Pedicled perforator flap of stellate design.

The perforator flap has proven to be effective as both a free flap and a pedicled flap in the reconstruction of a variety of regions. Usually, a V-Y advancement pattern or simple ellipse is the design selected for pedicled perforator island flaps. On the other hand, the transposition of multiple perforator flaps or skin grafting on the donor sites is required for larger defects. The authors used a stellate design to elevate a perforator flap with large dimensions, whilst allowing the easier closure of the donor defect. This method was used for reconstructing the sacral (six cases), trochanteric (one case), and lower leg (three cases) regions. Although minor wound dehiscence at the donor sites was encountered in three cases, all the defects were reconstructed successfully using a single perforator flap. This design would be a valuable option for planning a pedicled perforator flap, particularly when a difficult donor closure is expected.

Cavernous vascular tumor of the accessory parotid gland.

Accessory parotid gland tumors are uncommon and account for only 1% to 7.7% of all parotid gland tumors. Only one case report of hemangioma of the accessory parotid gland in infancy has been issued, and no report is available on this condition in an adult. We present the case of a 44-year-old woman with an accessory parotid gland tumor, which was finally diagnosed as a cavernous hemangioma histopathologically.

Reconstruction of postburn neck contractures using free thin thoracodorsal artery perforator flaps with cervicoplasty.

BACKGROUND: Severe postburn neck contractures are devastating functional and cosmetic deformities. The ideal material for coverage of defects created by neck contracture release is thin, supple, large, well-vascularized, healthy tissue. The thoracodorsal artery perforator flap, a workhorse flap for reconstruction, allows a large dimension and free thickness control with low donor-site morbidity. The value of a free thin thoracodorsal artery perforator flap for anterior neck burn deformities has not been evaluated in a substantial series. METHODS: Four men and eight women underwent neck reconstruction from December of 2002 to August of 2004. Mean patient age was 34.3 years (range, 21 to 47 years). Thorough burn scar contracture releases were performed and cervicoplasty was added for optimal neck appearance. Uniformly thin thoracodorsal artery perforator flaps were made. Both lateral ends of these flaps were designed with a fishtail shape for sufficient release and to minimize linear scar band formation in the most lateral region of the neck. RESULTS: Elevated flaps as large as 24 x 12 cm and with a mean thickness 5.3 mm were used. All flaps survived without significant complications. Range of neck motion increased, and the cervicomandibular angle was sharpened in all patients. A highly natural neck contour was universally obtained without a secondary debulking procedure. CONCLUSIONS: The free thin thoracodorsal artery perforator flap with cervicoplasty provides good functional and aesthetic results in terms of neck contour and cervicomental angle, with a reduced necessity for secondary procedures and low donor-site morbidity. This method is highly valuable for reconstruction of severe postburn neck contractures.

Radiofrequency volume reduction of gastrocnemius muscle hypertrophy for cosmetic purposes.

Muscularly prominent calves, caused mainly by hypertrophy of the gastrocnemius muscle (GCM), are prevalent among Asian women, and this condition can be a significant factor leading to psychological stress. The authors have devised a method for contouring the calf using radiofrequency (RF) applications to the GCMs to correct thick, muscular legs. This study was performed to investigate the effects of RF energy in reducing enlarged GCMs for 250 patients (249 women and 1 man) who sought aesthetic consultation for problems such as thick, muscular, asymmetric, or bowed calves. The operations were performed from June 2004 to April 2006. The patients first received a local anesthetic and sedation. After application of RF current, the prominent muscular contours improved, and the GCMs were contoured to an appropriate proportional volume. The range of the reductions in the calf circumferences at their thickest levels was 1 to 6 cm (mean, 2.5 cm) during the follow-up visits 6 months after the procedures. Most of the patients could return to their activities of daily living, except for exercise, after 1 to 7 days, and they were satisfied with the improved aesthetic contour lines of their lower legs. Clinical photography and ultrasonic examination were performed, and the leg circumferences were measured. Radiofrequency-induced coagulation tissue necrosis of the muscles caused no functional disabilities, and the clinical improvement was well maintained after the treatments for up to 17 months of follow-up evaluation.

Radiofrequency volumetric reduction for masseteric hypertrophy.

Masseteric hypertrophy occurs frequently among Asians, including Koreans, because of racial characteristics and dietary habits. It is thought to be an unpleasant feature, especially because of its strong and masculine impression. Recently, the authors developed a method for the volumetric reduction of hypertrophied masseter muscles using radiofrequency energy to correct the squared facial appearance caused by the hypertrophy. This study was performed to investigate the effects of radiofrequency applied to reduce hypertrophied masseter muscles of patients who sought an aesthetic alternative for a slim, smooth, and feminine-looking lower facial contour. A total of 340 patients were treated. The patients usually recognized the volume change 3 to 6 weeks after treatment, and an objective volume reduction was observed within 3 months of the operation. The range of the reduction in the masseter thickness, as measured by ultrasonic examination at a 6-month postoperative follow-up visit, was 10% to 60% (mean, 27%). Most of the patients could eat a nearly normal diet after 4 weeks and were satisfied with the improved aesthetic contour lines of their lower face. Radiofrequency-induced coagulation tissue necrosis of the masseter did not cause any infections or limitations of mouth opening, and the clinical improvement was well maintained after the treatment.

Excision of forehead osteomas: experience with 12 patients with use of an endoscopic technique.

Endoscopic excision of benign forehead masses has been previously reported on. A variety of pathology occurs on the forehead, and small-sized frontal bone osteoma is definitely a candidate for endoscopic surgery. The purpose of this study is to present our clinical experience with 12 consecutive forehead osteomas that were excised with the aid of an endoscope. With refinements in technique, the area of subperiosteal dissection was kept to a minimum; superficial ostectomy followed by smoothening of the frontal bone surface was efficiently performed. The patients' ages ranged from 20 to 67 years, and the diameter of the lesions varied from 0.8 to 2.2 (mean 1.1) cm. The mean operative time was 15 minutes, and there was no complication that required any other treatment. All the patients were satisfied with the final result. The authors have found that excision of forehead osteoma using an endoscope coupled with proper instruments to be very safe and effective with minimal morbidity.

A novel reconstruction of 2 distinct defects: concomitant use of a thoracodorsal artery perforator flap and its corresponding muscle flap.

A perforator flap completely spares the underlying muscle, so the muscle tissue can now be used as a second flap for the reconstruction of another defect after the harvest of the overlying perforator flap as long as sufficient nutritive branches to the muscle remain. The authors describe here the creation of 2 independent free flaps from a single donor site, the latissimus dorsi musculocutaneous unit. The 2 flaps, thoracodorsal artery perforator and its corresponding muscle flap, were created and transferred to 2 distinct defects. Using this technique, we could avoid creation of double donor sites and so minimize the donor morbidity to that associated with the traditional single musculocutaneous flap. This technique was employed by us for treating 2 patients who presented with 2 separate defects.