orbit and frontal sinus fractures. The percentage of nasal bone fractures declined, whereas those of orbital fractures increased from 2011 to 2016 (P < 0.001). Among orbital fractures, inferior wall fractures were the most common, followed by medial wall fractures. Among mandibular fractures, angle fractures were the most common, followed by condylar process and symphysis fractures. Although it was difficult to predict the most common type of zygomatic and maxilla fractures, their incidence consistently declined since 2011.CONCLUSION: We observed trends in facial fractures in Korea using big data including information for nearly all nations in Korea. Therefore, it is possible to predict the incidence of facial fractures. This study is meaningful in that it is the first study that investigated the incidence of facial fractures by specific type.

Surgical treatment of lymphedema

Lymphedema is a debilitating and progressive condition, which results in the accumulation of lymphatic fluid within the interstitial compartments of tissues and hypertrophy of adipose tissue due to the impairment of lymphatic circulation. The mainstay of current lymphedema treatment is nonsurgical management such as complex decongestive therapy and compression therapy. Recently, surgical treatment of lymphedema based on microsurgery has been developed to enable the functional recovery of lymphatic drainage and has complemented nonsurgical treatment. Lymphaticovenular anastomosis and vascularized lymph node transfer are representative physiologic surgeries in the treatment of lymphedema. Lymphaticovenular anastomosis is conducted to drain lymphatic fluid from obstructed lymphatic vessels to the venous circulation through surgically created lymphaticovenous shunts. Vascularized lymph node transfer involves harvesting lymph nodes with their vascular supply and transferring this vascularized tissue to the lymphedema lesion as a free flap. In addition to physiologic surgeries, ablative surgeries such as direct excision and liposuction also can be performed, especially for end-stage cases. Indications for surgical treatment vary across institutions. It is important not to delay physiologic surgery in mild to moderate cases of lymphedema.

Histologic determination of apocrine gland depth in patients with axillary osmidrosis

Background@#Subdermal shaving is a surgical procedure for the treatment of axillary osmidrosis. In this procedure, a direct axillary incision is made, and the apocrine glands are removed. Insufficient subcutaneous tissue removal during subdermal shaving can lead to recurrence due to the presence of remaining apocrine glands, while excessive removal can injure the subdermal plexus and cause skin necrosis. We measured the depth of the apocrine glands from the basement membrane of the epidermis to develop a quantitative method of determining the thickness of the skin flap to be removed. @*Methods@#A chart review of patients who underwent subcutaneous shaving to treat osmidrosis between 2012 and 2019 was performed. Axillary subcutaneous tissues were harvested from five randomly chosen patients with osmidrosis before and after surgery. The apocrine gland depth was then measured via immunofluorescence (IF) staining of the collected tissues. A questionnaire was administered to 10 of the patients to investigate postoperative outcomes. @*Results@#Of the 47 total patients, six (12.8%) experienced recurrence, seven (14.9%) had complications, four (8.5%) had skin necrosis, two (4.3%) had hematomas, and one (2.1%) had an infection. One patient underwent reoperation due to hematoma. IF staining revealed the mean distance from the basal layer of the epidermis to the apocrine glands to be 1.4312±0.8064 mm. On the questionnaire, the mean patient rating of axillary odor was 8.6 pre-surgery and 4.4 post-surgery. @*Conclusions@#During subdermal shaving, the subcutaneous tissue must be preserved up to 14.312±8.064 mm from the epidermal basement membrane to remove the apocrine glands while preserving the subdermal plexus.

An innovative nipple reconstruction technique for minimizing postoperative scars: The teardrop flap

Nipple reconstruction methods include various techniques, such as the local flap technique, free nipple grafting, and filler injection. The local flap technique can provide less donor site morbidity than a free nipple graft, but leaves an additional scar near the nipple. We present a novel method for reconstruction of the nipple using a flap located on one side of the nipple. The flap has a teardrop shape consisting of a circle and two wings folded to one side. The two wings form a pillar and cap, and the de-epithelialized tip of one wing fills the internal dead space of the new nipple. We applied this nipple reconstruction technique in the case of a 61-year-old patient who had a vertical scar due to inverted-T reduction mammoplasty. The patient had lost her nipple in previous breastconserving surgery. The immediate postoperative nipple projection was 10 mm. At the 7-month follow-up visit, the nipple projection was 7.5 mm. The teardrop flap is an innovative technique that leaves no additional scar by using the scar already present on one side of the nipple.

Big Data Statistical Analysis of Facial Fractures in Korea

BACKGROUND@#The big data provided by Health Insurance Review and Assessment (HIRA) contains data from nearly all Korean populations enrolled in the National Health Insurance Service. We aimed to identify the incidence of facial fractures and its trends in Korea using this big data from HIRA.@*METHODS@#We used the Korean Standard Classification of Disease and Cause of Death 6, 7 for diagnosis codes. A total of 582,318 patients were included in the final analysis. All statistical analyses were performed using SAS software and SPSS software.@*RESULTS@#The incidence of facial fractures consistently declined, from 107,695 cases in 2011 to 87,306 cases in 2016. The incidence of facial fractures was the highest in June 2011 (n = 26,423) and lowest in January 2014 (n = 10,282). Nasal bone fractures were the most common, followed by orbit and frontal sinus fractures. The percentage of nasal bone fractures declined, whereas those of orbital fractures increased from 2011 to 2016 (P < 0.001). Among orbital fractures, inferior wall fractures were the most common, followed by medial wall fractures. Among mandibular fractures, angle fractures were the most common, followed by condylar process and symphysis fractures. Although it was difficult to predict the most common type of zygomatic and maxilla fractures, their incidence consistently declined since 2011.@*CONCLUSION@#We observed trends in facial fractures in Korea using big data including information for nearly all nations in Korea. Therefore, it is possible to predict the incidence of facial fractures. This study is meaningful in that it is the first study that investigated the incidence of facial fractures by specific type.

Quantitative assessment of nipple perfusion with laser-assisted indocyanine green imaging in nipple-sparing mastectomy with breast reconstruction

BACKGROUND: It remains unknown whether perfusion mapping using the SPY system can predict mastectomy skin flap necrosis in each type of breast surgery. We analyzed intraoperative indocyanine green (ICG) angiography images of breast cancer patients who underwent nipple-sparing mastectomy (NSM) with implant-based breast reconstruction, and evaluated the perfusion of the nipple-areolar complex (NAC) with the SPY Elite system to predict NAC necrosis with a single quantitative value. METHODS: We analyzed nipple perfusion in 30 patients from October 2016 to November 2018. After NSM, ICG injection and SPY angiography were performed to characterize NAC perfusion before immediate reconstruction. The nipple perfusion rate was measured by analyzing fluorescence at the central point of the nipple, and the presence of NAC necrosis was evaluated at 5 days and 1 month postoperatively. RESULTS: Three of the 30 patients developed NAC necrosis that secondarily healed within 1 month, and five developed NAC necrosis and underwent surgical debridement within 1 month. Seven of eight patients with a perfusion rate < 13% developed NAC necrosis, and all four patients with a perfusion rate < 10% needed partial surgical debridement or total NAC excision. CONCLUSIONS: The nipple perfusion rate could be useful for predicting NAC necrosis before immediate reconstruction. For patients at a high risk for NAC necrosis, tissue expander insertion rather than a direct-to-implant procedure may be considered, and close follow-up with thorough wound management should be done to reduce complications.

A Guide to Designing a Case Series in Plastic Surgery

The case series is a descriptive study that follows a group of patients who have a similar diagnosis or who are undergoing the same procedure and is the most prevalent type of research in the field of plastic surgery. Results of case series can generate hypotheses that are useful in designing further studies, including randomized controlled trials or a prospective cohort study. However, no causal inferences should be made from case series regarding the efficacy of the investigated treatment. The authors provide a guide to the design and report on the case series.

Differences in Blood Loss According to Hemostatic Method in the Excision of Giant Neurofibroma

No abstract available.

The Clinical Course of Reverse-flow Anterolateral Thigh Flap: Need to Prepare for Venous Congestion and Salvage Operation

No abstract available.

Clinical Durability and Deflation of Saline-Filled Breast Implant in Breast Reconstruction

PURPOSE: Despite wide clinical use of breast implants, there is continued concern about the lifespan of these devices. The causes of explantation were infection, deflation of implant and patient's want. The deflation of saline-filled breast implant was related to strength and durability of implant shell. The purpose of this study is to evaluate the clinical durability of saline-filled breast implant through the analysis of duration until deflation occurred, causes, incidence and influencing factors. METHODS: Retrospective analyses were conducted on clinical records for 19 cases of deflation of saline-filled breast implant from 201 cases of breast reconstruction with saline-filled implant between May 1995 and June 2011. The authors had been analyzed the causes of deflation, survival duration, symptom, sign, nipple excision, volume of implant, saline filling, method of reoperation, breast cancer stage and combined capsular contracture. RESULTS: The causes of deflation were attributed to the cases that cannot be evaluated the causes in 15 cases, fall down in 1 case, mammography in 2 cases, accidental needle injury in 1 case. Mean survival duration was 4 years and 5 months. The duration of survival was less than 1 year for 5 cases, 1 year to 10 years for 10 cases, more than 10 years for 4 cases. The volume between 201 and 250cc of deflated breast implant was rated as high by 14.0 percent. The deflation rate of underfilled implants was 11.4 percent, adequate filled implants was 9.3 percent. None of overfilled implant was deflated. The deflation of smooth surface implant was 5 of 152 cases. Textured implant was 14 of 49 cases. The capsular contracture of non-deflated breast implant was 28 of 182 cases and that of deflated breast implant was 6 of 19 cases. CONCLUSION: The patients who underwent saline-filled breast implant implantation should be informed that their implant could deflate. The analysis of clinical durability and causes of deflation in breast implant was important for the prediction and prevention of reopeation. The authors could suppose the causes of deflation of saline-filled breast implant through history, duration of survival, inspection of the shell of implant.

Facial bone fractures in the elderly: a recent five year retrospective analysis of 300 patients

Trauma in the elderly, such as facial bone fractures, has been increasing, but there is paucity of literature examining the facial bone fractures of the elderly. Therefore, this study contributes to the prevention of facial bone fractures in the elderly and presents support from the literature for establishing a support policy for the elderly. Retrospective analyses were conducted on clinical records from January 2006 through December 2010 for facial bone fractures in 474 cases; of those cases, 300 patients were 55 years old or above. The statistical analyses were conducted according to the sex, age group, occupation, area of residence, time of accident, cause of accident, site, and multiplicity of the fractures, associated injuries, combined soft tissue injuries, treatment methods, and sequelae. Two hundred twenty-five (75.0%) were male and seventy-five (25.0%) were female patients. Among the age groups, patients in the age range of 65 to 74 years old were the most common. There were 136 (45.3%) patients who were farmers and agricultural support personnel. Patients in urban areas were more commocn than those from rural areas. The number of the patients increased each year except in 2008. The most common cause of fractures was traffic accidents, followed by slip down. Zygomatic fractures were the highest among all fracture types, followed by nasal bone fractures. There were more cases undergoing conservative treatment compared to those in a study of all age groups. Gathering information on facial bone fractures in the elderly will be valuable in establishing preventive strategies and policies.