PURPOSE: In cases of breast reconstruction with a free transverse rectus abdominis musculocutaneous(TRAM) flap after skin-sparing mastectomy with nipple-areolar complex(NAC) removal, the flat contour of the flap's skin paddle can easily look unnatural and dissatisfying. Reconstructed NAC on the flap surface lacks the elevated contour that the normal areola possesses, resulting in an unnatural final result. Therefore, we would like to introduce a novel method to improve this problem and report the satisfactory results we obtained. METHODS: Operations were conducted on 19 patients who underwent immediate breast reconstruction with a free TRAM flap and skin-sparing mastectomy from January 2009 to January 2010, with a mean follow-up of nine months. While the TRAM free flap was being inset, a purse-string suture was carried out on the dermal layer of skin flap to create a slight protrusion with Gore-Tex(R) sutures. RESULTS: The elevated mound surrounding the NAC was well maintained for an average follow-up period of nine months. Nipple projection was also well maintained. There was no complaint about breast contour or nipple height reduction. In addition, there was no reported incidence of other complications. CONCLUSION: The purse-string suture technique presents a more natural breast silhouette around the NAC and helps to maintain nipple projection. Furthermore, it does not require any supplementary incisions or complicated skills. There has been no report of additional complications using this technique.
Breast ; Female ; Follow-Up Studies ; Free Tissue Flaps ; Humans ; Incidence ; Mammaplasty ; Mastectomy ; Nipples ; Rectus Abdominis ; Skin ; Suture Techniques ; Sutures

PURPOSE: Angiosarcoma is a rare malignant neoplasm of endothelial type cells that line vessel walls. It tends to occur in aged male and the prognosis of angiosarcoma is very poor because of frequent local recurrence and early metastasis. The treatment regimen is yet to be established from its rare occurrence but the wide excision in early stage is known to be the most effective. The authors report two cases of near totally excised angiosarcoma with more than a safety margin of 5cm. METHODS: The two subjects were aged male patients, one of the two was diagnosed with angiosarcoma from our institution confirmed by the biopsy. The other one went through the wide excision with a safety margin of 2cm and split-thickness skin graft but local recurrence was observed. The two patients underwent near total excision with more than a safety margin of 5cm, leaving only the periosteum. After confirming that the angiosarcoma had not infiltrated the excision margin, reconstruction with split-thickness skin graft was performed. RESULTS: Based on 6 months and 24 months post-surgery assessment, no local recurrence or remote metastasis in the lungs, liver, bones, and lymph nodes at the neck, where remote metastasis is common, was reported by the two subjects who underwent near total excision with a safety margin of 5cm. CONCLUSION: Angiosarcoma has very poor prognosis from its frequent recurrence and metastasis. To enhance the survival rate of angiosarcoma patients, early diagnosis, timely surgical treatment, and radiotherapy after surgery are critical. In addition, authors suggest that it is necessary to further study the efficacy of wide excision using a wider safety margin as much as possible, and to apply this to more cases.
Aged ; Biopsy ; Early Diagnosis ; Glycosaminoglycans ; Hemangiosarcoma ; Humans ; Liver ; Lung ; Lymph Nodes ; Male ; Neck ; Neoplasm Metastasis ; Periosteum ; Prognosis ; Recurrence ; Scalp ; Skin ; Survival Rate ; Transplants

PURPOSE: Cardiac radiofrequency catheter ablation procedures using fluoroscopy were performed for the treatment of supraventricular and selected ventricular tachyarrhythmia. Fluoroscopy is used to localize the position of the intracardiac catheter. Fluoroscopically- guided procedures often involve high radiation doses to patient's skin, but the incidence of serious radiation injuries in these patients is rare. We reported two cases of severe postradiation skin injury on the back treated with the V-Y latissimus dorsi musculocutaneous flap. METHODS: These two patients underwent radiofrequency catheter ablation under the diagnosis of Woff Parkinson White syndrome(WPW syndrome). They had radiation- induced skin injuries on the subscapular area and these lesions represented chronic ulceration, surrounding induration, hardness, and dyspigmentation. We treated these lesions with complete excision and coverage with V-Y latissimus dorsi musculocutaneous flap. RESULTS: These two patients had no recurrence and no special complications during 20 months and 12 months follow-up periods and were satisfied aesthetically and functionally. CONCLUSION: V-Y latissimus dorsi musculocutaneous flap obtained better results functionally and aesthetically compared with conservative management and skin graft in severe radiation-induced skin injuries after cardiac radiofrequency catheter ablation procedure.
Cardiac Catheters ; Catheter Ablation ; Fluoroscopy ; Follow-Up Studies ; Hardness ; Humans ; Incidence ; Radiation Injuries ; Recurrence ; Skin ; Tachycardia ; Transplants ; Ulcer

PURPOSE: Augmentation mammoplasty by cohesive silicone gel implant is becoming more popular nowadays. Many types of complications have been reported, such as hematoma, seroma, infection, capsular contracture and etc. But there were no report of deep vein thrombosis(DVT) after augmentation mammoplasty in Korea. The authors experienced one case of DVT after augmentation mammoplasty using a cohesive silicone gel implant. METHODS: A 38-year-old woman with breast cancer underwent reconstruction by tissue expander and augmentation mammoplasty by cohesive silicone gel implant, and exchange of expander to cohesive silicone gel implant. The operation was finished without any complicating event. On 4th day after the operation, the patient complained of intermittent right lower leg pain. By doppler ultrasonography, the patient was diagnosed with acute venous thrombosis of the popliteal vein, posterior tibial vein and peroneal vein. RESULTS: Intravenous heparinization and oral warfarin were started immediately and elastic compression stocking was applied. Intravenous heparinization was continued until INR(blood coagulation unit) reached to target levels. The patient was discharged on 11th day of operation with oral warfarin. Other complication has not been reported after 10 weeks of operation. CONCLUSION: To our knowledge, this is the first report of DVT after silicone implant based breast augmentation.
Adult ; Breast ; Breast Neoplasms ; Contracture ; Female ; Hematoma ; Heparin ; Humans ; Korea ; Leg ; Mammaplasty ; Popliteal Vein ; Pulmonary Embolism ; Seroma ; Silicone Gels ; Stockings, Compression ; Tissue Expansion Devices ; Ultrasonography, Doppler ; Veins ; Venous Thrombosis ; Warfarin

PURPOSE: Angiosarcoma is a rare and aggressive malignant soft tissue tumor. Due to a lack of the established optimal treatment modalities, however, an extensive resection followed by an early detection has been reported to be the best treatment of choice. We analyzed the clinical course of six patients, hence attempted to contribute to making a treatment plan for patients with angiosarcoma. METHODS: Six patients who have been surgically treated between 2005 and 2010 are included. Through a retrospective analysis of the medical records, we evaluated the pattern of disease detection, a past history, time span between the detection and the primary surgery, surgical treatment modalities, time span between the primary surgery and the recurrence/metastasis, the sites of metastasis and the secondary treatment modalities. RESULTS: The mean age of patients was 70.5 years; all male; and the sites were the scalp. Four patients underwent the reconstruction using a local flap with a skin graft and two patients using a free flap. The mean period elapsed until the primary operation since the identification was 7.3 months and until a recurrence or a metastasis occurred following the primary operation was 12 months. Four patients had pulmonary metastasis. As a secondary therapy, four patients underwent the radiotherapy and one was treated with the chemotherapy. At the present, five patients died and one undergoes a monitoring of the clinical course. CONCLUSION: It would be mandatory to shorten the length of hospital stay and to return patients to their daily lives as the earliest as possible using relatively simpler surgical methods, thus attempting to give them opportunity to resume their previous normal life.
Free Tissue Flaps ; Hemangiosarcoma ; Humans ; Length of Stay ; Medical Records ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Scalp ; Skin ; Transplants

PURPOSE: The zygoma(Zygomaticomaxillary) complexes make up a large portion of the orbital floor and lateral orbital walls. Zygoma fracture frequently causes the posteromedial displacement of bone fragments, and the collapse or overlapping of internal orbital walls. This process consequently can lead to the orbital volume change. The reduction of zygoma in an anterolateral direction may influence on the potential bone defect area of the internal orbital walls. Thus we performed the quantitative analysis of orbital volume change in zygoma fracture before and after operation. METHODS: We conducted a retrospective study of preoperative and postoperative three-dimensional computed tomography scans in 39 patients with zygoma fractures who had not carried out orbital wall reconstruction. Orbital volume measurement was obtained through Aquarius Ver. 4.3.6 program and we compared the orbital volume change of injured orbit with that of the normal contralateral orbit. RESULTS: The average orbital volume of normal orbit was 19.68cm3. Before the operation, the average orbital volume of injured orbit was 18.42cm3. The difference of the orbital volume between the injured orbit and the normal orbit was 1.18cm3(6.01%) on average. After operation, the average orbital volume of injured orbit was 20.81cm3. The difference of the orbital volume between the injured orbit and the normal orbit was 1.17cm3(5.92%) on average. CONCLUSION: There are considerable volume changes in zygoma fracture which did not accompany internal orbital wall fracture before and after operation. Our study reflects the change of bony frame, also that of all parts of the orbital wall, in addition to the bony defect area of orbital floor, in an isolated zygoma fracture so that it evaluates orbital volume change more accurately. Thus, the measurement of orbital volume in isolated zygoma fractures helps predict the degree of enophthalmos and decide a surgical plan.
Displacement (Psychology) ; Enophthalmos ; Floors and Floorcoverings ; Humans ; Orbit ; Retrospective Studies ; Zygoma

PURPOSE: Nasal bone fracture is most common facial bone fracture. The cause of fractures is mainly trauma such as fighting, automobile accident and fall down, and it commonly involves young males. Very frequently nasal bone fractures are associated with other facial injuries such as orbital bone fracture, maxillary bone fracture and nasal septal deformities. Because of various dynamic directions of power are involved, phenomenon of fractures are also various and treatment cannot be simple. METHODS: We studied and analyzed retrospectively 452 cases nasal bone fractures from January 2008 to December 2010. Diagnosis were made with physical examination, Nasal bone X-rays, Facial bone CT and 3D facial bone CT. Four surgeons are involved in treatments of these patients and applied different procedure along patient's condition and deformity. We analyzed the cause of nasal bone fractures, deformities, associate injuries and applied surgical technique, and patient's satisfaction rate. In this study, old nasal bone fractures were excluded. RESULTS: Young male group was most commonly sustained nasal bone fracture and physical violence was most common cause of injury. 64 of 452 patient was involved associate injuries of face. Closed reduction were applied 246 cases and C-arm quide reduction were 167 cases and in 20 cases lateral osteotomy were applied. Approximately, more than 80% of the Patients were satisfied with the outcomes. CONCLUSION: Diagnosis and treatment of nasal bone fractures are considered simple but because of various deformity and associate injuries, treatment is not always simple and universal. Time to time, we face unsatisfied patient after treatment of nasal bone fractures. For obtaining satisfactory result, cause of injury and state of deformities and associate injuries such as nasal septal deformity should be evaluated properly and proper treatment should be applied.
Automobiles ; Collodion ; Congenital Abnormalities ; Facial Bones ; Facial Injuries ; Fractures, Bone ; Humans ; Male ; Maxilla ; Nasal Bone ; Orbit ; Osteotomy ; Physical Examination ; Retrospective Studies ; Violence

PURPOSE: Many facial burn patients suffer from hyperpigmentation and its treatment has been challenging. Vitamin C(ascorbic acid) has important physiologic effects on skin, including inhibition of melanogenesis, promotion of collagen biosynthesis, prevention of free radical formation, and acceleration on wound healing. The purpose of this study is to evaluate the effectiveness of Vitamin C iontophoresis for the treatment of postburn hyperpigmentation. METHODS: The authors performed a retrospective analysis of 93 patients who were admitted for the treatment of facial burn from February 2008 through February 2010. Among them, 51 patients were treated with Vitamin C iontophoresis to control postburn hyperpigmentation and 42 patients were not. Experimental group was chosen 20 of 51 patients who had been treated with Vitamin C iontophoresis and had normal facial skin on the comparable contralateral aesthetic unit. Control group was chosen 20 of 42 patients who were not treated with Vitamin C iontophoresis and had also contralateral normal aesthetic unit. The resulting color of 20 patients who were treated with Vitamin C iontophoresis was compared with the color of the contralateral normal facial skin using a digital scale color analysis. Results were analyzed with Wilcoxon signed rank test. RESULTS: The analysis revealed significant improvement of hyperpigmentation in the experimental group compared to control group. The difference of intial value and the value in 6 months showed significant change. Mean(Delta(initial)-Delta(6month)) of experimental group was 11.61 and control group was 7.23. Thus, the difference between the experimental group and the control group was 4.38. Therefore, Vitamin C iontophoresis revealed significant improvement of hyperpigmentation in the experimental group compared with control group. CONCLUSION: Vitamin C iontophoresis is an effective treatment modality for postburn hyperpigmentation.
Acceleration ; Ascorbic Acid ; Burns ; Collagen ; Humans ; Hyperpigmentation ; Iontophoresis ; Retrospective Studies ; Skin ; Vitamins ; Wound Healing

PURPOSE: Pediatric facial laceration takes a huge part of patients visiting emergency room and generates social attention for its proper emergency care. So much more attention should be paid to the proper treatment at emergency care unit, and furthermore, thorough survey of background information of the pediatric facial laceration may offer more proper prevention. METHODS: According to annual reports of 2009 and 2010, out of 5149 facial laceration patients who were given primary medical care at our clinic, 1452 patients were aged under 15 years old. Retrospective analysis of each pediatric facial lacerations were evaluated according to gender, age, periodic table, cause of injury, place of injury, sites of injury and so on. RESULTS: Pediatric facial laceration was found to occur mostly at 1 year old as they learn to walk and explore their environment. Evaluated analysis revealed that pediatric facial accidents occurred mostly on forehead region (75%), on Sundays, from 5 p.m. to 8 p.m., at home(61.5%). Most common cause of injury was collision(54.5%). CONCLUSION: In large group of pediatric facial laceration cases provided us with an surprising fact that accidents most commonly occur under parental supervision. This fact gives an actual understanding regarding pediatric facial laceration and more realistic approach in its prevention strategy.
Aged ; Emergencies ; Emergency Medical Services ; Facial Injuries ; Forehead ; Humans ; Hypogonadism ; Lacerations ; Mitochondrial Diseases ; Ophthalmoplegia ; Organization and Administration ; Parents ; Pediatrics ; Retrospective Studies

PURPOSE: Correction of cleft lip nose deformity(CLND) in adulthood is different from one in childhood. Usually correction of CLND is final surgery for adult patient who has cleft lip, so many things have to be considered for correction. Of course, it is different from common rhinoplasty, either. The adult patients can be corrected by complete rhinoplasty with various techniques. To recognize how rhinoplasty techniques was used for correction of CLND, authors analyzed detailed techniques which were selected in the adult patients for 10 years and reviewed comprehensive operation. METHODS: A retrospective review was conducted involving 64 patients with CLND who underwent surgery and aged after 14 years at operation between 2001 and 2010. Detailed techniques were investigated by medical record review and classified according to incision, septoplasty, osteotomies, correction of vault, tip plasty and etc. RESULTS: Except one, all patients were performed open rhinoplasty. 49 patients were performed septoplasty. 33 patients were performed complete rhinoplasty with osteotomies. Hump nose correction was performed for 10 patients. Dorsal augmentation was performed for 8 patients. And all patients were performed tip plasty. Tip plasty using suture technique was performed for 58 patients and graft was performed for 48 patients. CONCLUSION: Correction of CLND in adult is one of the most challenging and varied operation of plastic surgery. In this study, the majority of patients were performed complicated and delicated procedures. It seems to be because patient's demand level has been elevated and rhinoplasty procedures have been advanced. This study may help to planning of CLND correction.
Adult ; Aged ; Cleft Lip ; Congenital Abnormalities ; Humans ; Medical Records ; Nose ; Osteotomy ; Retrospective Studies ; Rhinoplasty ; Surgery, Plastic ; Suture Techniques ; Transplants