PURPOSE: The importance of the deformities in alar - columellar complex has been underestimated in Asian ethnic groups for the last few decades. Fortunately, with increasing familiarity of the open rhinoplasty techniques, the anatomic details of the nasal tip have been pointed up. Definitely, having an interest and demand for improving the sub-normal relationship between the alar rim and columella are indebted for such growing of knowledge about nasal tip anatomy. However, it is true that any single procedure is not settled as versatile and fully confident modality to correct the retracted notching of the alar rim. With this article, I would like to propose another useful option for treating retracted ala. METHODS: The authors have tried to correct alar rim retraction by means of: (1) Triangular onlay septal cartilage graft on the lower lateral cartilage with the medial end fixed to the anterior surface of the lateral crus(Alar extension graft), (2) Inserting lateral end of the alar extension graft to the vestibular skin pocket in the form of a finger-in-groove, (3) using the vestibular skin in the form of an advancement flap, and (4) using the soft shield graft to prevent possible visible step-off of the alar margin. RESULTS: The authors applied an alar extension graft to 16 patients in order to correct a retracted ala for the last 27 months (August 2003-October 2005). The distance from alar rim to long axis of nostril was improved to be within 2mm in all cases, and also the shape of the alar rim changed to a round form. Nostril asymmetry (6%) was observed in one case, temporary palpable step-off (18%) in three cases, temporary visible step-off (6%) in one case, and temporary paresthesia of the tip (25%) in four cases, respectively. CONCLUSION: The alar extension graft is simple and efficacious. It does not need donor sites other than the operative field, and its results are predictable. In particular, since it may give structural intensity to a weak lower lateral cartilage, it may be preferentially used for the correction of a retracted ala that arises from hypoplastic lower lateral cartilage. Moreover intensified lower lateral cartilage also improves the esthetic shape of lobule.
Asian Continental Ancestry Group ; Axis, Cervical Vertebra ; Cartilage ; Congenital Abnormalities ; Ethnic Groups ; Humans ; Inlays ; Paresthesia ; Recognition (Psychology) ; Rhinoplasty ; Skin ; Succinates ; Tissue Donors ; Transplants

BACKGROUND: Skin cancer is divided into two categories, melanoma and nonmelanoma skin cancer, by its malignant potential. The former is prone to be metastatic and it often requires regional lymph node dissection and chemotherapy, while the latter is rarely metastatic with no need for such further treatment. We report here on the reconstruction methods after surgical removal of skin cancers, with excluding melanoma. OBJECTIVE: Our purpose was to analyze the reconstruction methods according to the location and size of the lesions after surgical removal of nonmelanoma skin cancers and we report on the clinical findings. METHODS: We analyzed 186 cases of nonmelanoma skin cancers that were treated Between January, 2000 and December, 2006 at the Department of Dermatology, Chonbuk University Hospital. The cases were analyzed according to the reconstruction methods for the defects after surgery, the gender ratio, the age range, the lesion site and the lesion size. RESULTS: The mean age of onset was 67.7 years old. The ratio of men to women was 1:1.02. The most common nonmelanoma skin cancer was basal cell carcinoma (66.7%), followed by squamous cell carcinoma (22.1%), and Bowen's disease (4.3%). The most common site of all the nonmelanoma skin cancers was the face (68.8%), followed by the trunk (7.5%) and scalp (6.5%). The most common reconstruction method was local flap (40.3%), followed by primary closure (38.7%), skin graft (18.8%) and secondary intention (2.2%). In terms of location, the most commonly used method was local flap for the face (50.0%) and primary closure for the trunk (53.3%), scalp (83.3%) and the upper (44.4%) and lower extremities (63.6%). According to the lesions' size, the most common method was flap for tumor between 10 mm and 30 mm in diameter (95.1%), primary closure for tumor less than 10 mm in diameter (66.7%) and graft for tumor greater than 30 mm in diameter (66.7%). CONCLUSION: We offer this data for the reconstruction methods of nonmelanoma skin cancers and their clinical findings in Korea.
Age of Onset ; Bowen's Disease ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Dermatology ; Female ; Humans ; Intention ; Korea ; Lower Extremity ; Lymph Node Excision ; Male ; Melanoma ; Scalp ; Skin ; Skin Neoplasms ; Transplants

No abstract available.
Occupations

No abstract available.
Intubation, Intratracheal* ; Lacerations*

PURPOSE: The reverse digital island flap is useful for the repair of various fingertip injuries. We present a modified surgical technique with skin strip elevation for the prevention of postoperative congestion. METHODS: From January 2005 to October 2015, we performed 31 reconstructive procedures for finger injury using a reverse digital artery island flap with and without skin strip retention. Patients' clinical characteristics, surgical outcomes, and complications were investigated. RESULTS: All flaps survived and there were no donor site problems. The mean follow-up time was 5 months (range, 3-8 months). In skin strip retention group, mild venous congestion was observed in 1 case, although it resolved spontaneously. Another case retained flexion contracture, and 2 patients had stiffness at the distal interphalangeal joint. Whereas, in no retention group, venous congestion was observed in 3 cases, 1 patient had partial flap necrosis and 2 patient suffer in flexion contracture at metacarpophalangeal joint. CONCLUSION: The reverse digital island flap procedure produces consistent results and is reliable for the treatment of fingertip injury. Our modified surgical technique of elevating the flap accompanied by skin strip retention helps prevent postoperative congestion.
Arteries ; Contracture ; Estrogens, Conjugated (USP)* ; Finger Injuries ; Follow-Up Studies ; Humans ; Hyperemia ; Joints ; Metacarpophalangeal Joint ; Necrosis ; Skin* ; Tissue Donors

PURPOSE: Varicella-zoster virus (VZV) infection is a common childhood disease. However, old and immune compromised patients are also at risk. Necrotizing fasciitis is a life threatening infection of the subcutaneous tissues, rapidly extending along the fascial planes. It is associated with a significant mortality rate, reported between 20% and 50%, and is therefore regarded as a surgical emergency. The authors treated a patient, who developed skin necrosis of her nose and left hemifacial area, following VZV infection. There are few literatures concerning this case; therefore, we present a rare case with review of literature. METHODS: A 39-year-old woman had shown a localized, painful, multiple bullae and eschar formation in her nose and left hemifacial area for several days. Her skin lesion had rapidly worsened in size and morphology. RESULTS: We diagnosed her as a necrotizing fasciitis, following herpes zoster, and then we performed a debridement of necrotic tissue and took a full thickness skin graft on her nose and left hemifacial area. Now, she was followed up with acceptable aesthetic result after 6 months. CONCLUSION: Secondary bacterial skin infection following VZV, can cause a result in a higher risk of complications. Among the complication, a necrotizing fasciitis of the head and neck is uncommon, and involvement of the nose is even more rare. Through this uncommon case report, we intend to emphasize the fact that early diagnosis of necrotizing fasciitis is very important, since it frequently necessitates surgical treatment which improves morbidity and leads to good recovery.
Adult ; Blister ; Debridement ; Early Diagnosis ; Emergencies ; Fasciitis, Necrotizing ; Female ; Head ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Neck ; Necrosis ; Nose ; Skin ; Subcutaneous Tissue ; Transplants

PURPOSE: High-pressure injection injury is caused by accidental injection of the high-pressure injection devices in industry. The initial benign appearance of the wound fools patients into delays in an adequate treatment. And it can result in disastrous outcomes such as necrosis and amputation. To avoid the poor prognosis, the injuries require a prompt surgical intervention. The purpose of this article is to recognize the poor outcome of the high-pressure injection injury and to introduce an adequate treatment in need. METHODS: We have 4 cases of the high-pressure injection injuries in the hand from April, 2005 to March, 2009. Average age is 39 years (30-49 years old), 2 cases are the palm of dominant hand, 1 case is the thumb of dominant hand, and 1 case is the palm of non-dominant hand, respectively. We followed up these patients for 20 months on average. In 3 cases, the immediate, aggressive surgical intervention was carried out, but the other one was delayed in early adequate treatment. The wounds were covered by local advancement flap, anterolateral thigh free flap, conservative treatment with antibiotics and dressing. RESULTS: No pathogens after culture were found nor any findings of fracture in imaging study. Conservative treatment, local advancement flap and anterolateral thigh free flap for the open wound resulted in a desirable aesthetic outcome. In a long-term follow up, functional capability of the patient was also satisfactory. CONCLUSION: Upon initial evaluation, most high-pressure injection injuries present as innocuous wounds with very few symptoms and result in delaying the proper management. And the majority of high-pressure injection injuries will produce significant morbidity to the hand, amputation. And the initial aggressive surgical debridement was needed to prevent the poor outcome. The key to success in treating high-pressure injection injuries of the hand is the prompt aggressive surgical intervention.
Amputation ; Anti-Bacterial Agents ; Bandages ; Debridement ; Follow-Up Studies ; Free Tissue Flaps ; Hand ; Humans ; Necrosis ; Prognosis ; Thigh ; Thumb

BACKGROUND: Chondroid syringoma is a rare benign tumor composed of epithelial and stromal elements. Studies of chondroid syringoma are lacking in Korea and controversy still exists regarding the stromal cell origins. OBJECTIVE: To investigate the clinicopathological and immunohistochemical characteristics of chondroid syringoma in Korea. METHODS: We included 23 patients who were diagnosed with chondroid syringoma. RESULTS: There was a predilection for males (M : F=2.3 : 1), and the mean patient age was 50.4+/-15.4 years (range 22~78 years), peaking in the forties. Of the 23 cases, 22 (95.7%) had it on the head and neck. There were 21 apocrine type cases and 2 eccrine type cases. Apocrine type cases showed decapitation secretion as well as follicular and sebaceous differentiations. Myxohyaline matrix was present in all cases, and in some cases, chondroid, lipomatous, and osseous metaplasias were also observed. In apocrine type cases, inner cell layers displaying tubuloglandular structures expressed cytokeratin, carcino-embryonic antigen, and epithelial membrane antigen, while outer cell layers expressed vimentin, S-100 protein, neuron-specific enolase, and smooth muscle actin. Stromal cell immunophenotypes were similar to those of the outer layer. CONCLUSION: Chondroid syringoma was most commonly observed on the head and neck in middle-aged males. The apocrine type was far more common than the eccrine type and showed various differentiating characteristics. The matrix may contain myxohyaline stroma with alterations, including chondroid, lipomatous, and osseous metaplasias. Our immunohistochemical study suggests that myoepithelial cells play an important role in the histogenesis of chondroid syringoma and matrix production.
Actins ; Adenoma, Pleomorphic* ; Decapitation ; Head ; Humans ; Keratins ; Korea ; Male ; Metaplasia ; Mucin-1 ; Muscle, Smooth ; Neck ; Phosphopyruvate Hydratase ; S100 Proteins ; Stromal Cells ; Vimentin

PURPOSE: Marjolin's ulcer is rare but highly aggressive malignant cancer that is associated with chronic, nonhealing wounds such as burn wound. There are no confirmed effective protocols for treatment of this disease. This study was conducted to describe the clinical presentation and treatment modalities of Marjolin's ulcer in our hospital. METHODS: This was a retrospective study of Marjolin's ulcer. 20 cases were histologically confirmed malignant skin cancer seen at Chonbuk National University Hospital from January 2000 to December 2011. Data were retrieved from patients' medical records and photographs. RESULTS: The total 20 cases of Marjolin's ulcer were studied. Squamous cell carcinoma was the most common pathological type in 20 patients (100%). Lymph node metastasis at the time of diagnosis was recorded in 3 patient (15%). Wide excision was the most common surgical procedure performed in 17 patients (85%) of cases. The reconstruction modalities were various as free flap 3 patients (15%), skin graft 13 patients (65%), local advancement flap 2 patients (10%) and regional flap 1 patient (5%). Local recurrence was noted in 3 patients (15%) who had surgical treatment. And one patient (5%) expired in hospital. CONCLUSION: Marjolin's ulcer is an infrequent lesion. Unfortunately the diagnosis and treatment are often delayed. If the wound was histologically confirmed, aggressive excision and reconstruction is warranted in these highly malignant skin cancer. Early recognition and aggressive treatment of Marjolin's ulcers are essential to improve outcomes.
Burns ; Carcinoma, Squamous Cell ; Free Tissue Flaps ; Humans ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Skin ; Skin Neoplasms ; Transplants ; Ulcer

No abstract available.
Carcinoma, Squamous Cell*