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.
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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: Owing to the improvement of microscope, microsurgery implements, and microsuture, finger replantation has made a considerable development. With high success rate of microsurgery in children, positive results have been reported from distal amputation. We report the patients demographics, methods, and results of the microsurgery performed in children in our hospital for the last 8 years. METHODS: From the medical records of 21 patients who had given the treatment in our hospital from January 2000 to December 2007, we analyzed patients' sex, age, operative method, and complication retrospectively. RESULTS: The number of male patients was twice as many as female, where most patients belong to the ages of five to ten years. Operative methods performed in this study included end-to-end anastomosis of artery and vein, vein graft, and epineurial suture. As a result, 19 out of 21 cases were successfully accomplished, and four of them went through the debridement of necrotic tissue due to the partial necrosis of the lesion. A one-year follow-up observation was made after surgery and most of them were almost fully recovered as in their previous state. CONCLUSION: The success rate of finger replantaion in children is continuously improving despite the difficulty of vessel anastomotic procedure, rehabilitation treatment and management after surgery. We report the satisfactory results of pediatric finger replantation technically and aesthetically.
Amputation ; Arteries ; Child ; Debridement ; Demography ; Female ; Fingers ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Male ; Medical Records ; Microsurgery ; Necrosis ; Replantation ; Retrospective Studies ; Sutures ; Transplants ; Veins

PURPOSE: Neurofibromas of neuroectodermal origin are commonly found in Von Recklinghausens disease or neurofibormatosis type 1. It is an autosomal dominant disease caused by mutation of the long arm of chromosome 17. It can present from small nodules to disfiguring giant tumor. Plexiform neurofibroma is benign in most cases, but it could be transformed into malignant tumor, which requires surgical excision. To cover the defects after the excision, a number of surgical correction methods are available. This study is to report a surgical correction of disfiguring plexiform neurofibroma using anterolateral thigh free flap for extensive defects after surgical excision of neurofibrona. METHODS: Data of five neurofibroma patients with an average age of 39 including medical history, physical examination, computed tomography, and magnetic resonance imaging were checked. No disease other than neurofibroma were detected. Biopsy on the excised tissues was performed. The follow-up period was 7 to 27 months. RESULTS: The average size of defects after complete excision of neurofibroma was 13x10~25x15cm. Defects were covered by anterolateral thigh free flap, while donor sites were covered by local flap, split thickness skin graft and regional flap. Throughout follow-up, there were no complication, relapse, or any abnormalities. CONCLUSION: Despite various surgical correction methods are applicable to defects after excision on disfiguring plexiform neurofibroma, coverage of massive defects is still challenging in plastic and reconstructive surgeon. We have made five successful cases of surgical correction of disfiguring plexiform neurofibroma using anterolateral thigh free flap.
Arm ; Biopsy ; Chromosomes, Human, Pair 17 ; Follow-Up Studies ; Free Tissue Flaps ; Humans ; Magnetic Resonance Imaging ; Neural Plate ; Neurofibroma ; Neurofibroma, Plexiform ; Neurofibromatosis 1 ; Physical Examination ; Plastics ; Recurrence ; Skin ; Thigh ; Tissue Donors ; Transplants

PURPOSE: An osteoma is one of the common benign tumors that penetrate the nasal portion, paranasal and frontal sinus. This tumor is mostly found by radiation test accidentally, however in rare cases; it can be found to be touched or with its symptoms as the tumor grows. We report this case since we found and healed the benign tumor which was affecting orbit and the both sides of fronal sinus. METHODS: A 19 year old female patient visited to our hospital due to the mass on her forehead. The symptoms began 3 years ago but no special symptom was found except for touchable mass. She was diagnosed as the osteoma of superior orbital parts and both sides of frontal sinus using X-ray and CT scanning. The size of osteoma was 5x2.5x3.5cm and indicated the patterns penetrated to the right side of orbital region. The osteoma excision was conducted with coronal incision and wide area of defect part in frontal sinus and superior orbital part were reconstructed by cranial bone graft and resorbable fixation plates. RESULTS: The patient recovered without any postoperative infections or complications and symptoms. Dysaesthesia was found on her frontal area but improved in 1 month after the surgery. CONCLUSION: The occurrences of osteoma in frontal sinus are rare and can be treated with conservative methods if there are no infections and symptoms. We report this case since we found the benign tumor, which was affecting orbit and the both sides of fronal sinus and healed it with coronal resectomy without any complications.
Female ; Forehead ; Frontal Sinus ; Humans ; Orbit ; Organic Chemicals ; Osteoma ; Transplants

PURPOSE: Self-inflicted wrist laceration is a common injury in the department of hand surgery. The aim of this study was to investigate the clinical characteristics and psychiatric features of self-inflicted wrist laceration using categorization according to wound severity. METHODS: We reviewed 71 patients from 2002 through 2012. All of the patients were grouped into four groups. Data regarding the following characteristics were collected: age, gender, size, structure involved, instruments used, history of previous self-inflicted injury, comorbidities in psychiatric and presentation of follow-up outpatient appointment to the department of plastic surgery and psychiatry. RESULTS: In these patients, approximately 64% of patients were female. About 80% of patients cut their wrist using a knife. And in grade 3-4 injury, percentage of glass injury was relatively high (22%), compared with other grades (3%). Unlike previous studies, patients in grade 3-4 tended to cut their wrist repeatedly. Focusing on psychiatric problems, approximately one quarter of patients had a previous history of self-infliction. In all patient groups, mood disorder was the most common disorder in patients who had a previous psychiatric disorder. But after operation, more than two thirds of patients had not visited department of psychiatry again. CONCLUSION: We identified some other differences among their characteristics. All patients in group also should be evaluated and surgically treated properly. A multidisciplinary approach is required for patients with wrist laceration due to self-injury in comparison to those with laceration due to other causes. Because many of them have previous self-injury experiences and psychiatric disease.
Comorbidity ; Female ; Follow-Up Studies ; Glass ; Hand ; Humans ; Lacerations* ; Mood Disorders ; Outpatients ; Retrospective Studies* ; Self Mutilation ; Suicide ; Surgery, Plastic ; Wounds and Injuries ; Wrist*

Automobile airbags have been shown to reduce morbidity and mortality in the event of a vehicle crash; however, new problems have been identified. Among these problems, direct injury from the airbag itself has become a serious concern. This suggests that an airbag itself may not be safe. Burn injury from airbags accounts for about 7.8% of all injuries caused by vehicle crashes. There are three types of burn injuries from airbags: Thermal, chemical, and frictional. Moreover, there are three subtypes within the category of thermal airbag burn, as identified by Tsunetuki in 2003. Herein, we review a case of an airbag burn and report a unique burn case on ‘an upper extremity’, including both thermal and frictional burns.
Air Bags* ; Automobiles ; Burns* ; Friction ; Hot Temperature ; Mortality ; Upper Extremity*

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