A patient with frontal sinus hypertrophy complained about an bossing in eyebrow region, increased width of the upper nasal pyramid, inferior displacement of the eyebrow and deep furrows in his forehead, etc. This case report illustrated a method of correction for frontal sinus hypertrophy. Surgery was performed via the bicoronal incision. After the anterior wall of the frontal sinus was removed, we tried a frontal bone remodeling by dividing it into three pieces, trimmming each piece at the margin and fixed with microplate. Bilateral thick bony portions around the frontal sinus were shaved with a surgical burr. At the same time, a 1cm-forehead lift and frontal muscle partial resection was performed. A satisfactory aesthetic result with a smooth and wide forehead could be obtained by employing this technique.
Eyebrows ; Forehead* ; Frontal Bone* ; Frontal Sinus* ; Humans ; Hypertrophy*

Purpose: Currently, the most recommended method for burn first aid is the cool running water for 20 minutes (CRW20). If CRW20 is not practicable, cooling dressing products with tea tree oil are used as substitutes. In this study, we analyze the effect of various burn first aids, including CRW20, cooling products, on the treatment period. Methods: This study was conducted on patients who suffered burns and visited Hangangsoo Hospital from March 2019 to March 2020. The study conducted in a retrospective method. The duration of treatment was analyzed by dividing the experimental group. Results: The treatment period was shortened when first aid was given (P＜0.001). Cold water, ice, and ice packs resulted in reduced treatment periods (P＜0.001, P=0.004). The treatment period was reduced when cooling dressing products were used in all groups (P=0.041). The implementation of first aid has reduced the duration of burn treatment. This means that cooling helps burn treatment. CRW20 did not show statistically meaningful results. This is the result of a failure to fully control the temperature and time of tap water. In addition, the change in temperature of tap water according to season, the use of water is higher than that of animal testing, and the general lack of information on proper burn first aid may have affected. Conclusion The treatment period was statistically significantly reduced in the group that performed first aid. Among the various first aid methods, cold water and ice reduced the treatment period.

Purpose: Currently, the most recommended method for burn first aid is the cool running water for 20 minutes (CRW20). If CRW20 is not practicable, cooling dressing products with tea tree oil are used as substitutes. In this study, we analyze the effect of various burn first aids, including CRW20, cooling products, on the treatment period. Methods: This study was conducted on patients who suffered burns and visited Hangangsoo Hospital from March 2019 to March 2020. The study conducted in a retrospective method. The duration of treatment was analyzed by dividing the experimental group. Results: The treatment period was shortened when first aid was given (P＜0.001). Cold water, ice, and ice packs resulted in reduced treatment periods (P＜0.001, P=0.004). The treatment period was reduced when cooling dressing products were used in all groups (P=0.041). The implementation of first aid has reduced the duration of burn treatment. This means that cooling helps burn treatment. CRW20 did not show statistically meaningful results. This is the result of a failure to fully control the temperature and time of tap water. In addition, the change in temperature of tap water according to season, the use of water is higher than that of animal testing, and the general lack of information on proper burn first aid may have affected. Conclusion The treatment period was statistically significantly reduced in the group that performed first aid. Among the various first aid methods, cold water and ice reduced the treatment period.

PURPOSE: Talipes equinus deformity is defined as impossibility of heel weight-bearing and lacking of improvement of toe-tip gait despite sufficient duration of conservative treatment. The incidence of equinus deformity induces post-traumatic extensive soft tissue defect and subsequently increases it. Severe equinus deformities of the foot associated with extensive scarring of the leg and ankle were corrected using achilles Z-lengthening and free-tissue transfer. METHODS: Free radial forearm flap was done in nine cases of eight patients from January 2000 to November 2006. Causes of deformity were post-traumatic contracture (one patient) and post-burn scar contracture (seven patients). Seven patients were male, one patient was female. Mean age was 32.1 (range, 10-57). Flap donors were covered with artificial dermis (Terudermis(R)) and split thickness skin graft (five cases), and medium thickness skin graft only (four cases). RESULTS: The size of flaps varied from 6x12 to 15 x12cm (average, 12x7.8cm). Achilles tendon was lengthened 4.2cm on average. Free radial forearm flap was satisfactory in all cases. All patients could ambulate normally after the surgery. Cases having donor coverage with Terudermis(R) were aesthetically better than those having skin grafts only. CONCLUSION: This study suggested that severe equinus deformities associated with extensive scarring of the leg and ankle can be corrected effectively free radial forearm flap and Achilles tendon lengthening.
Achilles Tendon* ; Ankle ; Cicatrix ; Clubfoot* ; Congenital Abnormalities* ; Contracture ; Dermis ; Equinus Deformity* ; Female ; Foot ; Forearm* ; Gait ; Heel ; Humans ; Incidence ; Leg ; Male ; Skin ; Tissue Donors ; Transplants ; Weight-Bearing

PURPOSE: High tension electrical injuries result in major tissue(eg. bones, tendons, vessels and nerves) destruction. Therefore, the management of mutilating wrist caused by electrical injuries still represents a challenge. There are various approaches to this problem including local and regional flaps as well as pedicled distant flaps and microsurgical free tissue transfer. Although it has not gained wide acceptance, because of the technically demanding dissection of the pedicle, posterior interosseous flap is now well accepted for the reconstruction of hand and wrist in hand surgery. The principal advantages of this flap are minimal donor site morbidity, minimal vascular compromise, one stage operation. This flap also offers the advantages of ideal color match and composition. In this report, we describe our experience with the reverse posterior interosseous island flap for reconstruction of mutilating wrist with main vessel injuries. METHODS: From October, 2004 to June, 2006, we treated 11 patients with soft tissue defects and main vessel injuries on the wrist that were covered with reverse posterior interosseous island flap. RESULTS: These 11 patients were all male. The ages ranged from 27 to 67 years(mean age 41.75) and the follow-up period varied from 4 to 19 months. Complete healing of the reverse posterior interosseous island flaps were observed in 11 patients(12 flaps). The majority of these flaps showed a certain degree of venous congestion, which in a flap was treated with medical leech. 1 flap has partial necrosis owing to sustained venous congestion, requiring secondary skin graft. flap size varied from 3.5x8cm to 10x12cm(mean size 6.4x8.9m). The donor site defect was closed directly in 5 flaps, and by skin graft in 7 flaps. CONCLUSION: We found that the reverse posterior interosseous island flap is reliable and very useful for reconstruction of mutilating wrist and we recommend it as first choice in coverage of soft tissue defects in the wrist with electrical arc injuries.
Follow-Up Studies ; Hand ; Humans ; Hyperemia ; Male ; Necrosis ; Skin ; Surgical Flaps ; Tendons ; Tissue Donors ; Transplants ; Wrist*

PURPOSE: A wart is caused by epidermal infection with the human papilloma virus. Although wart naturally disappears in some cases, it require treatment because of pain, aesthetic problem, and the possibility of malignant change. Conventional non-surgical treatment cannot be a fundamental solution for the pain and has such disadvantages as frequent recurrence and difficulties in achieving a satisfactory outcome. A surgical procedure was performed on patients with wart and the procedure had a good outcome. METHODS: We investigated the gender, age, lesion site, mean treatment duration, and presence or absence of recurrence in 21 patients with a wart within the period of January 2007 to July 2011. For local lesions, primary closure, including subcuticular suture after the excision, was performed. If the defect size was too big to do primary closure, we performed rotation flap. For wide multiple lesions, a split thickness skin graft was performed. RESULTS: Among the 21 patients, 12 patients were male and 9 patients were female, and their mean age was 42 years(SD=17.38, range: 11~75 years). The lesion site was the foot in 10 patients, the hand in 8 patients, the face in 2 patients, and the scalp in 1 patient. The mean treatment duration was 13.5 days(SD=4.36, range: 6~15 days) for the primary closure or rotation flap, and 18.5 days(SD=2.12, range: 17~20 days) for the skin graft. 20 patients were cured without recurrence. No recurrence was observed in the patients who underwent primary closure or rotation flap. One of the two patients who underwent a skin graft of their wart that had covered their entire palm had local recurrence in part of her finger tips. CONCLUSION: We performed surgical procedure on recalcitrant wart. As a results, we can treat it with short treatment duration, low recurrence rate and less scarring and get high patient satisfaction.
Cicatrix ; Female ; Fingers ; Foot ; Hand ; Humans ; Male ; Papilloma ; Patient Satisfaction ; Recurrence ; Scalp ; Skin ; Sutures ; Transplants ; Viruses ; Warts

PURPOSE: The soft tissue injuries of the patellar area are difficult problems because of insufficient arterial blood supply and lack of muscle layer. There have been many methods for reconstructing the soft tissue injuries of the patellar area such as primary closure, skin graft, local flap and free tissue transfer. However, each method has some limitations in their application. After the first introduction, the fasciocutaneous flaps are widely used to reconstruct the soft tissue injuries. The saphenous nerve, one of the superficial sensory nerves in the lower leg, is supplied by the saphenous artery and its vascular network. We used the saphenous fasciocutaneous island flap to reconstruct the soft tissue injuries of the patellar area. METHODS: From March 2002 to May 2005, we used the saphenous fasciocutaneous island flap to reconstruct the soft tissue injuries of the patellar area. The flap was elevated with saphenous nerve, saphenous vein and saphenous artery and its vascular network. The flap donor site was reconstructed with primary closure or split-thickness skin graft. RESULTS: Five cases survived completely but 1 case developed partial necrosis of the skin on the upper margin of the flap. However, the necrosis was localized on skin layer, and we reconstructed with debridement and split-thickness skin graft only. After the operation, there was no contracture or gait disturbance in any patient. CONCLUSION: In conclusion, the saphenous fasciocutaneous island flap is safe, comfortable and effective method to reconstruct the soft tissue injuries of the patellar area.
Arteries ; Contracture ; Debridement ; Gait ; Humans ; Knee ; Leg ; Necrosis ; Saphenous Vein ; Skin ; Soft Tissue Injuries ; Tissue Donors ; Transplants

PURPOSE: DC cardioversion is the treatment choice for atrial fibrillation and flutter. Because of the high voltage power across the thorax, most patients suffer some degree of superficial erythema or burn at the pad site. 2nd or 3rd degree burn and muscle necrosis is very rare after shock. We experienced one case of 3rd degree burn with ulceration after DC cardioversion. METHODS: A 44-year-old male was admitted to local hospital with the presenting palpitation and atrial fibrillation on ECG. During radiofrequency catheter ablation (RFCA) for the treatment of atrial fibrillatoin, DC cardioversion was performed. The patient did not complain of any pain or discomfort at the pad site during or immediately after the procedure. Approximately 14 days after the shock, he had blisters at the pad site. But he received simple dressing treatment at the local hospital for 6 months. When he visited our burn clinic, there was 3x5 cm sized 3rd degree burn with eschar and necrotic fat tissue at the pad site of right back. Surgical removal of a necrotic tissue was performed on the patient by STSG (Split thickness skin graft) with Matriderm(R). RESULTS: Muscle fascia was exposed after debridement of the necrotic skin and fat tissue. The skin graft was well taken within 2 weeks after operation. CONCLUSION: In case of using monophasic 360 J, approximately 3,000 V energy is discharged. The energy is sufficient to cause burn injury to skin. Damage may result both thermal burn and electrical burn. The burn degree in the electric circuit is proportional to amperage and time, is inversely proportional to pad site area. We therefore suggest that in order to reduce deep burn, DC cardioversion is started with lower energy shocks, proper pad placement and correct pad application is important. And we give a notice that deep pad burn possibly occur after the cardioversion procedure.
Adult ; Atrial Fibrillation ; Bandages ; Blister ; Burns ; Catheter Ablation ; Debridement ; Electric Countershock ; Electrocardiography ; Erythema ; Fascia ; Humans ; Male ; Muscles ; Necrosis ; Shock ; Skin ; Thorax ; Transplants ; Ulcer

PURPOSE: In cases of high voltage electrical burns, a wound occurs as current enters or leaves the body and is accompanied by deep tissue injury. If upper extremity amputation is inevitable, consideration should be given to the residual limb functions, secondary reconstruction, and wearing of an upper prosthesis. Our hospital has achieved satisfactory outcomes through the use of a pedicled latissimus dorsi (LD) flap in patients undergoing transhumeral amputation and shoulder disarticulation due to upper extremity damage from high voltage electrical burns. METHODS: The study was targeted to five patients who suffered high voltage electrical burns, underwent above-elbow amputation, and were reconstructed in the acute and secondary phases using a pedicled LD flap from January 2005 to December 2011. All patients underwent equilateral pedicled LD flap surgery, with primary closure at the donating site. RESULTS: The average age of patients was 49.6 years (38~64); they were all male. One patient underwent sublayer skin grafting after a pedicled muscular LD flap, and four patients had a pedicled myocutaneous LD flap: one patient among the four had a forearm flap after the pedicled myocutaneous LD flap. All flaps were well adhered, and post-surgical flap reduction and local flaps were performed for adequate sizing and aesthetic improvement. CONCLUSION: In cases of upper arm amputation due to wide upper extremity damage caused by electrical burns, the use of the pedicled LD flap and adequate amputation length made subsequent wearing of a prosthesis possible. The pedicled LD flap procedure allowed reconstruction of a relatively large area of soft tissue and the surgery to the donating site was unproblematic.
Amputation ; Amputation Stumps ; Arm ; Burns ; Disarticulation ; Extremities ; Forearm ; Humans ; Male ; Prostheses and Implants ; Shoulder ; Skin Transplantation ; Upper Extremity

PURPOSE: The use of the Ondol, which is a traditional Korean floor heating system, has made the electric heating pad popular in Korea. Although the surface temperature of electric pads is around 45 degrees, rarely they can cause severe contact burns. Because an electric pad is usually used while sleeping, the skin could be exposed to heat and pressure for a prolonged period. The purpose of this study was to investigate the epidemiology and clinical features of these types of burns and to advise caution in the use of electric heating pads. METHODS: We performed a retrospective analysis of 58 cases identified from March 2007 to March 2012 at the Hangang Sacred Heart Hospital plastic surgery department. Collected data included sex, age, seasonal variation, distribution and extent of the burn, underlying disease, related factors, and treatment. RESULTS: Patients (23 females and 10 males) were predominantly in their twenties, with an average age of 40.7 years (range, 14~83). The majority of the burns occurred during winter (51.5%). According to the patients' histories, sleeping in a drunken state was the most common associated factor, with taking hypnotics and lying under spinal anesthesia being the second and third factors, respectively. Eight patients had diabetes mellitus and four patients had hypoesthesia after spinal cord injury and cerebral stroke. The lower extremity was the most commonly involved site (42.4%), followed by the buttocks (33%). The extent burn areas accounted for less than 2% of the total body surface area. But deep second degree and third degree burns were sustained that required surgical intervention. CONCLUSION: Unconsciousness and hypoesthesia were the primary factors that provoked contact burns related to the use of electrical pads. Although the percentage of body surface area burns is often small, the burns caused by electric pads can cause deep thermal injuries, necessitating the use of skin grafts and local flaps. These injuries could be prevented by taking precautions when using electric pads and by educating the public.
Anesthesia, Spinal ; Body Surface Area ; Burns ; Buttocks ; Deception ; Diabetes Mellitus ; Female ; Floors and Floorcoverings ; Heart ; Heating ; Hot Temperature ; Humans ; Hypesthesia ; Hypnotics and Sedatives ; Korea ; Lower Extremity ; Retrospective Studies ; Seasons ; Skin ; Spinal Cord Injuries ; Stroke ; Surgery, Plastic ; Transplants ; Unconsciousness