Eccrine spiradenoma is clinically characterized by a solitary, movable, tender noduie occurring most frequently on the ventral surfase of the upper body. A striking symptom is paroxysmal pain. Histopathologically, the encapsulated lobules of the tumor are composed of masses of basophilic cells, usually arranged in whorls, cords, and pseudogland.s. Within the whorls and pseudoglands, two types of celIs are notedperipheral intensely staining cells and central pale-staining cells. We describe herein a patient with an indolent eccrine spiradenoma, which had been diagnosed histopathologically.
Basophils ; Humans ; Strikes, Employee

Various surgical methods have been used to reconstruct severe soft tissue defects of the finger with exposed critical structures such as tendon, bone, and nerve. Some of these methods include rotation flap, cross finger flap, or regional flap similar to neurovascular island flap. However, there were often difficult situations where a flap could not be applied depending on the remaining surrounding tissue, injured area, and size of defect. As a result, free flap or distant flap may become necessary. However, distant flaps often cause stiffness of the finger joints since the hands need to be immobilized for a long time, while standard free flaps may be too thick to cover the finger and cause problems such as morbidities of the donor site. Since May, 1997, at Anam Hospital, we have performed reconstruction on 6 patients with soft tissue defect using a thin, flexible medial plantar septo-cutaneous free flap similar to the volar aspect of the finger in anatomical characteristics of the skin and subcutaneous tissue covering. The vessels used for this flap were superficial branches of medial division of the medial plantar artery and vena comitantes, or the subcutaneous veins. The mean size of the flaps was 2.75cm x 4.25cm. Primary repair or split-thickness skin graft was performed on the donor site depending on the size. All the flaps survived without significant complications, except one case of venous insufficiency. The composition of the transferred flaps was good with the recovery of pain, touch and temperature sensation. A free medial plantar septo-cutaneous flap has several advantages, e.g., it is small in comparison with other standard free flaps, having two draining venous pathways, good color and texture, and a good recovery of protective sensation. This flap can be used for the reconstruction of soft tissue defect on the heel and foot, as well as the volar aspect of fingers.
Arteries ; Finger Joint ; Fingers ; Foot ; Free Tissue Flaps* ; Hand ; Heel ; Humans ; Sensation ; Skin ; Subcutaneous Tissue ; Tendons ; Tissue Donors ; Transplants ; Veins ; Venous Insufficiency

Microform cleft lip is a mild form of incomplete cleft lip, also known as a minimal occult, abortive, forme fruste cleft lip. However, it has no definition and few methods have been reported for its correction. A microform cleft lip is characterized as the incomplete union of the superficial portion of the orbicularis oris muscle. It is more prominent during facial expression than in a resting state. We confined microform cleft lip in our study to the absence of philtral skin change and a contracted position on the top of cupid's bow. During the past 5 years, 17 patients of microform cleft lip were operated on. We corrected the defect of the upper vermilion border and nostril sill with minimal incision, and repaired the underlying lip musculature in superficial discontinuity. Reduction of the widened alar base was performed. Deformed alar cartilage was dissected via rim incision, and suspended in a medial and upper direction with pull-out sutures. The most important thing is precise repair of the superficial portion of the separated orbicularis oris muscle via minimal incision, and it is best to operate after 1-year of age for accurate repair. The results were satisfactory and the parents were also satisfied. The advantages of this procedure are as follows: 1. Less visible, minimal scar on upper lip 2. Simultaneous correction of vermillion notching, deformed cupid's bow and nasal deformity. 3. Eversion of philtral ridge due to tenting effect of horizontal mattress suture 4. Philtral elongation effect by reduction of alar base and Z-plasty of cupid's bow.
Cartilage ; Cicatrix ; Cleft Lip* ; Congenital Abnormalities ; Facial Expression ; Humans ; Lip ; Microfilming* ; Parents ; Skin ; Sutures

Scalp extension involves the continuous nonvolumetric expansion of the hair-bearing scalp, via biologic creep, using implanted surgical device consists of cutting a 5 cm wide strip of plain silastic (0.02 inch thick) from a larger 16x8 inch sheet, then gluing dacron-reinforced silastic strip (5x1 cm, 0.015 inch thich) to the distal ends. A stainless steel plate from hooks is then secured to each end of the extender. During the period from March 1996 to September 1997, 21 patients including 16 patients of male pattern baldness were treated for alopecia of the scalp using internal scalp extender in the department of plastic surgery Korea university hospital. All cases were successfully reconstructed without major complications. It not only reduces the number of scalp reductions and time necessary to totally excise bald vertex scalp, but also appears to decrease the amounts of stretch back and atrophic scarring that may accompany some reductions. Scalp extension appears to be a useful adjunctive technique in hair replacement and reconstructive surgery, and has distinct advantages over standard scalp reduction and tissue expansion techniques.
Alopecia* ; Cicatrix ; Hair* ; Humans ; Korea ; Male* ; Scalp* ; Stainless Steel ; Surgery, Plastic ; Tissue Expansion

For the last 20 years, several different techniques of fat injections have been developed. However, a standard technique of fat grafts has not yet been adopted for all practitioners. The purpose of this study was to evaluate the safety and long-term results of fat grafts using the modified Colman's technique. A total of 234 patients who underwent fat injections were retrospectively reviewed. The results were evaluated by patient satisfaction and photographs. The patient satisfaction was assessed using visual analogous scale(VAS), and photographs were evaluated by medical professionals. The fat was harvested using tumescent liposuction with a two hole Coleman harvesting cannula, and centrifuged at 3000rpm for 3 minutes. The refined fatty tissue was then transferred into a 1-ml syringe, and injected subcutaneously using 17-gauge cannula. The amount of fat tissue placed with each withdrawal of a cannula was 0.3~0.5mL. This technique showed good results with long-lasting volume consistency and few complications. The average value of VAS scored by patients was 8.7, and that by surgeons was 8.5, showing statistically no significant difference between the values evaluated by patients and surgeons. Author's fat injection procedure is a good choice for the correction of cosmetic defects and facial rejuvenation.
Adipose Tissue ; Catheters ; Cosmetics ; Follow-Up Studies ; Humans ; Lipectomy ; Patient Satisfaction ; Rejuvenation ; Retrospective Studies ; Syringes ; Transplants

PURPOSE: The epicanthus is a specific feature in Asian. Many techniques have been described to eliminate the epicanthal fold: resection of glabellar skin, resection of medial canthal skin, V-Y advancement, V-W technique, modified Z-plasty, multiple Z-plasties, and others. The authors observed postoperative epiphora after correction of epicanthal fold by periciliary skin flap without damaging lacrimal duct. METHODS: A 19-year-old woman underwent non-incisional blepharoplasty, septorhinoplasty, and periciliary epicanthoplasty. On her history, she didn't have any symptom of epiphora preoperatively. And there was no specific complaint of epiphora during the postoperative two weeks. However epiphora got worse from one month after the surgery. She was out of this country, so the patient re-visited the clinic on the postoperative six months for this on-going symptom. On an ophthalmologic examination, patient's lacrimal duct and sac was intact but both lacrimal puncta of the patient were covered with a thin membrane. This membrane was punctuated by a 25 gauge needle and dilated with a standard dilator. RESULTS: After ophthalmologic treatment, no recurrence was observed during five weeks of follow-up periods. CONCLUSION: Both lacrimal puncta of the patient were only covered with membranes. And we could not confirm the direct relationship between periciliary epicanthoplasty and postoperative epiphora. The probable factors will be a predisposing narrowed punctum, post operative peri-punctal edema and decrease in muscular function of orbicularis oculi.
Asian Continental Ancestry Group ; Blepharoplasty ; Edema ; Female ; Follow-Up Studies ; Humans ; Lacrimal Apparatus Diseases ; Membranes ; Needles ; Recurrence ; Skin ; Young Adult

It is not well known how the un-operated contralateral hand behaves in bilateral carpal tunnel syndrome(CTS). Out of 324 CTS patients, we studied 20 who had carpal tunnel release on one hand only, in order to evaluate the postoperative outcome of the un-operated contralateral hand in bilateral carpal tunnel syndrome. All 324 patients were subject to clinical and electrodiagnostic studies on both hands. This study group was composed of patients who had bilateral CTS, diagnosed clinically and electrophysiologically, but who had surgery done only on the hand with the most pronounced symptoms. The results of the electrodiagnosis were categorized according to the severity of median nerve damage (mild, moderate, severe). The decision for surgery was based on clinical assessment and electrodiagnostic study. The outcome and postoperative clinical course of the un-operated contralateral hand were evaluated by EMG and telephone survey. This method of survey was used because of the patients' residence area spread throughout the country. Within one year, all 20 operated hands showed significant improvement. Regarding progress of the un-operated contralateral hand, 10 patients showed improvement of one grade, while five patients showed three grades of improvements. In five other patients, there was no change whatsoever. The postoperative EMG findings of the un-operated contralateral hand did not commensurate with the symptoms. However, regardless of EMG results, the un-operated contralateral hand showed improvement that was of statistical significance(p < 0.0001).
Carpal Tunnel Syndrome* ; Electrodiagnosis ; Hand* ; Humans ; Median Nerve ; Telephone

A variety of treatments has been used to correct long forehead and frontal alopecia. These include forehead reduction (scalp reduction), hair graft and flap transfer. Among these procedures, forehead reduction (scalp reduction) is the most simple and effective method. In this procedure, various fixation techniques of scalp flap to cranial bone are used to prevent retraction of the scalp. We used Sherlock (or Piranha) screw to anchor the scalp flap to cranial bone. Between August 1998 and May 2000, this technique had been performed for 37 patients. Average follow-up period was 15 months. For forehead reduction (scalp reduction), the scalp was elevated back to the occipital region through a pretrichial incision, and relaxation incisions of galea was made at a right angle to the vector of advancement. The Sherlock (or Piranha) screw was fixed to the cranial bone. The entire scalp was then repositioned anteriorly, advancing the hairline caudally and shortening the forehead. Retraction of the scalp was prevented by anchoring the galeal fascia to the cranial bone using Sherlock (or Piranha) screws. This technique allows sufficient advancement of the scalp and a tension-free closure. Postoperatively scar widening was less than that of other methods. There were not any infection, hematoma, hair loss nor permanent paresthesia on scalp. In 2 cases, screws were palpable and we removed a screw for 1 case. Advantages of using Sherlock (or Piranha) screw are that the procedure is easy and simple, and sufficient advancement of the scalp, tension-free closure, and less scar widening can be achieved. Disadvantages of this procedure include cost of screw and palpability of screw. In conclusion, by using Sherlock (or Piranha) screw, the procedure was simple and we could get aesthetically good results.
Alopecia ; Cicatrix ; Fascia ; Follow-Up Studies ; Forehead* ; Hair ; Hematoma ; Humans ; Paresthesia ; Relaxation ; Scalp* ; Sutures* ; Transplants

Satisfactory surgical reconstruction of the external ear and nose is still a major challenge for the plastic surgeon. Therefore, the use of prosthesis in selected cases should be considered as viable alternative. During the period from December, 1995 to January, 1998, 10 patients, including 9 patients of ear defect and 1 patient of nose defect resulting from the resection of recurrent tumor ablation, were reconstructed by using osseointegration and prosthesis. The surgery was performed in two stages. All procedures were performed under local anesthesia and on an outpatient. At the first stage, the fixtures of titanium implant were placed in the mastoid process and maxilla. These implants were then left for 3 months before the second stage takes place, in which the skin penetrating abutments were attached. After 3-4 weeks, the impression of the defect area were taken and the silicone prosthesis was made by Anaplastologist. Two patients had focal infection but healed without problem. One patient had soft tissue infection, then flap was excised and skin graft performed. There was one loss from 20 fixtures, that was 3 years after implantation. We have concluded that osseointegration for reconstruction of the ear and nose defect is simple, soft, reliable method, which is more than autologous reconstruction and provides excellent aesthetic results.
Anesthesia, Local ; Ear ; Ear, External ; Focal Infection ; Humans ; Mastoid ; Maxilla ; Nose* ; Osseointegration* ; Outpatients ; Prostheses and Implants ; Silicones ; Skin ; Soft Tissue Infections ; Titanium ; Transplants

Maintaining patient safety in and outside the operating room is a major concern of plastic surgeons. Circumventing preventable complications is essential, as public acknowledgement and interest in the complications of cosmetic surgery rises. The plastic surgery patient is generally considered a safe candidate for surgery, but his or her health may have masked problems, and generally superficial surgery can still be subject to the common risks of surgery. Patient education and information on the procedure and the risks, benefits, and alternatives can help avoid surprise and confusion if a complication does occur. Peer-review systems in the form of weekly or monthly morbidity reporting conferences can help identify practice patterns that increase risks and can ultimately improve patient safety. After reviewing a patient's medical history, doing a thorough physical examination and review of systems, and pertinent laboratory or radiographic testing, the physician should select the patient's appropriate classification from the anesthesiologist's physical rating. Preparation and consideration for the common risks of plastic surgery should help to improve perioperative safety.
Classification ; Congresses as Topic ; Humans ; Masks ; Operating Rooms ; Patient Education as Topic ; Patient Safety* ; Perioperative Care ; Physical Examination ; Plastics ; Surgery, Plastic*