Abdominal displacement of breast filler after previous trans-umbilical breast augmentation (TUBA): a case report.

Background: Breast augmentation is one of the most commonly performed aesthetic procedures in the world. Aquafilling filler, since its introduction in 2005 has been used for breast or buttock augmentation in several countries. Aquafilling filler is composed of 2% polyacrylamide with 98% sodium chloride 0.9% solution, and is known to have a similar composition with polyacrylamide hydrogel (PAAG) filler, which is also related to a variety of complications. Although many studies have warned against the complications of aquafilling filler, it is still being used for aesthetic purposes. Case Description: In this case report, we share our experience of a 36-year-old female patient complaining of smaller left breast and bulging mass in her left upper abdomen. She had a history of transumbilical breast augmentation (TUBA) 11 years prior, which she had had removed via the transumbilical incision 6 years ago. To compensate for the removal of implants, the patient had received large volumes of aquafilling filler injection 2 years after implant removal. Surprisingly, we found out that the filler in the left breast had displaced to the abdominal area. Conclusions: Accidently displacement may occur, especially in patients who have had previous procedures breaching the inframammary fold including TUBA. Therefore, it is required to observe carefully for those patients who have received breast augmentation or the breast filler injections.

Closed extensor tendon rupture caused by Kienböck disease: a case report.

Kienböck disease, a rare disease that can cause chronic pain and motor dysfunction, occurs due to avascular necrosis of the lunate bone, which leads to dislocation of the carpal bone. Among various other etiologies, Kienböck disease can cause closed tendon rupture of the finger. In this report, we introduce a case of total rupture of the second extensor digitorum communis and the extensor indicis proprius tendons caused by undiagnosed Kienböck disease in an elderly female patient.

Nasal Reconstruction Using a Customized Three-Dimensional-Printed Stent for Congenital Arhinia: Three-Year Follow-up.

A male Mongolian child with a complete congenital absence of both nose and nasal passage had a poor survival prognosis due to respiratory distress. To enable his survival, a new nose capable of conferring respiratory function was constructed. Following reconstructive surgery, an absence of mucoepithelium in the nasal passage can lead to rhinostenosis. To avoid this complication, a custom-made nasal silicone stent was created using three-dimensional (3D) printing technology in conjunction with the patient's computed tomography data. The stent was implanted for 2 months to maintain the shape and size of the nasal passage. At 2 months after stent implantation, the mucoepithelium tissue in the passage had successfully regenerated with no immune reaction. Three years after stent removal, respiratory function, nasal passage structure, and external nose shape were maintained without additional medical care. These results indicate the successful nasal reconstruction in an arhinia patient using a customized, 3D-printed nasal stent. Laryngoscope, 129:582-585, 2019.

A prospective randomised comparison of fixation methods in Tamai's zone I amputation.

BACKGROUND: The treatment of choice for fingertip amputation is replantation to restore function and aesthetics. The purpose of this study was to compare the success rates and salvage periods between patients with Tamai's zone I amputation injuries treated with bony fixation and suture fixation. METHODS: Fifty-five patients with Tamai's zone I amputations with bony involvement were included in this study. The patients were allocated randomly to two groups treated by bony fixation with Kirschner (K-)wire and suture fixation, respectively. In the bony fixation group (n = 21), the distal phalangeal bone was fixed with K-wire; in the suture fixation group (n = 34), the amputated portion was fixed with sutures alone. The success rate was defined as the percentage of fully viable replanted cases, and the salvage period was defined as extending from the first postoperative day to the cessation of salvation. RESULTS: The success rates for the bony and suture fixation groups were 90.0% and 91.1%, respectively, with no significant difference. The average salvage period was longer in the bony fixation group than in the suture fixation group (8.7 ± 1.25 vs. 6.4 ± 0.98 days; P = 0.01). No case of non-union of the distal phalangeal bone, limitation of motion, or disfigurement was observed in either group. CONCLUSION: The average salvage period was significantly longer for the bony fixation group, but the success rates did not differ between groups. We suggest that bony fixation is not mandatory in the treatment of Tamai's zone I amputation.

The Role of Resorbable Plate and Artificial Bone Substitute in Reconstruction of Large Orbital Floor Defect.

It is essential to reduce and reconstruct bony defects adequately in large orbital floor fracture and defect. Among many reconstructive methods, alloplastic materials have attracted attention because of their safety and ease of use. We have used resorbable plates combined with artificial bone substitutes in large orbital floor defect reconstructions and have evaluated their long-term reliability compared with porous polyethylene plate. A total of 147 patients with traumatic orbital floor fracture were included in the study. Surgical results were evaluated by clinical evaluations, exophthalmometry, and computed tomography at least 12 months postoperatively. Both orbital floor height discrepancy and orbital volume change were calculated and compared with preoperative CT findings. The average volume discrepancy and vertical height discrepancies were not different between two groups. Also, exophthalmometric measurements were not significantly different between the two groups. No significant postoperative complication including permanent diplopia, proptosis, and enophthalmos was noted. Use of a resorbable plate with an artificial bone substitute to repair orbital floor defects larger than 2.5 cm(2) in size yielded long-lasting, effective reconstruction without significant complications. We therefore propose our approach as an effective alternative method for large orbital floor reconstructions.

Internal pudendal perforator artery-based gull wing flap for vulvovaginal 3D reconstruction after tumour excision: a new flap.

Various skin tumours such as squamous cell carcinoma and extramammary Paget's disease can occur in the vulval area, and reconstruction of the vulval area can be a very challenging task. A retrospective analysis of vulvar reconstruction using the new method 'internal pudendal perforator artery-based gull wing flap' was performed from April 2012 to December 2013. A perforator vessel from the internal pudendal artery was detected with a portable Doppler and marked, and this was the pivot point around which the flap was rotated. The flap was rotated by more than 150°-180° internally, and the labium and the external wall of the vagina were reconstructed with sufficient volume. Anatomical and aesthetic reconstruction of the labium and the vagina was performed without serious complications. Functional and aesthetic vulvar reconstruction can be achieved by using a flap that provides sufficient volume of the labium. Our new technique, the 'internal pudendal perforator artery-based gull wing flap', is good and it can be used to reconstruct a functional and aesthetically acceptable vulvovagina for large defect wound after tumour excision.

The effects of human keratinocyte coculture on human adipose-derived stem cells.

The potential for adipose-derived stem cells to differentiate into keratinocyte-like cells has recently been receiving attention, stemming from the hypothesis that a bioengineered skin may be manufactured from these readily available mesenchymal stem cells. This study was conducted to evaluate the influence of human keratinocyte non-contact coculture on hADSCs. Human epidermal keratinocytes and hADSCs obtained by lipoaspiration were cultured in keratinogenic growth media, which were divided into the following groups: human adipose-derived stem cell (hADSC) monoculture, non-contact coculture of hADSCs and human keratinocytes and keratinocyte monoculture. Cell proliferation was assessed, and keratogenicity was analysed through immunocytochemistry and polymerase chain reaction of early, intermediate and late keratogenic markers. hADSCs cocultured with keratinocytes displayed enhanced proliferation compared with the monoculture group. After a 7-day coculture period, immunohistochemistry and polymerase chain reaction findings revealed the presence of specific keratinocyte markers in the coculture group. This study demonstrates that hADSCs cocultured with keratinocytes have the capacity to transdifferentiate into keratinocyte lineage cells, and suggests that adipose tissue may be a source of keratinocytes that may further be used in structuring the bioengineered skin.

Perforators as recipients for free flap reconstruction of the inguinal and perineal region.

OBJECTIVE: Extensive defects of the perineal or inguinal area require well vascularized free flap coverage. This area has an abundance of perforating arteries and veins based on vessels from the femoral artery and internal iliac artery. We present our experience on the use of perforators as recipient vessels in reconstructing soft tissue defects of the perineal and inguinal area with free flaps. PATIENTS AND METHODS: From March 2012 to August 2014, 13 patients underwent free flap reconstruction for soft tissue defects of the inguinal or perineal area. Perforating arteries with diameters ranging from 0.7 to 1.2 mm were used as recipient arteries. Accompanying veins or neighboring superficial veins were secured as recipient veins. RESULTS: All flaps survived attached to a recipient perforator with a diameter ranging from 0.7 to 1.2 mm. These vessels were found in the inguinal or perineal areas, regions that are supplied by the superficial circumflex iliac vessels, superficial inferior epigastric vessels, superficial and deep external pudendal vessels, lateral and medial circumflex femoral vessels, and internal pudendal vessels. There were no cases of arterial insufficiency or venous congestion, flap necrosis, or infection. A single case of hematoma beneath the flap was treated by simple evacuation. There were no donor complications. CONCLUSION: Using perforators as the recipient during free flap reconstruction of the inguinal and perinea area allows the surgeon to choose from a wider choice of vessels, and yields acceptable flap survival.

Endotine Midface for Soft Tissue Suspension in Zygoma Fracture.

Treatment of zygomatic fractures necessitates dissection beneath the soft tissues of the cheek. Inadequate resuspension may lead to deformities, including cheek ptosis, lower lid ectropion, and lateral canthal dystopia. The authors present their experience using a biodegradable suspension device for cheek flap resuspension. Patients who received open reduction for unilateral zygomatic fracture between January, 2006 and December, 2013 at a single center were included in the study. Patients could choose whether or not to have Endotine midface inserted. Patients rated satisfaction on facial symmetry. Computed tomography (CT) at 15 months was assessed for soft tissue thickness at the level of the midpoint of the nasolabial fold on each side. Photographs at 15 months were viewed by 3 blinded plastic surgeons and rated for cheek drooping. The results for all 3 parameters were compared between the Endotine group and the control group. A total of 83 patients were included (43 in the Endotine group and 39 in the control group). Patient satisfaction scores were statistically higher (P = 0.03) in the Endotine group (3.70 ±â€Š0.76) than the control group (2.85 ±â€Š0.96). Computed tomography soft tissue thickness score ratio between affected and unaffected side was significantly lower (P < 0.001) in the Endotine group than the ratio in the control group. Photography evaluation score difference between affected and unaffected side for the Endotine group (0.70 ±â€Š0.77) was significantly (P = 0.041) smaller than the control group (1.92 ±â€Š1.24). Endotine midface is easy to apply and effective in repositioning the elevated cheek flap in zygomatic fracture patients.

Successful treatment of posttraumatic arteriovenous malformation of the lower lip.

Arteriovenous malformations (AVMs) are most commonly reported in the brain. Head and neck AVMs are reported to occur in 0.1% of the general population. On the other hand, posttraumatic AVMs are quite rare. Traumatic AVMs are extremely rare in the head and neck and are mostly seen in the extremities. The management of such lesions may include selective embolization or surgical exploration with ligation. A 13-year-old male adolescent visited our hospital for lower lip swelling, which developed 5 years ago after a lower lip laceration. The AVM was expanded and was graded as stage II. It was fed by the mandibular branch of both facial arteries and drained to the posterior facial vein. The radiologic intervention department performed an embolization before the operation. The main operation was performed 12 days after the embolization. A well-demarcated AVM lesion was found in the oral mucosa and was totally excised under general anesthesia. The authors easily performed the operation owing to the embolization making the AVM definitely demarcated and firmly palpable. The lip closure was done carefully considering the lip contour. No sign of recurrence was seen during 6 months of follow-up. The excellent treatment result of the posttraumatic facial AVMs occurs largely because of a collaboration with the radiologic intervention department using the selective embolization.

Comparative Orbital Volumes between a Single Incisional Approach and a Double Incisional Approach in Patients with Combined Blowout Fracture.

PURPOSE: Blowout fracture characterized by concurrent floor and medial wall fractures is a rare entity. We compared surgical outcomes between a single approach and a double approach in patients with orbital fracture by measuring the postoperative orbital volume. METHODS: We confirmed that 21 (8.5%) of a total of 246 patients with orbital fractures had fractures of the medial wall and floor through a retrospective chart review. Of these, 10 patients underwent the single approach and the remaining 11 patients had the double approach. We performed a statistical analysis of changes between the preoperative and postoperative orbital volumes at a 6-month follow-up. RESULTS: Compared with the contralateral, nonaffected side, the orbital volume was 115.3 (±6.09)% preoperatively and 106.5 (±6.15)% postoperatively in the single approach group and 118.2 (±11.16)% preoperatively and 108.6 (±13.96)% postoperatively in the double approach. These results indicated that there was a significant difference between the preoperative and postoperative orbital volumes in each group (P < 0.05). However there was no significant difference between the single approach and the double approach (P > 0.05). CONCLUSIONS: Our results showed that there were no significant differences in surgical outcomes between the two modalities. The treatment modality may be selected based on the surgeons' preference, as well as the fracture type.

Secretory factors of human chorion-derived stem cells enhance activation of human fibroblasts.

BACKGROUND AIMS: Wound healing remains a principal challenge in modern medical science. Chorion-dervied stem cells (CDSCs), isolated from human placenta, have largely been overlooked, and few studies on their potential in wound healing have been conducted. In this study, we investigated the functional characteristics of CDSCs compared with adipose-derived stem cells (ASCs) on human fibroblasts (HFs). METHODS: We analyzed CDSCs by means of flow cytometry to confirm their mesenchymal stromal cell characteristics. We then evaluated the paracrine effects of CDSCs on HFs in a co-culture system and focused on fibroblast proliferation, migration and collagen synthesis. To explore the potential of CDSCs in wound healing, CDSC- and ASC-secreted factors were compared by use of a cytokine antibody array. RESULTS: CDSCs had morphology similar to MSCs and expressed a mesenchymal stromal cell phenotype. HF proliferation and migration increased more than 5-fold when co-cultured with CDSCs. Furthermore, Western blot and reverse transcription-polymerase chain reaction analysis showed that expression of collagen (types I and III) in fibroblasts was upregulated 2-fold when co-cultured with CDSCs. Cytokine array results of CDSC-conditioned medium and ASC-conditioned medium revealed the presence of growth factors known to influence wound healing, including interleukin -6, interleukin -8, monocyte chemotactic protein 1 and regulated on activation, normal T cells expressed and secreted. CONCLUSIONS: Our data demonstrated that CDSCs are functionally similar to ASCs, promote HF activation, and secrete growth factors that influence wound healing. Therefore, we suggest that CDSCs are potentially applicable in wound healing.

Huge nasopharyngeal teratoma with a cleft palate and bifid tongue in a patient with pierre robin syndrome.

PURPOSE: Nasopharyngeal teratoma is a very rare neoplasm that develops on the oronasal cavity as an expanding and cavity-filling lesion. We present a rare case of nasopharyngeal teratoma associated with a cleft palate and bifid tongue in a patient with Pierre Robin syndrome. METHODS: A preterm male neonate of 33 weeks and 6 days was referred to our department. A protruding solid mass with approximately 7.0 × 4.0-cm size arising from the vomer and combined cleft palate and tongue covered with pinkish skin with lanugo were observed. In addition, there was a bandlike tissue connecting vomer and sublingual area, which divided and restricted the anterior portion of the tongue. RESULTS: An early surgical intervention was decided because of problems with airways and nutrition caused by the mass. The mass was completely removed from the vomer. The histologic examination of the mass was consistent with mature teratoma. After his first operation, he was finally diagnosed with the Pierre Robin syndrome. After 4 months, a tongue reduction was conducted for macroglossia, and after 9 months, remnant teratoma excision and a palate repair were conducted using 2-flap palatoplasty. CONCLUSIONS: A nasopharyngeal teratoma is a rare case and induces a cleft palate and bifid tongue in a preterm infant, leading to severe airway and nutritional problems. A teratoma interferes with the fusion of embryonic tissues in the early developmental period, in particular, with the palatal fusion severely prevented if the teratoma is accompanied by a Pierre Robin syndrome such as in this case.

Radiologic misunderstanding of cutaneous angiomyolipoma in the alar base.

In this article, we will examine a case of cutaneous angiomyolipoma in the right nasal alar base area of a 36-year-old man. Generally, angiomyolipoma occurs in the kidney and, histologically, has features that are similar to cutaneous angiomyolipoma: smooth muscle cells, mature adipose cells, and a convoluted thick-walled blood vessel. Clinically, renal angiomyolipoma is related to tuberous sclerosis, but cutaneous angiomyolipomas occur very rarely, with a total of only 23 cases documented in the literature, with 39% (9/23) of those cases occurring in the ear or surrounding areas. In particular, the abundance of blood vessels inside a cutaneous angiomyolipoma produces good enhancement on computed tomographic image, making it easy for the tumor to be mistaken for a vascular tumor. In this particular case, we will report about a previously unheard case of cutaneous angiomyolipoma occurring in the nasal alar base that was mistaken for a vascular tumor.

Sebaceous carcinoma of the suprapubic area in a liver transplant recipient.

Sebaceous carcinoma is a very rare and potentially aggressive carcinoma originating from the epithelial lining of the sebaceous gland. More than 70% of all cases are in the head and neck region, especially the periorbita; therefore, they are classified into ocular and extraocular sebaceous carcinoma. The reported risk factors are advanced age, male sex, previous irradiation, and genetic predisposition for Muir-Torre syndrome. The current case is of sebaceous carcinoma found in the suprapubic area of a 67-year-old male patient who had received liver transplantation 6 years before, and had been receiving oral tacrolimus. Examination of the gastrointestinal system did not reveal any other malignancies. Although nonmelanoma skin cancers may occur as a complication after liver transplantation, there have been no previous reports of sebaceous carcinoma after liver transplantation. Furthermore, the sebaceous carcinoma in this case occurred in an uncommon location. We report this case along with a review of the literature.

A Huge Morel-Lavallée Lesion Treated Using a Quilting Suture Method: A Case Report and Review of the Literature.

The Morel-Lavallée lesion is a collection of serous fluid that develops after closed degloving injuries and after surgical procedures particularly in the pelvis and abdomen. It is a persistent seroma and is usually resistant to conservative methods of treatment such as percutaneous drainage and compression. Various methods of curative treatment have been reported in the literature, such as application of fibrin sealant, doxycycline, or alcohol sclerodhesis. We present a case of a huge recurrent Morel-Lavallée lesion in the lower back and buttock region that was treated with quilting sutures, fibrin sealant, and compression, with a review of the literature.

Treatment for intramuscular lipoma frequently confused with sarcoma: a 6-year restrospective study and literature review.

INTRODUCTION: Intramuscular lipoma is a very rare form of lipoma, known to be categorized as an infiltrating lipoma due to its tendencies to infiltrate the muscle or the synovium. Contrary to other subcutaneous lipomas, even after surgical removal, the rate of local recurrence ranges at a high rate from 50∼80% and differential diagnosis with liposarcoma is very difficult. PATIENTS AND METHODS: A retrospective chart review was conducted for a total of 27 patients. Before performing a surgery based on the types of mass, a radiologic imaging study was performed. An intraoperative frozen biopsy was performed on every patient and the results were compared. The progress was monitored every 3 to 6 months for recurrence or struggles with rehabilitation. RESULTS: There were 13 male and 14 female patients with an average age of 54.6. The average tumor size was 8.2 cm (1.1 cm∼31.6 cm). Excision was performed using a wide excision. All 27 individuals were initially diagnosed as intramuscular lipoma; however, 1 of the patients was rediagnosed as liposarcoma in the final checkup. The patients had an average of 3 years and 1 month of follow-up and did not suffer recurrences. CONCLUSION: Thus, it is essential that a frozen biopsy is performed during the surgery in order to identify its malignancy. And a wide excision like malignant tumor operation is a principle of treatment.

The stem cell potential and multipotency of human adipose tissue-derived stem cells vary by cell donor and are different from those of other types of stem cells.

Human adipose tissue-derived mesenchymal stem cells (AT-MSCs) from various sites are applied in tissue engineering and cell therapy. The condition of AT-MSCs depends on the donor's age, body mass index (BMI), and gender. AT-MSCs from 66 human donors were analyzed, and the cells were sorted according to donor age (10-19 years: n = 1; 20-29 years: n = 5; 30-39 years: n = 12; 40-49 years: n = 22; 50-59 years: n = 12; 60-69 years: n = 9, and 70 years or older: n = 5), BMI (under 25, 25-30, and over 30), and gender (19 males and 48 females). Additionally, AT-MSCs were compared to bone marrow MSCs and chorionic tissue-derived MSCs. We measured the MSC yield, growth rate, colony-forming units, multipotency, and surface antigens. AT-MSC proliferation was greater in cells isolated from individuals aged less than 30 years compared to the proliferation of AT-MSCs from those over 50 years old. BMI was correlated with osteogenic differentiation potency; increased BMI enhanced osteogenesis. Adipogenic differentiation was more strongly induced in cells isolated from donors aged less than 30 years compared to those isolated from other age groups. Also, a BMI above 30 was associated with enhanced adipogenic differentiation compared to cells isolated from individuals with a BMI below 25. Bone marrow MSCs were strongly induced to differentiate along both osteogenic and adipogenic lineages, whereas AT-MSCs predominantly differentiated into the chondrogenic lineage. Therefore, the type of regeneration required and variations among potential donors must be carefully considered when selecting MSCs for use in applied tissue engineering or cell therapy.