Scar revision in areas subjected to excessive tension using intraoperative and postoperative long-term tension reduction techniques

Background@#Surgical scars subjected to excessive tension tend to widen and become hypertrophic due to strong mechanical stretching forces. In this study, we evaluated the clinical outcomes of combined intraoperative and postoperative long-term tension reduction techniques for the revision of scars subjected to excessive tension. @*Methods@#In total, 64 cases (62 patients) underwent scar revision and were followed for 6 months or more. The long-term tension reduction technique included intraoperative subcutaneous fascial and deep dermal closure using nonabsorbable nylon sutures and postoperative long-term skin taping for 3 to 8 months. The final scars were objectively evaluated using our Linear Scar Evaluation Scale (LiSES, 0-10 scale), which consisted of five categories: width, height, color, texture, and overall appearance. @*Results@#All 64 cases healed successfully, without early postoperative complications such as infection or dehiscence. The follow-up period ranged from 6 months to 6 years. The LiSES scores ranged from 5 to 10 (mean: 8.2). Fifty-one cases (79.6%) received a score of 8 to 10, which was assessed as “very good” by the evaluator. Two cases with a score of 5 (3%) showed partial hypertrophic scars at the last follow-up visit. All patients were highly satisfied with their final outcomes, including the two patients who experienced partial hypertrophic scars. @*Conclusions@#A combination of intraoperative and postoperative long-term tension reduction techniques can achieve the goal of long-term dermal support and satisfactory aesthetic outcomes for scar revision in areas subjected to excessive tension.

Inferomedially impacted zygomatic fracture reduction by reverse vector using an intraoral approach with Kirschner wire

Background@#In inferomedially rotated zygomatic fractures sticking in the maxillary sinus, it is often difficult to achieve complete reduction only by conventional intraoral reduction. We present a new intraoral reduction technique using a Kirschner wire and its clinical outcome. @*Methods@#Among 39 inferomedially impacted zygomatic fractures incompletely reduced by a simple intraoral reduction trial with a bone elevator, a Kirschner wire (1.5 mm) was vertically inserted from the zygomatic body to the lateral orbital rim in 17 inferior-dominant rotation fractures and horizontally inserted to the zygomatic arch in nine medial-dominant and 13 bidirectional rotation fractures. A Kirschner wire was held with a wire holder and lifted in the superolateral or anterolateral direction for reduction. Following reduction of the zygomaticomaxillary fracture, internal fixation was performed. @*Results@#Fractures were completely reduced using only an intraoral approach with Kirschner wire reduction in 33 cases and through an additional lower lid or transconjunctival incision in six cases. There were no surgical complications except in one patient with undercorrection. Postoperative 6-month computed tomography scans showed complete bone union and excellent bone alignment. Four patients experienced difficulty with upper lip elevation; however, these problems spontaneously resolved after manual tissue lump massage and intralesional steroid (Triamcinolone) injection. @*Conclusions@#We completely reduced infraorbital rim fractures, zygomaticomaxillary buttresses, and zygomaticofrontal suture fractures in 84% of patients through an intraoral approach alone. Intraoral Kirschner wire reduction may be a useful option by which to obtain effective and powerful reduction motion of an inferomedially rotated zygomatic body.

Accessory auricle: Classification according to location, protrusion pattern and body shape

BACKGROUND: Accessory auricles (AAs) are common congenital anomalies. We present a new classification according to location and shape, and propose a system for coding the classifications. METHODS: This study was conducted by reviewing the records of 502 patients who underwent surgery for AA. AAs were classified into three anatomical types: intraauricular, preauricular, and buccal. Intraauricular AAs were divided into three subtypes: intracrural, intratragal, and intralobal. Preauricular AAs were divided into five subtypes: precrural, superior pretragal, middle pretragal, inferior pretragal, and prelobal. Buccal AAs were divided into two subtypes: anterior buccal and posterior buccal. AAs were also classified according to their protrusion pattern above the surrounding surface: pedunculated, sessile, areolar, remnant, and depressed.Pedunculated and sessile AAs were subclassified as spherical, ovoid, lobed, and nodular, according to their body shape. Cartilage root presence and family history of AA were reviewed. A coding system for these classifications was also proposed. RESULTS: The total number of AAs in the 502 patients was 1,003. Among the locations, the superior pretragal subtype (27.6%) was the most common. Among the protrusion patterns and shapes, pedunculated ovoid AAs were the most common in the preauricular (27.8%) and buccal areas (28.0%), and sessile lobed AAs were the most common in the intraauricular area (48.7%). The proportion of AAs with a cartilage root was 78.4%, and 11% of patients had a family history. The most common type of preauricular AA was the superior pretragal pedunculated ovoid AA (13.2%) with a cartilage root. CONCLUSIONS: This new system will serve as a guideline for classifying and coding AAs.

Treatment of intractable parotid sialocele occurred after open reduction-fixation of mandibular subcondylar fracture

A sialocele is a subcutaneous cavity containing saliva, most often caused by facial trauma or iatrogenic complications. In subcondylar fractures, most surgeons are conscious of facial nerve injury; however, they usually pay little attention to the parotid duct injury. We report the case of a 41-year-old man with a sialocele, approximately 5×3 cm in size, which developed 1 week after subcondylar fracture reduction. The sialocele became progressively enlarged despite conservative management. Computed tomography showed a thin-walled cyst between the body and tail of the parotid gland. Fluid leakage outside the cyst was noted where the skin was thin. Sialography showed a cutting edge of the inferior interlobular major duct before forming the common major duct that seemed to be injured during the subcondylar fracture reduction process. We decided on prompt surgical treatment, and the sialocele was completely excised. A duct from the parotid tail, secreting salivary secretion into the cyst, was ligated. Botulinum toxin was administrated to block the salivary secretion and preventing recurrence. Treatment was successful. In addition, we found that parotid major ducts are enveloped by the deep lobe and extensive dissection during the subcondylar fracture reduction may cause parotid major duct injury.

Treatment of Tongue Lymphangioma with Intralesional Combination Injection of Steroid, Bleomycin and Bevacizumab

Lymphangioma is a congenital malformed lymphatic tumor that rarely involves the tongue. In our clinic, a 10-year-old female presented with lymphangioma circumscriptum involving the right two-thirds of the tongue. We administered an intralesional combination injection of triamcinolone, bleomycin, and bevacizumab as a treatment. Almost complete remission after combination therapy was achieved without complications such as edema, swallowing difficulties or recurrence. Bevacizumab, an inhibitor of vascular endothelial growth factor, was effective for the treatment of lymphangioma of the tongue in this case. No recurrence was noted at the 1-year follow up.

A Modified Closed Cartilage-Preserving Otoplasty Technique for Prominent Ear Correction

BACKGROUND: In the surgical correction of prominent ear, a technique known as percutaneous adjustable closed otoplasty (PACO), which does not involve skin incision, undermining, or cartilage manipulation, has been developed to resolve problems including hematoma, infection, contour deformities, prolonged use of a compressive dressing, and hospitalization. We modified this procedure to make it more practical and accessible and to achieve better results. In this article, we introduce our modifications and demonstrate the clinical applicability of the modified procedure to patients with hardened auricular cartilage. METHODS: Two adult patients with prominent upper ears underwent closed otoplasty in an outpatient setting. Based on the anatomical features of the patients, three lines for traction sutures were designed on the scapha and counter scapha. Tab incisions were made at all predetermined puncture sites. Three antihelix-forming sutures (4-0 nylon) were put in place via percutaneous punctures. The sutures were performed from the counter scapha to the postauricular sulcus subcutaneously, using an 18-mm empty curved needle. The sutures were scraped over the mastoid bone such that they were anchored to the mastoid periosteum. After determining an adequate auriculocephalic distance, the sutures were tied at the postauricular sulcus. A slight overcorrection was made to compensate for post-surgical relapse. RESULTS: We observed no complications such as hematoma, infection, contour deformities, epithelial inclusion cyst formation, suture extrusion, or dimples on the scapha. At a long-term follow-up examination, the patients had well-defined antihelical folds and were satisfied with the aesthetic results of the procedure. CONCLUSIONS: We propose our technique as a reliable treatment option for the correction of prominent ear.

A Wrapping Method for Inserting Titanium Micro-Mesh Implants in the Reconstruction of Blowout Fractures

Titanium micro-mesh implants are widely used in orbital wall reconstructions because they have several advantageous characteristics. However, the rough and irregular marginal spurs of the cut edges of the titanium mesh sheet impede the efficacious and minimally traumatic insertion of the implant, because these spurs may catch or hook the orbital soft tissue, skin, or conjunctiva during the insertion procedure. In order to prevent this problem, we developed an easy method of inserting a titanium micro-mesh, in which it is wrapped with the aseptic transparent plastic film that is used to pack surgical instruments or is attached to one side of the inner suture package. Fifty-four patients underwent orbital wall reconstruction using a transconjunctival or transcutaneous approach. The wrapped implant was easily inserted without catching or injuring the orbital soft tissue, skin, or conjunctiva. In most cases, the implant was inserted in one attempt. Postoperative computed tomographic scans showed excellent placement of the titanium micro-mesh and adequate anatomic reconstruction of the orbital walls. This wrapping insertion method may be useful for making the insertion of titanium micro-mesh implants in the reconstruction of orbital wall fractures easier and less traumatic.

Manual Kirschner-Wire Insertion through the Soft Tissue for Finger Immobilization after Scar Contracture Release

PURPOSE: Finger immobilization by Kirschner-wire (K-wire) insertion may be used for postoperative stability after release of scar contracture. K-wire insertion through the phalangeal bone requires drilling and can result in joint and/or tendon injury or pain during wire removal. To prevent these problems, we inserted the K-wire through the soft tissue. METHODS: Seventy-five fingers of 45 patients who underwent reconstruction of scar contracture of the fingers were immobilized by K-wire. After contracture release, just before skin grafting and/or local flap surgery, in full extension of the finger, a K-wire was inserted manually from the fingertip to the proximal phalanx or metacarpal bone through the soft tissue under the phalangeal bone, along the longitudinal axis on the volar side. If the graft site did not have enough soft tissue or the K-wire was felt on the recipient bed, the K-wire was inserted on the dorsal side of the finger. K-wires were manually removed two weeks after surgery. RESULTS: In most cases, the time to insert the K-wire was 2-3 minutes per finger, and immobilization and stability was maintained for two weeks. In two fingers, the K-wire came out prematurely during wound care; this did not affect the overall outcome. There were no complications due to K-wire insertion or pain during removal. CONCLUSION: Finger immobilization by K-wire insertion through soft tissue is simple to perform, leads to stable immobilization, has no adding procedure. This method is useful for temporary finger immobilization in full extension.

Full-Thickness Skin Grafting with De-Epithelization of the Wound Margin for Finger Defects with Bone or Tendon Exposure

BACKGROUND: Full-thickness skin grafts (FTSGs) are generally considered unreliable for coverage of full-thickness finger defects with bone or tendon exposure, and there are few clinical reports of its use in this context. However, animal studies have shown that an FTSG can survive over an avascular area ranging up to 12 mm in diameter. In our experience, the width of the exposed bones or tendons in full-thickness finger defects is <7 mm. Therefore, we covered the bone- or tendon-exposed defects of 16 fingers of 10 patients with FTSGs. METHODS: The surgical objectives were healthy granulation tissue formation in the wound bed, marginal de-epithelization of the normal skin surrounding the defect, preservation of the subdermal plexus of the central graft, and partial excision of the dermis along the graft margin. The donor site was the mastoid for small defects and the groin for large defects. RESULTS: Most of the grafts (15 of 16 fingers) survived without significant surgical complications and achieved satisfactory functional and aesthetic results. Minor complications included partial graft loss in one patient, a minimal extension deformity in two patients, a depression deformity in one patient, and mild hyperpigmentation in four patients. CONCLUSIONS: We observed excellent graft survival with this method with no additional surgical injury of the normal finger, satisfactory functional and aesthetic outcomes, and no need for secondary debulking procedures. Potential disadvantages include an insufficient volume of soft tissue and graft hyperpigmentation. Therefore, FTSGs may be an option for treatment of full-thickness finger defects with bone or tendon exposure.

Treatment of Verruca Vulgaris in Both External Auditory Canals Using Bleomycin Injections

Verruca vulgaris is caused by human papillomavirus (HPV) infections. Verruca in the external auditory canal (EAC) has rarely been reported. A previous case report introduced surgical excision as a treatment for verruca in the EAC. We present a case of verruca vulgaris in both EACs that was successfully treated with an intralesional bleomycin injection. A 32-year-old male patient presented with ear fullness and palpable lumps in both EACs. Both of his canals were filled with multiple pinkish, papillomatous masses. Verruca vulgaris was confirmed by skin biopsy. An otolaryngologist referred this patient and recommended surgical excision. However, we performed intralesional bleomycin injections for treatment. Twice intralesional bleomycin injections at one-month intervals had excellent results without recurrence, ulceration or scar formation. This result indicates that bleomycin injections may prove to be an effective first-line treatment of verruca in the EAC.

Minimally Invasive Excision of Epidermal Cysts through a Small Hole Made by a CO2 Laser

To improve the cosmetic results of removing epidermal cysts, minimally invasive methods have been proposed. We proposed a new minimally invasive method that completely removes a cyst through a small hole made by a CO2 laser. Twenty-five patients with epidermal cysts, which were 0.5 to 1.5 cm in diameter, non-inflamed, and freely movable, were treated. All of the patients were satisfied with the cosmetic results. This method is simple and results in minimal scarring and low recurrence rates without complications.

Microplate Fixation without Maxillomandibular Fixation in Double Mandibular Fractures

BACKGROUND: Maxillomandibular fixation (MMF) is usually used to treat double mandibular fractures. However, advancements in reduction and fixation techniques may allow recovery of the premorbid dental arch and occlusion without the use of MMF. We investigated whether anatomical reduction and microplate fixation without MMF could provide secure immobilization and correct occlusion in double mandibular fractures. METHODS: Thirty-four patients with double mandibular fractures were treated with open reduction and internal fixation without MMF. Both fracture sites were surgically treated. For bony fixations, we used microplates with or without wire. After reduction, each fracture site was fixed at two or three points to maintain anatomical alignment of the mandible. Interdental wiring was used to reduce the fracture at the superior border and to enhance stability for 6 weeks. Mouth opening was permitted immediately. RESULTS: No major complications were observed, including infection, plate exposure, non-union, or significant malocclusion. Five patients experienced minor complications, among whom the only one patient experienced a persistant but mild malocclusion with no need for additional management. CONCLUSION: This study showed that double mandibular fractures correction with two- or three-point fixation without MMF simplified the surgical procedure, increased patient comfort, and reduced complications, due to good stability and excellent adaptation.

Microplate Fixation without Maxillomandibular Fixation in Double Mandibular Fractures

BACKGROUND: Maxillomandibular fixation (MMF) is usually used to treat double mandibular fractures. However, advancements in reduction and fixation techniques may allow recovery of the premorbid dental arch and occlusion without the use of MMF. We investigated whether anatomical reduction and microplate fixation without MMF could provide secure immobilization and correct occlusion in double mandibular fractures. METHODS: Thirty-four patients with double mandibular fractures were treated with open reduction and internal fixation without MMF. Both fracture sites were surgically treated. For bony fixations, we used microplates with or without wire. After reduction, each fracture site was fixed at two or three points to maintain anatomical alignment of the mandible. Interdental wiring was used to reduce the fracture at the superior border and to enhance stability for 6 weeks. Mouth opening was permitted immediately. RESULTS: No major complications were observed, including infection, plate exposure, non-union, or significant malocclusion. Five patients experienced minor complications, among whom the only one patient experienced a persistant but mild malocclusion with no need for additional management. CONCLUSION: This study showed that double mandibular fractures correction with two- or three-point fixation without MMF simplified the surgical procedure, increased patient comfort, and reduced complications, due to good stability and excellent adaptation.

Vascularized Bipedicled Pericranial Flaps for Reconstruction of Chronic Scalp Ulcer Occurring after Cranioplasty

BACKGROUND: Intractable chronic scalp ulcers with cranial bone exposure can occur along the incision after cranioplasty, posing challenges for clinicians. They occur as a result of severe scarring, poor blood circulation of the scalp, and focal osteomyelitis. We successfully repaired these scalp ulcers using a vascularized bipedicled pericranial flap after complete debridement. METHODS: Six patients who underwent cranioplasty had chronic ulcers where the cranial bone, with or without the metal plate, was exposed along the incision line. After completely excising the ulcer and the adjacent scar tissue, subgaleal dissection was performed. We removed the osteomyelitic calvarial bone, the exposed metal plate, and granulation tissue. A bipedicled pericranial flap was elevated to cover the defect between the bone graft or prosthesis and the normal cranial bone. It was transposed to the defect site and fixed using an absorbable suture. Scalp flaps were bilaterally advanced after relaxation incisions on the galea, and were closed without tension. RESULTS: All the surgical wounds were completely healed with an improved aesthetic outcome, and there were no notable complications during a mean follow-up period of seven months. CONCLUSIONS: A bipedicled pericranial flap is vascularized, prompting wound healing without donor site morbidity. This may be an effective modality for treating chronic scalp ulcer accompanied by the exposure of the cranial bone after cranioplasty.

Prognosis of Full-Thickness Skin Defects in Premature Infants

BACKGROUND: In the extremities of premature infants, the skin and subcutaneous tissue are very pliable due to immaturity and have a greater degree of skin laxity and mobility. Thus, we can expect wounds to heal rapidly by wound contraction. This study investigates wound healing of full-thickness defects in premature infant extremities. METHODS: The study consisted of 13 premature infants who had a total of 14 cases of full-thickness skin defects of the extremities due to extravasation after total parenteral nutrition. The wound was managed with intensive moist dressings with antibiotic and anti-inflammatory agents. After wound closure, moisturization and mild compression were performed. RESULTS: Most of the full-thickness defects in the premature infants were closed by wound contraction without granulation tissue formation on the wound bed. The defects resulted in 3 pinpoint scars, 9 linear scars, and 2 round hypertrophic scars. The wounds with less granulation tissue were healed by contraction and resulted in linear scars parallel to the relaxed skin tension line. The wounds with more granulation tissue resulted in round scars. There was mild contracture without functional abnormality in 3 cases with a defect over two thirds of the longitudinal length of the dorsum of the hand or foot. The patients' parents were satisfied with the outcomes in 12 of 14 cases. CONCLUSIONS: Full-thickness skin defects in premature infants typically heal by wound contraction with minimal granulation tissue and scar formation probably due to excellent skin mobility.

Treatment of Complete Scalp Avulsion with the Conditions of Unstable Vital Signs: A Case Report

PURPOSE: Scalp avulsion is a life-threatening injury that may cause trauma to the forehead, eyebrows, and periauricular tissue. It is difficult to treat scalp avulsion as it may lead to severe bleeding. Therefore, emergency scalp replantation surgery is necessary, and we must consider the function, aesthetics, and psychology of the patients. A case of scalp avulsion leading to massive bleeding was encountered by these authors, which led to a failure to achieve the proper operation conditions in an adequate time period. METHODS: A 49-year-old female was hospitalized due to having had her head caught in a rotatory machine, causing complete scalp avulsion which included the dorsum of the nose, both eyebrows, and ears. Emergent microsurgical replantation was performed, where a superficial temporal artery and a vein were anastomosed, but the patient's vital signs were too unstable for further operation due to excessive blood loss. Three days after the microanastomosis, venous congestion developed at the replanted scalp, and a medicinal leech was used. Leech therapy resolved the venous congestion. A demarcation then developed between the vitalized scalp tissue and the necrotized area. Debridement was performed 2 times on the necrotized scalp area. Finally, split-thickness skin graft with a dermal acellular matrix(Matriderm(R)) was performed on the defective areas, which included the left temporal area, the occipital area, and both eyebrows. RESULTS: The forehead, vertex, right temporal area, and half of the occipital area were successfully replanted, and the hair at the replanted scalp was preserved. As stated above, two-thirds of the scalp survived; the patient could cover the skin graft area with her hair, and could wear a wig. CONCLUSION: Complete scalp avulsion needs emergent replantation with microsurgical revascularization, but it often leads to serious vital conditions. We report a case with acceptable results, although the microanastomosed vessel was minimal due to the patient's unstable vital signs.

Giant Neurofibroma on Both Buttocks

PURPOSE: Neurofibromatosis(NF) is an autosomal- dominant systemic disease. Up to fifty percent of patients with NF are reported to have concomitant vascular abnormalities. In the resection of a larger NF, the risk of uncontrolled hemorrhage is much higher due to the difficulty of hemostasis of large vessels within the tumor. We ligated the base of the giant NF with a simple loop- shaped ligation before removal of the giant NF in both buttocks. And then we successfully reduced the amount of hemorrhage during the operation. METHODS: A 46-year-old female patient presented for giant masses of both gluteal area, which has been growing slowly for the last ten years. Each mass was about 30x20 cm in size. After designing the elliptical resection margin, we tightened the tumor base by using continuous loop- shaped suture ligation(weaving the thread up and down in a loop-shaped pattern, leaving a space of 2cm between each loop) with a straight needle and prolene 2-0. After skin incision, we proceeded the dissection toward the central and inferior side of the mass obliquely while we avoided breaking large vascular sinuses. We resected the tumor in a wedged-shape. Subcutaneous tissue was sutured layer by layer and skin was closed by vertical mattress and interrupted suture. The loop-shaped ligation of the base was removed and compressive dressing was done with gauzes and elastic bandages. RESULTS: Postoperative complications such as infection, hemorrhage, hematoma, and dehiscence did not occur. Perioperatively the patient was sufficiently transfused with five units of blood and two units of fresh frozen plasma. During the subsequent 1 year follow-up, the functional and cosmetic results were excellent. CONCLUSION: A continuous loop-shaped suture ligation procedure along the base of the giant NF effectively reduced the amount of hemorrhage during the operation, made dissection and ligation of vessels easily and quickly, and shorten the operating time and postoperative recovery time.

The Effect of Melatonin on the Random Flap Survival in the Rat

PURPOSE: In skin flap surgery, surgeons often encounter distal ischemia of the flap. If a powerful free radical scavenger is used, it may reduce the formation of free radical and improves the survival of flap. Thus, the present study purposed to examine whether the survival of flap can be enhanced by administering melatonin, which is known to be a powerful free radical scavenger a antioxidant molecule. METHODS: We divided 40 Sprague-Dawley rats into 4 groups, 10 in each group. For the control group(n=10), we intraperitoneally injected only carrier solution once 30 minutes before the operation, and once a day for 7 days from the day of operation. Among the experimental groups, a group(n=10) was administered with dimethyl sulfoxide(DMSO), in another group(n=10), melatonin was intraperitoneally injected, and in the other(n=10) melatonin was intraperitoneally injected and applied topically(2cc of 1% melatonin) to the operation site. Caudally based skin flaps measuring 3x10cm2 were elevated on the mid-dorsum of the rats. and then repositioned. On the seventh postoperative day, the survival area of the flap was measured and tissues were examined under the light microscope. RESULTS: The control group, the DMSO group, the melatonin administration group and the melatonin administration and application group showed the mean survival rates of 55.26+/-9.2%, 70.29+/-7.47%, 81.45+/-4.14% and 86.1+/-1.52%, respectively, for 30cm2 of flap. Compared to the control group, the experimental groups showed a significantly high increase in survival area at significance level of 95%. CONCLUSION: In this study, the survival rate of flap was enhanced through the administration of melatonin after flap surgery. This suggests that melatonin not only functions as a powerful free radical scavenger and oxygen radical scavenger but also stabilizes and protects cells, and by doing so, enhances the survival of moderately injured ischemic sites in the distal end of flap.

Reconstruction of Disarticulated Knee Stump by Using Distally Based Anterolateral Thigh Island Flap

PURPOSE: The basic vascular anatomy and versatility of the anterolateral thigh flap was reported firstly by Song in 1984 and then by Zhang who introduced the reverse flow pattern of this flap. In this case, the authors reviewed various articles and their experiences with the distally based anterolateral thigh flap and applied it for coverage of bone-exposed wound occurred at the distal of the disarticulated knee stump. We consequently reported the reliability and resourcefulness of this flap in the difficult and limited situation. METHODS: A 67-year-old-man who had suffered from arteriosclerotic obliterans inevitably underwent the disarticulation at knee joint due to clinical deterioration. He presented to our clinic with soft tissue necrosis and bone exposure at the stump. We debrided the wound and conducted the distally based anterolateral thigh island flap by transecting proximal portion of descending branch of the lateral circumflex femoral artery and the 14x10cm sized flap was transferred to cover the defect. The pedicle measured 14cm in length with pivot point 7cm above the patella. RESULTS: The postoperative course was mainly uneventful except early venous congestion for 4 days and subsequent partial skin loss. The wound was healed by secondary intension and no other sequelae had been observed during follow-up period of 12 months. CONCLUSION: Despite the presence of various reconstructive choices, the distally based anterolateral thigh island flap can be designed to repair soft tissue defects around the knee region, providing its reliable blood supply and long pedicle length, especially in the challenging cases.

Acquired Dermoid Cysts within Subcutaneous Scar Tissue

PURPOSE: Dermoid cysts are almost always caused by congenital events. The most widely accepted pathogenesis is that the cysts are dysembryogenetic lesions that arise from ectodermic elements entrapped during the midline fusion. We report a rare case of dermoid cyst, which occurred not congenitally but newly in the subcutaneous scar tissue secondary to trauma. METHODS: A 26-year-old man had a deep submental laceration caused by a car accident and got a primary wound closure 16 months ago. There were 18 cm-long submental hypertrophic scar and newly developed palpable masses inside the subcutaneous layer at the center of the scar. Initial impression was an epidermal cyst or a thyroglossal duct cyst. Ultrasonographic finding showed two cystic masses inside the scars at the submental area, but impressed dermoid cysts. The cystic masses were completely removed with W-plasty and histological examination were followed. RESULTS: The histological diagnosis was dermoid cysts which were mainly composed of keratotic squamous epithelium in their inner surface linings and numerous skin appendages such as sebaceous glands, sweat glands, and hair follicles in their cystic lumens histopathologically. During the follow-up period of 25 months, there was no recurrence of any subcutaneous mass in the site of scar. CONCLUSION: We report a very unusual case of dermoid cysts developed by an acquired cause, considering that the accidental inclusion of deep skin elements caused by a trauma can be a critical origin of dermoid cysts.