Background: The traditional nasolabial V-Y advancement flap is widely used for midface reconstruction, particularly for the lower third of the nose and upper lip, as its color and texture are similar to these areas. However, it provides insufficient tissue to cover large defects and cannot restore the nasal convexity, nasal ala, and adjacent tissues. The purpose of this study is to investigate the modified nasolabial V-Y advancement flap with extension limbs the along alar crease for the reconstruction of complex midface defects. Methods: A retrospective analysis of 18 patients, who underwent reconstruction with the modified nasolabial V-Y advancement flap, was performed between September 2014 and December 2022. An extension limb was added along the alar crease, adjacent to the defect area, and was hinged down as a transposition flap at the end of the advancement flap. Results: The extension limb along the alar crease successfully covered large and complicated defects, including those of the ala, the alar rim, the alar base, the nostrils, and the upper lip, with minor complications. Conclusion The alar crease is a good donor site for the reconstruction of large and complex nasal and upper lip defects.

BACKGROUND: The goal of this study was to investigate the anatomy of the peroneal artery and its perforators, and to report the clinical results of reconstruction with peroneal artery perforator flaps. METHODS: The authors dissected 4 cadaver legs and investigated the distribution, course, origin, number, type, and length of the perforators. Peroneal artery perforator flap surgery was performed on 29 patients. RESULTS: We identified 19 perforators in 4 legs. The mean number of perforators was 4.8 per leg, and the mean length was 4.8 cm. Five perforators were found proximally, 9 medially, and 5 distally. We found 12 true septocutaneous perforators and 7 musculocutaneous perforators. Four emerged from the posterior tibia artery, and 15 were from the peroneal artery. The peroneal artery perforator flap was used in 29 patients. Retrograde island peroneal flaps were used in 8 cases, anterograde island peroneal flaps in 5 cases, and free peroneal flaps in 16 cases. The mean age was 59.9 years, and the defect size ranged from 2.0 cm×4.5 cm to 8.0 cm×8.0 cm. All the flaps survived. Five flaps developed partial skin necrosis. In 2 cases, a split-thickness skin graft was performed, and the other 3 cases were treated without any additional procedures. CONCLUSIONS: The peroneal artery perforator flap is a good alternative for the reconstruction of soft tissue defects, with a constant and reliable vascular pedicle, thin and pliable skin, and the possibility of creating a composite tissue flap.
Arteries ; Cadaver* ; Humans ; Leg ; Necrosis ; Perforator Flap ; Skin ; Surgical Flaps ; Tibia ; Transplants

Background: Various materials, commonly called fillers, have been developed and are now used for cosmetic and reconstruction purposes. Indiscriminate injections of illegal and unknown substances have various side effects, among which foreign body granulomas are particularly difficult to treat. Surgical resection can be considered for small and well-defined foreign body granulomas, but complete resection is often impossible for wide facial granulomas, and postoperative deformities may occur. Therefore, this study presents cases where foreign bodies were evaluated using imaging studies and removed through minimally invasive procedures depending on their characteristics. Methods: Thirty-five patients with chronic granulomas after illegal filler injections treated from 2012 to 2019 were enrolled. Clinically, these granulomas were classified into cystic and infiltrating groups according to the imaging study patterns. Patients in the cystic group underwent puncture and drainage, and those in the infiltrating group were first treated with intralesional laser treatment and then suctioned. If the results were insufficient, surgical removal combined with a lifting procedure was performed. Results: All 35 patients were women, and their average age was 51 years. Surgery was successful in almost all cases, but four cases of insufficient removal and contour deformity were encountered during follow-up. Two patients underwent reoperation and two patients improved naturally. Conclusions In this study, we classified the characteristics of granulomas using preoperative imaging studies. Aesthetically favorable results were obtained using puncture and drainage and tumescent suction, along with, if necessary, surgical removal accompanied by a lifting procedure when removing facial foreign body granulomas.

Congenital melanocytic nevus (CMN) is a benign condition that either is present at birth or develops in the first weeks of life. Surgical removal is typically performed to improve cosmetic appearance and reduce the risk of malignant transformation. In this report, we present the case of a 26-year-old woman with a medium-sized CMN on her left breast. The nevus measured 14×8 cm, and the patient desired a single-stage excision. However, this approach would result in a large skin defect that would be challenging to reconstruct using a local flap or skin graft. Moreover, it could potentially compromise the maintenance of natural sagging and the contour of the breast. Consequently, we opted to place a thin thoracodorsal artery perforator free flap following the removal of the CMN. The patient was satisfied with the overall surgical results. By utilizing this free flap for reconstruction, we successfully preserved the natural shape and contour of the breast without complications such as postoperative hypertrophic scarring or contracture at the recipient site.

This study aims to present a novel use of coil embolization in managing postoperative bleeding after free flap surgery, a technique typically reserved for other medical complications. We report the case of a 77-year-old female patient who underwent muscle-sparing latissimus dorsi free flap surgery for recurrent myxofibrosarcoma on her left thigh. Although hemostasis was achieved hemostasis during surgery, the patient experienced postoperative bleeding, which was initially managed with compression and blood transfusions. Upon a critical drop in the hemoglobin level, coil embolization was performed at the proximal segment of the descending branch of the lateral circumflex femoral artery. Coil embolization successfully controlled bleeding, while preserving blood flow to the flap. The patient’s hemoglobin levels stabilized, and the flap’s perfusion improved post-procedure. This approach proved effective in managing bleeding in areas other than the anastomosis site, with the patient showing a satisfactory recovery and no significant complications in the 30-day postoperative period. Coil embolization, a method commonly used for gastrointestinal bleeding and other vascular issues, can be a viable and effective option for controlling postoperative bleeding after free flap surgery. This case demonstrates its potential as a lifesaving intervention while preserving flap viability. However, further research with more cases is needed to evaluate the generalizability and long-term outcomes of this technique in similar surgical contexts.

This study aims to present a novel use of coil embolization in managing postoperative bleeding after free flap surgery, a technique typically reserved for other medical complications. We report the case of a 77-year-old female patient who underwent muscle-sparing latissimus dorsi free flap surgery for recurrent myxofibrosarcoma on her left thigh. Although hemostasis was achieved hemostasis during surgery, the patient experienced postoperative bleeding, which was initially managed with compression and blood transfusions. Upon a critical drop in the hemoglobin level, coil embolization was performed at the proximal segment of the descending branch of the lateral circumflex femoral artery. Coil embolization successfully controlled bleeding, while preserving blood flow to the flap. The patient’s hemoglobin levels stabilized, and the flap’s perfusion improved post-procedure. This approach proved effective in managing bleeding in areas other than the anastomosis site, with the patient showing a satisfactory recovery and no significant complications in the 30-day postoperative period. Coil embolization, a method commonly used for gastrointestinal bleeding and other vascular issues, can be a viable and effective option for controlling postoperative bleeding after free flap surgery. This case demonstrates its potential as a lifesaving intervention while preserving flap viability. However, further research with more cases is needed to evaluate the generalizability and long-term outcomes of this technique in similar surgical contexts.

This study aims to present a novel use of coil embolization in managing postoperative bleeding after free flap surgery, a technique typically reserved for other medical complications. We report the case of a 77-year-old female patient who underwent muscle-sparing latissimus dorsi free flap surgery for recurrent myxofibrosarcoma on her left thigh. Although hemostasis was achieved hemostasis during surgery, the patient experienced postoperative bleeding, which was initially managed with compression and blood transfusions. Upon a critical drop in the hemoglobin level, coil embolization was performed at the proximal segment of the descending branch of the lateral circumflex femoral artery. Coil embolization successfully controlled bleeding, while preserving blood flow to the flap. The patient’s hemoglobin levels stabilized, and the flap’s perfusion improved post-procedure. This approach proved effective in managing bleeding in areas other than the anastomosis site, with the patient showing a satisfactory recovery and no significant complications in the 30-day postoperative period. Coil embolization, a method commonly used for gastrointestinal bleeding and other vascular issues, can be a viable and effective option for controlling postoperative bleeding after free flap surgery. This case demonstrates its potential as a lifesaving intervention while preserving flap viability. However, further research with more cases is needed to evaluate the generalizability and long-term outcomes of this technique in similar surgical contexts.

This study aims to present a novel use of coil embolization in managing postoperative bleeding after free flap surgery, a technique typically reserved for other medical complications. We report the case of a 77-year-old female patient who underwent muscle-sparing latissimus dorsi free flap surgery for recurrent myxofibrosarcoma on her left thigh. Although hemostasis was achieved hemostasis during surgery, the patient experienced postoperative bleeding, which was initially managed with compression and blood transfusions. Upon a critical drop in the hemoglobin level, coil embolization was performed at the proximal segment of the descending branch of the lateral circumflex femoral artery. Coil embolization successfully controlled bleeding, while preserving blood flow to the flap. The patient’s hemoglobin levels stabilized, and the flap’s perfusion improved post-procedure. This approach proved effective in managing bleeding in areas other than the anastomosis site, with the patient showing a satisfactory recovery and no significant complications in the 30-day postoperative period. Coil embolization, a method commonly used for gastrointestinal bleeding and other vascular issues, can be a viable and effective option for controlling postoperative bleeding after free flap surgery. This case demonstrates its potential as a lifesaving intervention while preserving flap viability. However, further research with more cases is needed to evaluate the generalizability and long-term outcomes of this technique in similar surgical contexts.

Serratia marcescens is a Gram-negative, facultatively anaerobic bacillus that has been implicated in hospital-acquired infections. Because no previous cases of delayed infections caused by S. marcescens after autologous fat injection have been reported, we introduce a case report. A 74-year-old woman underwent fat injection for aesthetic purposes and visited our hospital for left cheek swelling after this procedure. Blood tests showed a slightly elevated white blood cell count. Facial computed tomography demonstrated an abscess and emergency surgery was performed. A work-up of the necrotic tissue and drained abscess contents was conducted. Cultures showed growth of S. marcescens. Based on the culture results , a proper antibiotic was prescribed. Follow-up blood tests showed normal findings, and there was no recurrent infection or inflammation. In most acute infections after a fat graft, Staphylococcus aureus or Staphylococcus epidermidis can be suspected, while mycobacterial infections are often suspected in cases of delayed infection and chronic inflammation. However, clinicians should keep in mind that there may be infections of uncommon bacteria. When an atypical delayed infection is suspected after an autologous fat graft, it is important to perform aseptic wound culture and biopsy as soon as possible, use appropriate antibiotics, and conduct proper surgical treatment.

A 25-year-old woman was referred for discomfort when breathing through her left nose. The patient had undergone augmentation rhinoplasty 5 years ago, after which hypertrophic scarring occurred in the left nostril. Several corticosteroid injections were administered as the first line of treatment, but with no symptom improvement. Therefore, we proceeded with surgical scar removal, with the use of a nasal conformer. However, scarring in the left nostril recurred. Accordingly, we proceeded with further surgical treatment using the scar folding technique. After scar folding, neither scarring nor nostril stenosis recurred during 1 year of postoperative follow-up. To summarize, herein, we report a case of hypertrophic scarring in the nostril that was successfully treated with the scar folding technique.