Malignant peripheral nerve sheath tumor (MPNST) is a very rare type of sarcoma, with an incidence of 0.001%. MPNST has a 5-year survival rate near 80%, so successful reconstruction techniques are important to ensure the patient's quality of life. Sarcoma of the forearm is known for its poor prognosis, which leads to wider excision, making reconstruction even more challenging due to the unique anatomical structure and delicate function of the forearm. A 44-year-old male presented with a large mass that had two aspects, measuring 9×6 cm and 7×5 cm, on the dorsal aspect of the right forearm. The extensor compartment muscles (EDM, EDC, EIP, EPB, EPL, ECRB, ECRL, APL) and invaded radius were resected with the mass. Tendon transfer of the entire extensor compartment with skin defect coverage using a 24×8 cm anterolateral thigh (ALT) perforator free flap was performed. The patient was discharged after 18 days without wound complications, and has not complained of discomfort during supination, pronation, or wrist extension/flexion through 3 years of follow-up. To our knowledge, this is the first report of successful reconstruction of the entire forearm extensor compartment with ALT free flap coverage after resection of MPNST.
Adult ; Follow-Up Studies ; Forearm* ; Free Tissue Flaps ; Humans ; Incidence ; Male ; Muscles ; Neurilemmoma ; Peripheral Nerves ; Prognosis ; Pronation ; Quality of Life ; Radius ; Sarcoma ; Skin* ; Supination ; Surgical Flaps ; Survival Rate ; Tendon Transfer ; Tendons* ; Thigh ; Wounds and Injuries ; Wrist

Background: Various types of external breast tissue expanders have been found to be effective for aesthetic breast augmentation. However, their use has been limited when compared with implant-based breast augmentation due to the burdensome nature of their application. This article reports the possibility that external breast tissue expanders may be applied safely and effectively with higher pressure and shorter application time. Methods: The participants comprised patients who desired breast augmentation using the EVERA-RAPHA device between January 2020 and March 2020. A double-blinded prospective study was conducted on two groups of eight patients each, with either 60 mmHg or 100 mmHg of pressure applied. Standardized photographs were taken and blinded measurements of volume and circumference were made. The Mann-Whitney and paired t-tests were conducted. Results: Sixteen patients were evaluated after 1 month of treatment. The women in groups 1 and 2 (60 mmHg and 100 mmHg, respectively) used EVERA-RAPHA for 15.400± 0.704 and 15.300±0.477 minutes per day, respectively. The mean volume increases in groups 1 and 2 were 39.000±42.526 cc and 27.700±20.260 cc, respectively. No patients dropped out of the study. All patients reported that the device was tolerable. Mild bruising was found in 62.5% of the patients in group 2. Conclusions Breast augmentation using external tissue expanders can be a safe, effective, and practical option. Pressures of 60 mmHg or 100 mmHg can be safely applied for a shorter duration. Larger studies are needed to further confirm our findings.

Many techniques have been developed for reconstruction of the hand; however, less attention has been paid to foot reconstruction techniques. In particular, reconstruction of the forefoot and big toe has been considered a minor procedure despite the importance of these body parts for standing and walking. Most of the weight load on the foot is concentrated on the forefoot and big toe, whereas the other toes have a minor role in weight bearing. Moreover, the forefoot and big toe are important for maintaining balance and supporting the body when changing directions. Recently, attention has been focused on the aesthetic appearance and functional aspects of the body, which are important considerations in the field of reconstructive surgery. In patients for whom flap reconstruction in the forefoot and big toe is planned, clinicians should pay close attention to f lap survival as well as functional and cosmetic outcomes of surgery. In particular, it is important to assess the ability of the flap to withstand functional weight bearing and maintain sufficient durability under shearing force. Recovery of protective sensation in the forefoot area can reduce the risk of flap loss and promote rapid rehabilitation and functional recovery. Here, we report our experience with two cases of successful reconstruction of the forefoot and big toe with a sensate anterolateral thigh flap, with a review of the relevant literature.

Finger reconstruction involves paramount significance of both functional and aesthetic aspects, due to its great impact on quality of life. The options range from primary closure, skin grafts, local flaps, pedicled flaps, and free flaps. The optimal method should consider various circumstances of the patient and surgeon. We would like to report a case of a young woman who initially presented with cellulitis and necrosis of the left second finger-tip who underwent reconstruction with bilateral toe pulp free flap. The patient could successfully return to her job that involves keyboard typing and playing the piano, with acceptable donor site morbidity.

OBJECTIVES: The purpose of this study was to quantitatively assess the degree of myasthenia gravis (MG) affecting mental health through the results of multiphasic military personality inventory in late adolescence. METHODS: We collected and analyzed the results of the military personality inventory for healthy controls and MG patients among the 19-year-old men who visited the Military Manpower Administration from February 2007 to January 2010. Military personality inventory invented for Korean military test has similar system to Minnesota multiphasic personality inventory. RESULTS: Among validity scales, each score of faking good, faking bad and infrequency subscales showed no difference between healthy control and MG groups, respectively (t=−0.51, p=0.607 ; t=0.11, p=0.913 ; t=1.41, p=0.158). Among neurosis scales, the score of somatization subscale was higher (t=2.29, p=0.023) in MG group. Among psychopath scales, the score of schizophrenia subscale was lower in MG group (t=−2.38, p=0.018). CONCLUSIONS According to MPI results, we can confirm that MG patients in late adolescence may be more concerned with their somatic symptoms than the control group, and that they may be more likely to abide by the regulation and be conventional in their behavior than the control group.

Background: Recent studies have successfully implemented next-generation sequencing (NGS) in HLA typing. We performed HLA NGS in a Korean population to estimate HLA-A, -B, -C, and -DRB1 allele and haplotype frequencies up to an 8-digit resolution, which might be useful for an extended application of HLA results. Methods: A total of 128 samples collected from healthy unrelated Korean adults, previously subjected to Sanger sequencing for 6-digit HLA analysis, were used. NGS was performed for HLA-A, -B, -C, and -DRB1 using the AllType NGS kit (One Lambda, West Hills, CA, USA), Ion Torrent S5 platform (Thermo Fisher Scientific, Waltham, MA, USA), and Type Steam Visual NGS analysis software (One Lambda). Results: Eight HLA alleles showed frequencies of ≥ 10% in the Korean population, namely, A*24:02:01:01 (19.5%), A*33:03:01 (15.6%), A*02:01:01:01 (14.5%), A*11:01:01:01 (13.3%), B*15:01:01:01 (10.2%), C*01:02:01 (19.9%), C*03:04:01:02 (11.3%), and DRB1*09:01:02 (10.2%). Nine previous 6-digit HLA alleles were further identified as two or more 8-digit HLA alleles. Of these, eight alleles (A*24:02:01, B*35:01:01, B*40:01:02, B*55:02:01, B*58:01:01, C*03:02:02, C*07:02:01, and DRB1*07:01:01) were identified as two 8-digit HLA alleles, and one allele (B*51:01:01) was identified as three 8-digit HLA alleles. The most frequent four-loci haplotype was HLA-A*33:03:01-B*44:03:01:01-C*14:03-DRB1*13:02:01. Conclusions We identified 8-digit HLA-A, -B, -C, and -DRB1 allele and haplotype frequencies in a healthy Korean population using NGS. These new data can be used as a representative Korean data for further disease-related HLA type analysis.

Hemangioma is a benign vascular tumor that grows by endothelial cell hyperplasia. It occurs most frequently in the head and neck region. Nose reconstruction is tricky because of its unique threedimensional structure and different tissue components. We report a case of successful reconstruction of near-total nose defect using the paramedian forehead flap combined with a nasolabial flap, immediately after excision of nasal hemangioma. A 49-year-old male patient was presented with a huge mass at the nose. Preoperative magnetic resonance imaging showed prominent vascular channels extending to the forehead and cheek. Complete resection of the mass was performed, which resulted in an eccentric defect. The right paramedian forehead flap and the left nasolabial flap were designed and transferred to the defect. Flap division was performed 1 month later. The patient is satisfied with the overall appearance and did not develop any functional deficit.

Human immunodeficiency virus (HIV) infection presents a major global health challenge. According to the World Health Organization, approximately 39.0 million people have HIV, as of 2022, with 1.3 million new infections annually. In Korea, the first HIV cases were reported in 1985, and the number of cases has increased continuously since 1988. In 2022, 1,066 cases were newly diagnosed, increasing the total number of cases to approximately 15,880.Current Concepts: Diagnostics play a crucial role in the management of HIV, for early diagnosis and initiation of antiretroviral therapy. Approval of the first HIV antibody test in 1985 by the US Food and Drug Administration marked a notable advance in the ability to diagnose HIV infection. The screening test for HIV infection typically consists of a two-step approach, in which a fourth-generation combination HIV-1/2 immunoassay is followed by a confirmatory Western blot. Despite its high accuracy for chronic infections, the window period and the early-stage of HIV infections are problematic, and populations with low HIV prevalence show a low positive predictive value. A false positive result can occur from blood transfusions, vaccinations, and autoantibodies. Novel diagnostic tools, such as nucleic acid testing for viral RNA/DNA and antigen testing for p24 antigen have reduced the window period, allowing for earlier detection and differentiation between HIV-1 and HIV-2. Pointof-care tests are beneficial in resource-limited settings although their lower sensitivity and specificity require additional confirmatory follow-up testing.Discussion and Conclusion: In this review, we provide a historical perspective on the evolution of HIV diagnostics (serological and molecular) and describe the roles of conventional and point-of-care testing within the laboratory diagnostic network.

BACKGROUND: Tongue reconstruction is challenging with the unique function and anatomy. Goals for reconstruction differ depending on the extent of reconstruction. Thin and pliable flaps are useful for tongue tip reconstruction, for appearance and mobility. This study reports lateral arm free flap (LAFF) as a safe and optimal option for hemi-tongue reconstruction, especially for tongue tip after hemiglossectomy. METHODS: Thirteen LAFFs were performed for hemi-tongue reconstruction after hemiglossectomy from 1995 to 2018. Of the 13 patients, seven were male and six were female, age varying from 24 to 64 years. RESULTS: All flaps healed uneventfully without complications. Donor sites were closed primarily. The recipient vessels for microvascular anastomosis were mainly superior thyroidal artery, external jugular vein. All patients returned to normal diet, with no complaints regarding reconstructed tongue and donor site. CONCLUSION: The LAFF is hairless, thin (especially with lateral epicondyle approach), and potentially sensate. They are advantageous features for tongue tip and hemi-tongue reconstruction. Donor site sacrifices the inessential posterior radial collateral artery, and the scar is hidden under short sleeve shirts. We believe that LAFF can be considered as the first choice flap for hemitongue reconstruction, over radial forearm free flaps.
Arm ; Arteries ; Cicatrix ; Diet ; Female ; Forearm ; Free Tissue Flaps ; Humans ; Jugular Veins ; Male ; Reconstructive Surgical Procedures ; Surgical Flaps ; Thyroid Gland ; Tissue Donors ; Tongue

Background: This is the first clinical study conducted among Asian women using breast implants manufactured by an Asian company. Four-year data regarding the safety and efficacy of BellaGel breast implants have already been published, and we now report 6-year data. Methods: This study was designed to take place over 10 years. It included 103 patients who underwent breast reconstruction or augmentation using BellaGel breast implants. The rates of implant rupture and capsular contracture were measured and analyzed to evaluate the effectiveness of the breast implant. Results: At patients’ 6-year postoperative visits, the implant rupture and capsular contracture rates were 1.15% and 2.30%, respectively. The implant rupture rate was 3.77% among reconstruction cases and 0% among augmentation cases. The capsular contracture rate was 5.66% among reconstruction cases and 0.83% among augmentation cases. Conclusions The 6-year data from this planned 10-year study suggest that the BellaGel cohesive silicone gel-filled breast implant is an effective and safe medical device that can be used in breast reconstruction and augmentation.