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Supported by recent literature on the signs of aging of the middle and lower face, our clinical research has documented a loss of volume of the deep structural components of the central face and a progressive descent of the nasolabial fat and the jowl fat, leading to facial fragmentation. The signs that appear around the age of 45 to 50 years are well targeted by the mini-invasive technique described here. We focused on refitting the jowl fat and the nasolabial fat associated with cutaneous tightening. The use of absorbable barbed sutures (Quill) led to significant improvements, enabling the fitting of fat on fat. In the past 4 years, 167 operations were performed using this technique. The clinical results were very satisfactory, yielding a natural effect caused by the mobilization and strong fixation of the nasolabial fat and the jowl fat in the direction opposite to their displacement.
Aging ; Cheek* ; Minimally Invasive Surgical Procedures ; Rejuvenation* ; Rhytidoplasty ; Sutures

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Salvage of Unilateral Complete Ear Amputation with Continuous Local Hyperbaric Oxygen, Platelet-Rich Plasma and Polydeoxyribonucleotide without Micro-Revascularization.

Sang Keon LEE ; Yoon Min LIM ; Dae Hyun LEW ; Seung Yong SONG

Archives of Plastic Surgery.2017;44(6):554-558. doi:10.5999/aps.2017.00451

In many cases of complete ear amputation, microvascular surgery is required for tissue perfusion and organ survival. However, microvascular reconstruction is not always feasible in the absence of suitable vessels. Here, we present the case of a 76-year-old man who underwent complete amputation of the left ear after a collapse at home because of cardiogenic syncope. He was treated with primary replantation and underwent a postoperative salvage course including continuous local hyperbaric oxygen therapy (HBOT), platelet-rich plasma (PRP) injections, and polydeoxyribonucleotide (PDRN) injections. The ear was almost completely salvaged, with a tiny eschar at the mid-scapha on both the anterior and posterior aspects. This case demonstrates the efficacy of local HBOT with PRP and PDRN injections.
Aged ; Amputation* ; Ear* ; Humans ; Hyperbaric Oxygenation ; Oxygen* ; Perfusion ; Platelet-Rich Plasma* ; Replantation ; Salvage Therapy ; Syncope ; Tissue Survival

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Is Robot-Assisted Surgery Really Scarless Surgery? Immediate Reconstruction with a Jejunal Free Flap for Esophageal Rupture after Robot-Assisted Thyroidectomy.

Seong Hoon PARK ; Joo Hyun KIM ; Jun Won LEE ; Hii Sun JEONG ; Dong Jin LEE ; Byung Chun KIM ; In Suck SUH

Archives of Plastic Surgery.2017;44(6):550-553. doi:10.5999/aps.2017.00941

Esophageal perforation is a rare but potentially fatal complication of robot-assisted thyroidectomy (RAT). Herein, we report the long-term outcome of an esophageal reconstruction with a jejunal free flap for esophageal rupture after RAT. A 33-year-old woman developed subcutaneous emphysema and hoarseness on postoperative day1 following RAT. Esophageal rupture was diagnosed by computed tomography and endoscopy, and immediate surgical exploration confirmed esophageal rupture, as well as recurrent laryngeal nerve injury. We performed a jejunal free flap repair of the 8-cm defect in the esophagus. End-to-side microvascular anastomoses were created between the right external carotid artery and the jejunal branches of the superior mesenteric artery, and end-to-end anastomosis was performed between the external jugular vein and the jejunal vein. The right recurrent laryngeal nerve injury was repaired with a 4-cm nerve graft from the right ansa cervicalis. Esophagography at 1 year after surgery confirmed that there were no leaks or structures, endoscopy at 1 year confirmed the resolution of vocal cord paralysis, and there were no residual problems with swallowing or speech at a 5-year follow-up examination. RAT requires experienced surgeons with a thorough knowledge of anatomy, as well as adequate resources to quickly and competently address potentially severe complications such as esophageal rupture.
Adult ; Animals ; Carotid Artery, External ; Deglutition ; Endoscopy ; Esophageal Perforation ; Esophagus ; Female ; Follow-Up Studies ; Free Tissue Flaps* ; Hoarseness ; Humans ; Jejunum ; Jugular Veins ; Mesenteric Artery, Superior ; Microsurgery ; Rats ; Recurrent Laryngeal Nerve Injuries ; Rupture* ; Subcutaneous Emphysema ; Surgeons ; Thyroidectomy* ; Transplants ; Veins ; Vocal Cord Paralysis

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Reconstruction of the Foot Using a Superficial Inferior Epigastric Artery Free Flap.

Jin Ho HAN ; Hyun Woo SHIN ; Kun Chul YOON ; June Kyu KIM

Archives of Plastic Surgery.2017;44(6):545-549. doi:10.5999/aps.2017.02033

When foot reconstruction is performed in the pretibial area, the ankle, or the dorsum of the foot, the need for a reliable flap remains a challenge. We found that the superficial inferior epigastric artery (SIEA) free flap can be used as an alternative tool for this purpose, as it helps to solve the problems associated with other flaps. We describe 2 cases in which we reconstructed the foot using an SIEA free flap, which was pliable enough to fit the contours of the area. Postoperatively, the flaps were intact and showed excellent aesthetic results. Thus, the SIEA free flap can be an alternative tool for patients with a low body mass index who undergo reconstructive surgery involving the pretibial area, ankle, knee, or dorsum of the foot, all of which require a soft and flexible flap.
Ankle ; Body Mass Index ; Epigastric Arteries* ; Foot* ; Free Tissue Flaps* ; Humans ; Knee ; Lower Extremity ; Microsurgery

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Factors Associated with a Prolonged Length of Hospital Stay in Patients with Diabetic Foot: A Single-Center Retrospective Study.

Sang Kyu CHOI ; Cheol Keun KIM ; Dong In JO ; Myung Chul LEE ; Jee Nam KIM ; Hyun Gon CHOI ; Dong Hyeok SHIN ; Soon Heum KIM

Archives of Plastic Surgery.2017;44(6):539-544. doi:10.5999/aps.2017.01207

BACKGROUND: We conducted this study to identify factors that may prolong the length of the hospital stay (LHS) in patients with diabetic foot (DF) in a single-institution setting. METHODS: In this single-center retrospective study, we evaluated a total of 164 patients with DF, and conducted an intergroup comparison of their baseline demographic and clinical characteristics, including sex, age, duration of diabetes, smoking status, body mass index, underlying comorbidities (e.g., hypertension or diabetic nephropathy), wound characteristics, type of surgery, the total medical cost, white blood cell (WBC) count, C-reactive protein (CRP) levels, erythrocyte sedimentation rate, and albumin, protein, glycated hemoglobin, and 7-day mean blood glucose (BG) levels. RESULTS: Pearson correlation analysis showed that an LHS of >5 weeks had a significant positive correlation with the severity of the wound (r=0.647), WBC count (r=0.571), CRP levels (r=0.390), DN (r=0.020), and 7-day mean BG levels (r=0.120) (P < 0.05). In multiple regression analysis, an LHS of >5 weeks had a significant positive correlation with the severity of the wound (odds ratio [OR]=3.297; 95% confidence interval [CI], 1.324–10.483; P=0.020), WBC count (OR=1.423; 95% CI, 0.046–0.356; P=0.000), CRP levels (OR=1.079; 95% CI, 1.015–1.147; P=0.014), albumin levels (OR=0.263; 95% CI, 0.113–3.673; P=0.007), and 7-day mean BG levels (OR=1.018; 95% CI, 1.001–1.035; P=0.020). CONCLUSIONS: Surgeons should consider the factors associated with a prolonged LHS in the early management of patients with DF. Moreover, this should also be accompanied by a multidisciplinary approach to reducing the LHS.
Blood Glucose ; Blood Sedimentation ; Body Mass Index ; C-Reactive Protein ; Comorbidity ; Diabetes Mellitus ; Diabetic Foot* ; Hemoglobin A, Glycosylated ; Humans ; Hypertension ; Length of Stay* ; Leukocytes ; Limb Salvage ; Prognosis ; Retrospective Studies* ; Smoke ; Smoking ; Surgeons ; Wounds and Injuries

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