PURPOSE: Various operations have been proposed to compensate for congenital absence of the vagina using ileal or colonic interposition. These methods involve laparotomy, which shows postoperative complications such as long scar and delayed recovery. One case of neovagina reconstruction with laparoscopic rectosigmoid colpopoiesis in Mayer-Rokitansky-Kuster-Hauser syndrome is presented to avoid laparotomic complications. METHODS: Laparoscopic surgery was performed in a 27-year-old MRKH syndrome patient. After a cruciate incision, blunt dissection through two-finger wide space was created between the bladder and the rectum. A 14-cm rectosigmoid segment vascularized by a branch of sigmoid artery was isolated by laparoscopy. The distal end was sutured with vaginal vestibule mucosa. A continuity of intestine was restored by circular end-to-end proximate curved intraluminal stapler CDH29(R) through perineal opening. RESULTS: Total operation time was 4 hr 15 min. Normal walking and ingestion were possible within 3 days and 4 days after surgery. The hospital stay was 7 days and the patient was followed up for 6 months. The neovaginal introitus was wide enough for inserting two fingers, and there has been no narrowing of the neovagina on palpation as confirmed by vaginogram. The patient had functional self-lubricating neovagina without excessive mucous production or the need for routine dilation or unnoticeable scar. CONCLUSION: The successful result of this laparoscopic vaginal reconstruction technique with rectosigmoid segment suggests that this technique can be considered for the option of vaginal reconstruction in girls with the MRKH syndrome.
Abnormalities, Multiple ; Adult ; Arteries ; Cicatrix ; Colon ; Colon, Sigmoid ; Eating ; Fingers ; Humans ; Intestines ; Kidney ; Laparoscopy ; Laparotomy ; Length of Stay ; Mucous Membrane ; Mullerian Ducts ; Palpation ; Postoperative Complications ; Rectum ; Somites ; Spine ; Urinary Bladder ; Uterus ; Vagina ; Walking

PURPOSE: In developed countries, vesicovaginal fistula occur from various pelvic operations including total hysterectomy, leading to urinary leakage and incontinence. Although various methods have been proposed for adequate tissue coverage in fistula repair, the surgical treatment of is not simple and still controversial. We report a case of neobladder-vaginal fistula repair using modified Martius fat pad flap. METHODS: A 62-year-old female patient underwent radical cystectomy with total abdominal hysterectomy and neobladder formation due to invasive bladder tumor 5 years ago. For 3 years following the operation, urine leakage was observed. Exploration demonstrated neobladder-vaginal fistula and primary repair including fistulectomy and direct closure was performed. Urinary incontinence relapsed 2 years after primary repair, and after demonstrating the recurrence of fistula on urography, repair of recurrent fistula was performed. After dissection of vagina and neobladder and closure of fistula by urologic surgeon, fibroadipose flap was elevated, rotated and advanced through the tunnel at vaginal sidewall, and interpositioned to the fistula site between neobladder and vagina. RESULTS: There was no acute complication after the surgery and urethral catheter was extracted on the 8th day after the operation. During six month follow-up period after the operation, there is no clinical evidence of fistula recurrence. CONCLUSION: From our clinical experience and literature review, we think Martius fat pad flap is a useful technique in management of neobladder-vaginal fistula, for it provides enough vascularity, major epithelization surface and better lymphatic drainage, and also prevents overlapping of vesical, vaginal suture lines at the same time.
Adipose Tissue ; Cystectomy ; Developed Countries ; Drainage ; Female ; Fistula ; Follow-Up Studies ; Humans ; Hysterectomy ; Middle Aged ; Recurrence ; Sutures ; Urinary Bladder Neoplasms ; Urinary Catheters ; Urinary Incontinence ; Urography ; Vagina ; Vesicovaginal Fistula

PURPOSE: The anatomical anomaly of the rectus abdominis muscle and it's fascia is very rare. No case of the absence of the linea alba below the umbilicus has yet been reported. During breast reconstruction with pedicled TRAM flap, we experienced one case of absence of linea alba. METHODS: The patient was a 38-years old female who underwent immediate breast reconstruction with pedicled TRAM flap after Right modified radical mastectomy in June 2010. While the TRAM flap was being elevated, bilateral twitching of the rectus abdominis muscle occurred when electrocautery was applied, and we found the absence of the linea alba below the umbilicus. RESULTS: When the rectus abdominis muscle was exposed, the linea alba below the umbilicus was not observed, and the bilateral rectus abdominis muscle was indistinguishably fused in a gross observation. In addition, bilateral twitching of rectus abdominis muscle was simultaneously observed as one muscle unit when electrocautery was applied. As with both rectus abdominis muscles was bluntly dissected with scissors, the scanty fatty tissues were observed between the both rectus muscles, and the bilateral rectus abdominis muscle was easily separated. The flap was transposed into the corresponding defect to make breast mound. Midline fascia was fixed to the posterior rectus sheath to reconstruct smilar anatomic linea alba. Abdominal defect was reinforced by suturing between remaining anterior rectus sheath. CONCLUSION: As the unexpected anatomical anomaly may affect the operation outcome, surgeons should be careful when they unexpectedly encounter the anatomical anomaly during an operation. Here, we report a rare case of absence of the linea alba seen at the time of pedicled TRAM flap elevation for breast reconstruction.
Breast ; Electrocoagulation ; Fascia ; Female ; Humans ; Mammaplasty ; Mastectomy, Modified Radical ; Muscles ; Rectus Abdominis ; Umbilicus

PURPOSE: Breast implant ruptures and displacement are problematic complications after augmentation mammoplasty. The authors report a patient whose cohesive silicone gel implant ruptured and migrated into the pleural cavity after augmentation mammoplasty. METHODS: A 23-year-old female had received augmentation mammoplasty at a local clinic a week before visiting our hospital. When the patient's doctor performed a breast massage on the sixth postoperative day, the left breast became flattened. The doctor suspected a breast implant rupture and performed revision surgery. The implant, however, was not found in the submuscular pocket and no definite chest wall defect was found in the operative field. The doctor suspected implant migration into the pleural cavity, and after inserting a new breast implant, the doctor referred the patient to our hospital for further evaluation. The patient's vital signs were stable and she showed no specific symptoms except mild, intermittent pain in the left chest. A CT scan revealed the ruptured implant in the left pleural cavity and passive atelectasis. RESULTS: The intrapleurally migrated ruptured implant was removed by video-assisted thoracic surgery(VATS). There were no adhesions but there was mild inflammation of the pleura. No definite laceration of the pleura was found. The patient was discharged on the first day after the operation without any complications. CONCLUSION: Surgeons should be aware that breast implants can rupture anytime and the injury to the chest wall, which may displace the breast implant into the pleural cavity, can happen during submuscular pocket dissection and implant insertion.
Breast ; Breast Implants ; Displacement (Psychology) ; Female ; Humans ; Inflammation ; Lacerations ; Mammaplasty ; Massage ; Pleura ; Pleural Cavity ; Rupture ; Silicone Gels ; Thoracic Wall ; Thorax ; Vital Signs ; Young Adult

PURPOSE: Glomus tumor is a benign neoplasm of the normal glomus body, occurring as painful subcutaneous nodules, frequently located in the subungual area. There are few cases of facial glomus tumor reported and we report a case of glomus tumor developing on the columella of nose. METHODS: A 68-year-old female presented with a mass of the columella grown for 2 years. The nodule was 0.6 cm in diameter, red-colored without any symptoms such as pain, tenderness and cold hypersensitivity. The pathologic result after punch biopsy was hemangiopericytoma. Excision with local anesthesia was executed. RESULTS: The postoperative recovery of the patient was uneventful, Histopathological examination indicated a glomus tumor. Immunostaining revealed positivity for vimentin, actin, and negativity for desmin, CD-34. After 8 months follow up, there is neither complication nor evidence of local recurrence on clinical examination. CONCLUSION: To accomplish an accurate diagnosis of glomus tumor, the histopathological examination is essential together with immunochemical studies. The differential diagnosis include hemangioma, lipoma, epidermal inclusion cyst, dermoid cyst and arteriovenous malformation in this region. We report a case of glomus tumor on the face with uncommon clinical features.
Actins ; Aged ; Anesthesia, Local ; Arteriovenous Malformations ; Biopsy ; Cold Temperature ; Cryopyrin-Associated Periodic Syndromes ; Dermoid Cyst ; Desmin ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Glomus Tumor ; Hemangioma ; Hemangiopericytoma ; Humans ; Hypersensitivity ; Lipoma ; Recurrence ; Vimentin

PURPOSE: An aneurysm is defined as a permanent, localized dilation of an artery with a 50% increase in diameter over its expected normal diameter. Aneurysms can be classified by cause as traumatic and nontraumatic. Traumatic aneurysms can be divided into true and false aneurysms. Nontraumatic causes of peripheral artery aneurysms include mycotic, atherosclerotic, inflammatory, and idiopathic. In the hand, true aneurysms occurring at the common digital artery have been rarely reported. We present a rare case of a true aneurysm of the common digital artery that was resected and reconstructed using a reversed vein graft. METHODS: A 49-year-old male patient was refered to our institution with a 0.73x0.44x1.37cm sized pulsating mass between 2nd and 3rd flexor digitorum tendons on Lt. palm area. The mass had been present for 5 years and had increased in size over the previous year. No history of trauma was reported. After a physical examination and ultrasound sonography review, a diagnosis of aneurismal dilatation of common digital artery was made. Surgical treatment by excision of the aneurysm, and a reversed vein graft was performed. RESULTS: Histologic examination of the specimen(3.4x0.7cm) showed aneurismal dilatation, with elastin fibers present in the arterial wall. The lesions were healed without any complications and there were no evidence of recurrence. Doppler examination of the reconstruction showed good perfusion. CONCLUSION: Early excision is recommended to relieve symptoms and avoid neurologic damage. Also, artery reconstruction can be performed by primary end-to-end anastomosis or the placement of a reversed interposition vein graft. Micro surgical repair was the only possible treatment in this case. The authors believe that the vascular anatomy should always be restored as natural as possible.
Aneurysm ; Aneurysm, False ; Arteries ; Dilatation ; Elastin ; Hand ; Humans ; Male ; Middle Aged ; Physical Examination ; Recurrence ; Tendons ; Transplants ; Veins

PURPOSE: To correct breast ptosis, reduction mammoplasty and mastopexy have been developed in a way that minimizes complications. Recently, as the mean age of breast cancer occurrence is decreasing, the need for breast reconstruction in patients with breast cancer is rising. If mastopexy is performed with breast reconstruction at the same time, the size of the normal breast and the new one is not quite different. We decided to apply Z-plasty, which is a widely-used technique in plastic surgery to lengthen or change the direction of tension of the tissue. METHODS: From March 2008 to December 2009, we performed breast reconstruction in 6 patients with breast cancer and scar contracture. After breast reconstruction, mastopexy with Z-plasty was applied to correct the asymmetry. The new nipple-areolar complex is placed on the line connecting the midclavicle and the current nipple. The inferior border of the new areola corresponds with the inferior border of the original areola, and the superior border about 2 cm upward the original superior border. We drew two oblique lines connecting the medial end of the incision line lower to the nipple-areola complex and the lateral end of the inframammary fold for Z-plasty. The excess tissue between these two lines was removed and the new triangular flaps were put together. RESULTS: The average age of patients was 42.6 years, aged from 36.1 to 48.1 The weight of removed tissue was between 54g and 95 g, with the mean of 74 g. The average distance from the midclavicle to the nipple was 24 cm before surgery, and 21 cm after the surgery. The average operation time per patient (1 mastopexy) was 45 minutes, and the patients were satisfied with the size and shape. CONCLUSION: Applying Z-plasty for the mastopexy on the normal breast ptosis is a relatively simple way to achieve symmetry in patients who need breast reconstruction.
Aged ; Breast ; Breast Neoplasms ; Cicatrix ; Contracture ; Female ; Humans ; Mammaplasty ; Nipples ; Surgery, Plastic

PURPOSE: A number of flap for nipple reconstruction have been well described in the literature. However, most of these techniques do not permit the reconstruction of a projecting nipple and all are hampered to some extent by long-term loss of nipple projection. The objective of this study is to evaluate the long-term result and clinical efficacy of nipple reconstruction using skate flap technique after breast reconstruction. METHODS: A retrospective chart review was carried out on 23 patients who underwent 25 nipple reconstructions. In those patients with greater than 10 mm nipple projection, reconstruction with skate flap and full-thickness skin graft and/or tattooing was performed. Maintenance of nipple projection was then carefully assessed over one-year follow-up. The following factors were analyzed: type of breast reconstruction, type of areola reconstruction, follow-up period, decrease in nipple projection, complication, and whether secondary nipple reconstruction was necessary and/or performed. RESULTS: Breast reconstructions were performed in 17 patients with free transverse rectus abdominis musculocutaneous flap, 3 patients with extended latissimus dorsi musculocutaneous flap, and 3 patients with expander and implant. The mean follow-up after nipple reconstruction was 17 months. Mean loss of projection were 17.0 +/- 13.99%, 25.0 +/- 12.70%, 30.0 +/- 12.57% and 30.8 +/- 12.49% at 3, 6, 9 months and over one year, respectively. The greatest decrease in projection was noted in the first 3 months following surgery. CONCLUSION: These results indicated that nipple reconstruction with skate flap showed about 70 percent of the projection achieved over one year postoperation. Therefore, the skate flap may be a reliable method of nipple reconstruction in those patients with greater than 10 mm nipple projection.
Breast ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Nipples ; Rectus Abdominis ; Retrospective Studies ; Skin ; Tattooing ; Transplants

PURPOSE: Subungual tumors are a common cause of nail plate deformity, and may be caused by fibrokeratoma, Koene's tumor and glomus tumors. Neurofibromas, either as part of neurofibromatosis or as a solitary tumor are exceptionally rare in the digits. METHODS: A 44-year-old man presented with painless onychodystrophy and nail plate elevation of the right thumb due to a small subungual mass that had started growing 3 years ago. Sensory evaluation of the distal phalanx was normal, and no discoloration nor infection signs were seen. The nail plate was extracted under local anesthesia, and the mass was delicately removed without injury to the nail bed. The nail matrix was repaired with primary closure. RESULTS: Histopathology shows a well circumscribed, cellular tumor with myxoid stroma. Tumor cells were S-100 protein positive, and the patient was diagnosed with myxoid neurofibroma. There has been no sign of recurrence to date, 14 months after the operation. CONCLUSION: Presentation of cutaneous neurofibromas in the digits is an uncommon finding. They may occur as a manifestation of neurofibromatosis or as a solitary tumor. Subungual neurofibromas are exceptionally rare. To our knowledge, there are only ten reports of solitary subungual neurofibroma unrelated to neurofibromatosis to date. We report a rare case of solitary subungual myxoid neurofibroma of the thumb, that was treated through total excision, with preservation of the nail matrix.
Adult ; Anesthesia, Local ; Congenital Abnormalities ; Glomus Tumor ; Humans ; Nail Diseases ; Nails ; Neurofibroma ; Neurofibromatoses ; Recurrence ; S100 Proteins ; Thumb

PURPOSE: The injection of various materials, including medical fillers and unregulated products, is widespread, potentially causing the development of foreign body granulomas. Should this occur on the nose, the contour deformity and inflammatory signs that result from these granulomas are aesthetically undesirable to patients. The purpose of our study is to share our experiences using different surgical approaches, depending on the affected portion of the nose, to optimize management of this challenging problem and to evaluate patient's satisfaction using our in-house questionnaire along with degree of improvement by two independent plastic surgeons. METHODS: We treated 18 patients who underwent surgical excision of nasal foreign body granulomas via a perilesional approach to the lesion (n=12) or by transcolumellar incision (n=6) at our hospital over a period of seven years from March 2003 to October 2010. Nonparametric statistics were used and are presented as medians (25th-75th). Patient satisfaction was evaluated on a scale of 1 to 5 using an in-house questionnaire. All pre-and post-operative photographs were analyzed by two independent plastic surgeons. Post-operative outcomes were evaluated based on the surgeons' consensus ratings. RESULTS: All patients receiving the transcolumellar approach reported a high level of satisfaction with the results. All but two patients who received the perilesional approach were satisfied with the outcome. No outcomes were rated as no change or worse by the consensus ratings. CONCLUSION: For the upper two-thirds of the nose, perilesional surgical excision can lead to substantial patient satisfaction with modified contour deformity and infection control. The transcolumellar approach resulted in better outcomes and patient satisfaction for the lower one-third of the nose.
Congenital Abnormalities ; Consensus ; Foreign Bodies ; Granuloma ; Granuloma, Foreign-Body ; Humans ; Infection Control ; Nose ; Paraffin ; Patient Satisfaction ; Surveys and Questionnaires