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Sebaceous Carcinoma Arising from the Nevus Sebaceous.

Myoung Soo JO ; Ki Hyun KWON ; Hea Kyeong SHIN ; Joon CHOE ; Tae Jung JANG

Archives of Plastic Surgery.2012;39(4):431-433. doi:10.5999/aps.2012.39.4.431

No abstract available.
Nevus

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The Surgical Release of Dupuytren's Contracture Using Multiple Transverse Incisions.

Hyunjic LEE ; Surak EO ; Sanghun CHO ; Neil F JONES

Archives of Plastic Surgery.2012;39(4):426-430. doi:10.5999/aps.2012.39.4.426

Dupuytren's contracture is a condition commonly encountered by hand surgeons, although it is rare in the Asian population. Various surgical procedures for Dupuytren's contracture have been reported, and the outcomes vary according to the treatment modalities. We report the treatment results of segmental fasciectomies with multiple transverse incisions for patients with Dupuytren's contracture. The cases of seven patients who underwent multiple segmental fasciectomies with multiple transverse incisions for Dupuytren's contracture from 2006 to 2011 were reviewed retrospectively. Multiple transverse incisions to the severe contracture sites were performed initially, and additional incisions to the metacarpophalangeal (MCP) joints, and the proximal interphalangeal (PIP) joints were performed if necessary. Segmental fasciectomies by removing the fibromatous nodules or cords between the incision lines were performed and the wound margins were approximated. The mean range of motion of the involved MCP joints and PIP joints was fully recovered. During the follow-up periods, there was no evidence of recurrence or progression of disease. Multiple transverse incisions for Dupuytren's contracture are technically challenging, and require a high skill level of hand surgeons. However, we achieved excellent correction of contractures with no associated complications. Therefore, segmental fasciectomies with multiple transverse incisions can be a good treatment option for Dupuytren's contracture.
Asian Continental Ancestry Group ; Contracture ; Dupuytren Contracture ; Follow-Up Studies ; Hand ; Humans ; Joints ; Range of Motion, Articular ; Recurrence ; Retrospective Studies ; Surgical Procedures, Operative

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Alternative Treatment of Osteoma Using an Endoscopic Holmium-YAG Laser.

Ba Leun HAN ; Ho Seong SHIN

Archives of Plastic Surgery.2012;39(4):422-425. doi:10.5999/aps.2012.39.4.422

Osteoma is one of the most common tumors of the cranial vault and the facial skeleton. For osteoma in the facial region, endoscopic resection is widely used to prevent surgical scarring. Tumors in a total of 14 patients were resected using an endoscopic holmium-doped yttrium aluminium garnet (Ho:YAG) laser with a long flexible fiber. Aside from having the advantage of not leaving a scar due to the use of endoscopy, this procedure allowed resection at any position, was minimally invasive, and caused less postoperative pain. This method yielded excellent cosmetic results, so the endoscopic Ho:YAG laser is expected to emerge as a good treatment option for osteoma.
Cicatrix ; Cosmetics ; Endoscopy ; Holmium ; Humans ; Imidazoles ; Lasers, Solid-State ; Nitro Compounds ; Osteoma ; Pain, Postoperative ; Skeleton ; Yttrium

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Reconstruction of a Severely Crushed Leg with Interpositional Vessel Grafts and Latissimus Dorsi Flap.

Chan Woo PARK ; Youn Hwan KIM ; Kyu Tae HWANG ; Jeong Tae KIM

Archives of Plastic Surgery.2012;39(4):417-421. doi:10.5999/aps.2012.39.4.417

We present a case of a near total amputation at the distal tibial level, in which the patient emphatically wanted to save the leg. The anterior and posterior tibial nerves were intact, indicating a high possibility of sensory recovery after revascularization. The patient had open fractures at the tibia and fibula, but no bone shortening was performed. The posterior tibial vessels were reconstructed with an interposition saphenous vein graft from the contralateral side and a usable anterior tibial artery graft from the undamaged ipsilateral distal portions. The skin and soft tissue defects were covered using a subatmospheric pressure system for demarcating the wound, and a latissimus dorsi myocutaneous free flap for definite coverage of the wound. At 6 months after surgery, the patient was ambulatory without requiring additional procedures. Replantation without bone shortening, with use of vessel grafts and temporary coverage of the wound with subatmospheric pressure dressings before definite coverage, can shorten recovery time.
Amputation ; Bandages ; Fibula ; Fractures, Open ; Free Tissue Flaps ; Glycosaminoglycans ; Humans ; Leg ; Limb Salvage ; Negative-Pressure Wound Therapy ; Replantation ; Saphenous Vein ; Skin ; Tibia ; Tibial Arteries ; Tibial Nerve ; Transplants ; Vascular Grafting

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A Retrospective Review of Iatrogenic Skin and Soft Tissue Injuries.

Tae Geun LEE ; Seum CHUNG ; Yoon Kyu CHUNG

Archives of Plastic Surgery.2012;39(4):412-416. doi:10.5999/aps.2012.39.4.412

BACKGROUND: Even though the quality of medical and surgical care has improved remarkably over time, iatrogenic injuries that require surgical treatment including injuries caused by cast and elastic bandage pressure, extravasation, and dopamine-induced ischemia still frequently occur. The goal of this study was to estimate the incidence and analyze the distribution of iatrogenic injuries referred to our department. METHODS: A retrospective clinical review was performed from April 2006 to November 2010. In total, 196 patients (116 females and 80 males) were referred to the plastic surgery department for the treatment of iatrogenic injuries. We analyzed the types and anatomic locations of iatrogenic complications, along with therapeutic results. RESULTS: An extravasation injury (65 cases, 37.4%) was the most common iatrogenic complication in our study sample, followed by splint-induced skin ulceration, dopamine-induced necrosis, prefabricated pneumatic walking brace-related wounds and elastic bandage-induced wounds. Among these, prefabricated pneumatic walking brace-related complication incidence increased the most during the 5-year study period. CONCLUSIONS: The awareness of the very common iatrogenic complications and its causes may allow physicians to reduce their occurrence and allow for earlier detection and referral to a plastic surgeon. We believe this is the first study to analyze iatrogenic complications referred to a plastic surgery department in a hospital unit.
Compression Bandages ; Extravasation of Diagnostic and Therapeutic Materials ; Female ; Hospital Units ; Humans ; Incidence ; Ischemia ; Medical Errors ; Necrosis ; Pressure Ulcer ; Referral and Consultation ; Retrospective Studies ; Skin ; Skin Ulcer ; Soft Tissue Injuries ; Surgery, Plastic ; Walking

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Treatment of Fingertip Amputation in Adults by Palmar Pocketing of the Amputated Part.

Mi Sun JUNG ; Young Kook LIM ; Yong Taek HONG ; Hoon Nam KIM

Archives of Plastic Surgery.2012;39(4):404-410. doi:10.5999/aps.2012.39.4.404

BACKGROUND: First suggested by Brent in 1979, the pocket principle is an alternative method for patients for whom a microsurgical replantation is not feasible. We report the successful results of a modified palmar pocket method in adults. METHODS: Between 2004 and 2008, we treated 10 patients by nonmicrosurgical replantation using palmar pocketing. All patients were adults who sustained a complete fingertip amputation from the tip to lunula in a digits. In all of these patients, the amputation occurred due to a crush or avulsion-type injury, and a microsurgical replantation was not feasible. We used the palmar pocketing method following a composite graft in these patients and prepared the pocket in the subcutaneous layer of the ipsilateral palm. RESULTS: Of a total of 10 cases, nine had complete survival of the replantation and one had 20% partial necrosis. All of the cases were managed to conserve the fingernails, which led to acceptable cosmetic results. CONCLUSIONS: A composite graft and palmar pocketing in adult cases of fingertip injury constitute a simple, reliable operation for digital amputation extending from the tip to the lunula. These methods had satisfactory results.
Adult ; Amputation ; Cosmetics ; Fingers ; Humans ; Nails ; Necrosis ; Replantation ; Transplants

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Flexor Tenorrhaphy Using Absorbable Suture Materials.

Hyung Joo KANG ; Dong Chul LEE ; Jin Soo KIM ; Sae Hwi KI ; Si Young ROH ; Jae Won YANG

Archives of Plastic Surgery.2012;39(4):397-403. doi:10.5999/aps.2012.39.4.397

BACKGROUND: Nonabsorbable sutures are favorable for repairing flexor tendons. However, absorbable sutures have performed favorably in an animal model. METHODS: Two-strand sutures using the interlocking modified Kessler method with polydioxanone absorbable sutures 4-0 were used to repair completely ruptured flexor tendons in 55 fingers from 41 consecutive patients. The medical records of average 42 follow up weeks were analyzed retrospectively. The data analyzed using the chi-squared test, and Fisher's exact test was used for postoperative complications. The results were compared with those of other studies. RESULTS: Among the index, middle, ring, and little fingers were injured in 9, 17, 16, and 13 fingers, respectively. The injury levels varied from zone 1 to 5. Of the 55 digits in our study, there were 26 (47%) isolated flexor digitorum profundus (FDP) injuries and 29 (53%) combined FDP and with flexor digitorum superficialis injuries. Pulley repair was also conducted. Concomitant injuries of blood vessels and nerves were found in 17 patients (23 fingers); nerve injuries occurred in 5 patients (10 fingers). Two patients had ruptures (3.6%), and one patient had two adhesions (3.6%). Using the original Strickland criteria, all the patients were assessed to be excellent or good. Also, fibrosis and long-term foreign body tissue reactions such as stitch granuloma were less likely occurred in our study. Compared to the Cullen's report that used nonabsorbable sutures, there was no significant difference in the rupture or adhesion rates. CONCLUSIONS: Therefore, this study suggests that appropriate absorbable core sutures can be used safely for flexor tendon repairs.
Animals ; Blood Vessels ; Fibrosis ; Fingers ; Follow-Up Studies ; Foreign Bodies ; Formycins ; Granuloma ; Hand ; Humans ; Medical Records ; Polydioxanone ; Postoperative Complications ; Retrospective Studies ; Ribonucleotides ; Rupture ; Sutures ; Tendon Injuries ; Tendons

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The Etiology and Treatment of the Softened Phallus after the Radial Forearm Osteocutaneous Free Flap Phalloplasty.

Seok Kwun KIM ; Tae Heon KIM ; Jin Il YANG ; Myung Hoon KIM ; Min Soo KIM ; Keun Cheol LEE

Archives of Plastic Surgery.2012;39(4):390-396. doi:10.5999/aps.2012.39.4.390

BACKGROUND: The radial forearm osteocutaneous free flap is considered to be the standard technique for penile construction. One year after their operation, most patients experience a softened phallus, so that they suffer from difficulties in sexual intercourse. In this report, we present our experience with phalloplasty by radial forearm osteocutaneous free flap, as well as an evaluation of the etiology and treatment of the softened phallus. METHODS: Between March 2005 and February 2010, 58 patients underwent phalloplasty by radial forearm osteocutaneous free flap. Most of their neophallus had been softened subjectively and among them, 12 patients who wanted correction were investigated. We performed repetitive fat injection, artificial dermis grafting, silicone rod insertion, and rib bone with cartilaginous tip graft. Physical examination, plain radiograph, computed tomography, bone scintigraphy, and satisfaction scores were investigated. RESULTS: Most of the participants' penises have been softened after phalloplasty, and the skin elasticity had been also decreased. On plain radiograph, the distal end of the bone was self-rounded; however, the bone shape of the neophallus had no significant interval changes or resorption. Computed tomography showed equivocal density of cortical bone. On bone scintigraphy, the bone metabolism was active at 3 months postoperatively, and remained active 9 years postoperatively. CONCLUSIONS: The use of a rib bone with cartilaginous tip graft could be an option for improvement of the softened phallus. Silicon rod insertion is also worth considering for rigidity of the softened phallus. Decreased rigidity due to soft tissue atrophy could be alleviated with repeated fat injection and artificial dermis grafting.
Atrophy ; Coitus ; Dermis ; Elasticity ; Forearm ; Free Tissue Flaps ; Humans ; Male ; Penis ; Physical Examination ; Postoperative Complications ; Ribs ; Silicones ; Skin ; Transplants

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Reducing Donor Site Morbidity When Reconstructing the Nipple Using a Composite Nipple Graft.

Taik Jong LEE ; Hyung Joo NOH ; Eun Key KIM ; Jin Sup EOM

Archives of Plastic Surgery.2012;39(4):384-389. doi:10.5999/aps.2012.39.4.384

BACKGROUND: Numerous procedures are available for nipple reconstruction without a single gold standard. This study presents a method for reducing donor-site morbidity in nipple reconstruction using a composite nipple graft after transverse rectus abdominis musculocutaneous flap breast reconstruction. METHODS: Thirty-five patients who underwent nipple reconstruction using a composite nipple graft technique between July of 2001 and December of 2009 were enrolled in this study. To reduce the donor site morbidity, the superior or superior-medial half dome harvesting technique was applied preserving the lateral cutaneous branch of the fourth intercostal nerves. The patients were asked to complete a previously validated survey to rate the color and projection of both nipples, along with the sensation and contractility of the donor nipple; and whether, in retrospect, they would undergo the procedure again. To compare projection, we performed a retrospective chart review of all the identifiable patients who underwent nipple reconstruction using the modified top hat flap technique by the same surgeon and during the same period. RESULTS: Thirty-five patients were identified who underwent nipple reconstruction using a composite nipple graft. Of those, 29 patients (82.9%) responded to the survey. Overall, we received favorable responses to the donor site morbidity. Projection at postoperative 6 months and 1 year was compared with the immediate postoperative results, as well as with the results of nipples reconstructed using the modified top hat flap. CONCLUSIONS: The technique used to harvest donor tissue is important. Preserving innervation of the nipple while harvesting can reduce donor site morbidity.
Breast ; Humans ; Intercostal Nerves ; Nipples ; Reconstructive Surgical Procedures ; Rectus Abdominis ; Retrospective Studies ; Sensation ; Tissue Donors ; Transplants

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Outcome of Management of Local Recurrence after Immediate Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction.

Taik Jong LEE ; Wu Jin HUR ; Eun Key KIM ; Sei Hyun AHN

Archives of Plastic Surgery.2012;39(4):376-383. doi:10.5999/aps.2012.39.4.376

BACKGROUND: No consensus has been reached regarding the outcome of management of local recurrence after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. This study demonstrated the presentation, management, and outcomes of local recurrence after immediate TRAM breast reconstruction. METHODS: A comparison was conducted among 1,000 consecutive patients who underwent immediate breast reconstruction with a pedicled TRAM flap (TRAM group) and 3,183 consecutive patients who underwent only modified radical mastectomy without reconstruction (MRM group) from January 2001 to December 2009. The presentation, treatment, and outcome including aesthetics and overall survival rate were analyzed. RESULTS: Local recurrences occurred in 18 (1.8%) patients (TRAM-LR group) who underwent TRAM breast reconstruction and 38 (1.2%) patients (MRM-LR group) who underwent MRM only (P=0.1712). Wide excision was indicated in almost all the local recurrence cases. Skin graft was required in 4 patients in the MRM-LR group, whereas only one patient required a skin graft to preserve the mound shape in the TRAM-LR group. The breast mound was maintained in all 17 patients that survived in the TRAM-LR group even after wide excision. The overall survival rate was 94.4% in the TRAM-LR group and 65.8% in the MRM-LR group (P=0.276). CONCLUSIONS: Local recurrence after immediate TRAM flap breast reconstruction could be detected without delay and managed effectively by multiple modalities without reducing overall survival rates. Breast mound reconstruction with soft autologous tissue allowed for primary closure in most of the cases. In all of the patients who survived, the contour of their reconstructed breast remained.
Breast ; Breast Neoplasms ; Consensus ; Esthetics ; Female ; Humans ; Mammaplasty ; Mastectomy, Modified Radical ; Neoplasm Recurrence, Local ; Rectus Abdominis ; Recurrence ; Skin ; Survival Rate ; Transplants

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