Abdominal wall endometriosis is a condition in which functioning endometrial tissue is present outside the uterine cavity, and the standard treatment is extensive surgical excision. A 46-year-old woman presented with an irregular lower abdominal mass measuring 8.5×4.5 cm. The patient had a history of a cesarean delivery 15 years previously. For treatment, a mini-abdominoplasty was designed to avoid possible wound complications and to optimize the cosmetic outcomes. The lesion was excised with an adequate margin because of the possibility of recurrence. The resected structures were the lower mid-abdominal skin, subcutaneous fat, anterior and posterior rectus sheath, and rectus abdominis muscle. The incisional wound was closed layer by layer, including abdominal fascia repair with acellular dermal matrix. At a 3-month postoperative outpatient follow-up visit, the patient was highly satisfied with the cosmetic results and reported no complications. Optimal oncological, functional, and cosmetic surgical outcomes can be achieved by complete excision followed by mini-abdominoplasty.
Abdominal Wall* ; Abdominoplasty ; Acellular Dermis ; Endometriosis* ; Fascia ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Outpatients ; Rectus Abdominis ; Recurrence ; Skin ; Subcutaneous Fat ; Wounds and Injuries

Objective: To systematically translate the Duchenne muscular dystrophy Functional Ability Self-Assessment Tool (DMDSAT) into Korean and verify the reliability and validity of the Korean version (K-DMDSAT). Methods: The original DMDSAT was translated into Korean by two translators and two pediatric physiatrists. A total of 88 patients with genetically confirmed Duchenne muscular dystrophy (DMD) participated in the study. They were evaluated using the K-DMDSAT once as a self-assessment and once by an interviewer. The interviewer evaluated the K-DMDSAT again 1 week later using a test-retest approach. The intraclass correlation coefficient (ICC) was used to verify the interrater and test-retest reliabilities. Pearson correlation analysis between the K-DMDSAT and the Brooke or Vignos scales were used to assess validity. Results: The total score and all domains of the K-DMDSAT showed excellent interrater and test-retest reliability, with an ICC for total scores of 0.985 and 0.987, respectively. All domains had an ICC >0.90. From the Pearson correlation analysis, the total K-DMDSAT score was significantly correlated with the Vignos and Brooke scales (r=0.918 and 0.825, respectively; p<0.001), and each domain of K-DMDSAT showed significant correlation with either the Vignos or Brooke scales. Conclusion DMDSAT was systematically translated into Korean, and K-DMDSAT was verified to have excellent reliability and validity. K-DMDSAT can help clinicians easily describe and categorize various functional aspects of patients with DMD through the entire disease progression.

Postmastectomy pain syndrome (PMPS) is defined as chronic pain lasting more than 3 months after surgery. PMPS reduces the quality of life for patients and affects their daily life. Although the pathogenesis of PMPS has not been clearly elucidated, it is strongly suggestive of neuropathic pain caused by damage to the intercostobrachial nerve. While previous studies have used stromal vascular fraction (SVF)-enriched fat grafts in patients with neuralgia, few studies have used it for PMPS. Therefore, the present study evaluated the use of SVF-enriched fat, which includes adipose-derived stem cells with good differentiation capacity, in patients with PMPS to improve quality of life and reduce neuropathic pain. In three patients, the fat was mixed with concentrated SVF using a centrifuge and injected into the primary pain sites. After surgery, in all three cases, the subjective pain scale score decreased significantly over time.

With the recent increase in reported cases of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), fears of breast implants have increased. In particular, some patients now desire expander removal without implant insertion. In the case described herein, a 41-year-old female patient who had undergone a skin-sparing mastectomy with expander insertion due to breast cancer requested expander removal due to fear of BIA-ALCL during expansion. The authors modified the Goldilocks technique to prevent a chest wall deformity due to expansion. The expanded skin was sufficiently thick, as it was engrafted with acellular dermal matrix, and some of it was de-epithelized and rolled in. The patient’s chest wall depression was completely corrected and an acceptable breast mound was created. To summarize, this technique was used to correct a chest wall deformity and to form a breast mound in a patient who underwent expander removal without implant insertion.

Few cases of injuries caused by wild boars have been reported in the literature. Here, we present the case of a 64-year-old male patient who was attacked by a wild boar. The patient had a laceration to the right forehead and a penetrating wound in the area before the right auricle. Computed tomography scan revealed traumatic subarachnoid hemorrhage, subdural hemorrhage, right temporal lobe contusion hemorrhage, pneumocephalus, right zygomatic arch and temporal bone fracture, and right coronal process fracture of the mandible.Prophylactically, 2,000 mg of ceftriaxone and 400 mg of moxifloxacin were intravenously administered every 24 hours. An emergency craniectomy was performed because the skull fracture was an open fracture and control of the increased intracranial pressure was necessary. Inactivated Rabies Virus Vaccine was also administered postoperatively. We concluded that, unlike typical wounds from other traumatic causes, the risk of wound infection is higher. In order to reduce morbidity and mortality due to wild boar attacks, rapid stabilization of the patient’s vital signs, prevention of infection with appropriate antibiotics, and surgical intervention at the appropriate time and method are necessary.

We report a case of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), which had a history of spontaneous resorption of late seroma before diagnosis. A 47-year-old woman with a history of augmentation mammoplasty with round textured implants in January 2013 presented with a swelling on her right breast 6 years later, which was diagnosed as late seroma with suspected intracapsular rupture using ultrasonography (USG). Although aspiration was not done at the time of the initial USG, the seroma resolved spontaneously within weeks. A further workup proceeded with USG-guided aspiration followed by magnetic resonance imaging. Cytology of the aspirated fluid showed atypical cells. Cell block cytology and immunohistochemical staining confirmed the diagnosis of BIA-ALCL. En bloc resection with total capsulectomy and explantation was performed as curative surgery. Pathologic stage pT2N0M0 was confirmed and the patient was followed up without further treatment. Although the classic presentation of BIA-ALCL is known as late persistent seroma, an atypical manifestation such as spontaneous resorption may occur, as in the current case. A high level of suspicion and a thorough investigation with appropriate modalities will make it possible to detect this rare and potentially devastating disease.

In cases where there is insufficient abdominal tissue or a history of previous abdominal surgery, thigh tissue may be considered as an alternative for reconstruction. This report discusses a case involving a 49-year-old Asian woman with thin abdominal fat and thick thigh fat, who underwent a right nipple-sparing mastectomy followed by bilateral profunda artery perforator flap breast reconstruction. The discussion will address specific considerations relevant to Asian patients preoperatively.

Scalp defects necessitate diverse approaches for successful reconstruction, taking into account factors such as defect size, surrounding tissue, and recipient vessel quality. This case report presents a challenging scenario involving a temporal scalp defect where ipsilateral recipient vessels were unavailable. The defect was effectively reconstructed utilizing a transposition flap and a latissimus dorsi free flap, which was anastomosed to the contralateral recipient vessels. Our report underscores the successful reconstruction of a scalp defect in the absence of ipsilateral recipient vessels, emphasizing the importance of employing appropriate surgical interventions without necessitating vessel grafts.

Postmastectomy nipple necrosis is a factor that leads to a poor aesthetic outcome in breast reconstruction because of the unique projective structure of the nipple. We present a case of successful nipple reconstruction using a de-epithelialized rectangular flap. A 45-year-old woman was diagnosed with left breast cancer. She had a vertical scar below the nipple-areolar complex due to previous reduction mammoplasty. She underwent nipple-sparing mastectomy, breast reconstruction with a deep inferior epigastric artery perforator (DIEP) flap, and contralateral reduction. After the operation, the nipple gradually necrotized, and full-thickness nipple necrosis was observed on postoperative day 12. For nipple reconstruction, we designed a 38×23 mm rectangular flap from the DIEP flap considering the contralateral nipple diameter (12 mm), protrusion (2 mm), and ipsilateral mastectomy skin flap thickness (15 mm). The area in contact with the mastectomy skin flap was placed in the defect area after de-epithelialization. The reconstruction was successful and the nipple survived with a slight loss of projection. When unexpected nipple necrosis occurs after DIEP-based breast reconstruction, designing a de-epithelialized rectangular flap using the DIEP flap tissue is a feasible reconstructive method to consider.