BACKGROUND: Serial (staged) excision of congenital melanocytic nevi (CMN) is an important treatment option for medium-sized CMN. However, few studies have investigated the outcomes of serial excision in detail.OBJECTIVE: We report our experience regarding serial excision of CMN, including methods to effectively reduce the procedural stages and scar length.METHODS: We retrospectively reviewed medical records of patients with CMN treated between 2008 and 2015; 33 patients (7 men and 26 women) underwent serial excision.RESULTS: The CMN were located on the face (n=11), arms (n=6), legs (n=11), and other areas of the body (n=11), including the back (n=2), chest (n=1), deltoid region (n=1), and buttocks (n=1). The mean CMN area was 19.7 cm². The mean number of surgical stages was 2.2. The mean interval between surgeries was 10.6 months. A marginal S-shaped incision along both edges of the nevus was preferred over elliptical excision, to reduce scarring. Pulsed dye, erbium:yttrium–aluminum–garnet (YAG), neodymium-doped:YAG, and carbon dioxide fractional lasers were used to improve the final outcomes and minimize scarring.CONCLUSION: Serial excision is an effective treatment option associated with greater patient satisfaction, particularly for medium-sized and hairy CMN. Conventional elliptical serial excision is associated with the formation of elongated scars and sacrifices normal skin adjacent to the lesion. The marginal S-shaped incision reduces scarring by dispersing mechanical tension on the scar without skin wastage. Compared with the elliptical excision method, the marginal S-shaped incision reduces the number of surgical stages and results in a cosmetically superior scar. Performing a marginal S-shaped incision is technically challenging in certain anatomical locations, such as the eyes, nose, and mouth. Therefore, it is necessary to combine this procedure with erbium:YAG and neodymium-doped:YAG ablation.
Arm ; Buttocks ; Carbon Dioxide ; Cicatrix ; Dermatologic Surgical Procedures ; Humans ; Leg ; Male ; Medical Records ; Methods ; Mouth ; Nevus ; Nevus, Pigmented ; Nose ; Patient Satisfaction ; Retrospective Studies ; Skin ; Thorax

OBJECTIVE: Decompressive craniectomy (DC) is a useful surgical method to achieve adequate decompression in hypertensive intracranial patients. This study suggested a new skin incision for DC, and analyzed its efficacy and safety. METHODS: In the retrograde reviews, 15 patients underwent a newly suggested surgical approach using n-shape skin incision technique (Group A) and 23 patients were treated with conventional question mark skin incision technique (Group B). Two groups were compared in the terms of the decompressed area of the craniectomy, protruded brain volume out of the skull layer, the operation time from skin incision to bone flap removal, and modified Rankin Scale (mRS) which was evaluated for 3 months after surgery. RESULTS: The decompressed area of craniectomy (389.1 cm² vs. 318.7 cm², p=0.041) and the protruded brain volume (151.8 cm³ vs. 116.2 cm³, p=0.045) were significantly larger in Group A compared to the area and the volume in Group B. The time interval between skin incision and bone flap removal was much shorter in Group A (23.3 minutes vs. 29.5 minutes, p=0.013). But, the clinical results were similar between 2 groups. Group A showed more favorable outcome proportion (mRS 0-3, 6/15 patients vs. 5/23 patients, p=0.225) and lesser mortality cases proportion 1/15 patients vs. 4/23 patients, but these differences were not significantly observed (p=0.225 and 0.339). CONCLUSION: DC using n-shaped skin incision was a feasible and safe surgical technique. It may be an easier and faster method for the purpose of training neurosurgeons.
Brain ; Decompression ; Decompressive Craniectomy* ; Dermatologic Surgical Procedures ; Humans ; Methods ; Mortality ; Neurosurgeons ; Skin* ; Skull ; Surgical Flaps ; Surgical Procedures, Operative

OBJECTIVETo explore the method of the treatment for hallux valgus with the proximal crescentic osteotomy of the first metatarsal bone, combining with distal lateral soft tissue release.

METHODSFrom January 2008 to December 2012, 21 cases 21 hallux valgus feet were treated by operative procedure, included 1 male (1 foot) and 20 females (20 feet), with the mean age of 52 years (range, 36-68 years). Among all patients were followed up for 12 to 26 months, with the mean 16 months. The preoperative, post-operative and final follow-up X-ray films of all patients were collected. The hallux valgus angle, intermetatarsal angle and distal metatarsal articular angle were measured and analyzed. The surgical outcome was evaluated combined with the AOFAS score.

RESULTSThe average hallux valgus angle decreased from 42.3° ± 1.8° preoperatively to 14.5° ± 1.8 postoperatively, the average intermetatarsal angle did from 21.9° ± 1.7 to 9.1° ± 1.8°, and the average distal metatarsal articular angle did from 14.9° ± 1.8 to 7.2° ± 1.5, respectively. There were significant differences between the preoperative and postoperative roentgenographic index. AOFAS score was improved from 44.0 ± 1.8 preoperatively to 83.9 ± 2.2 at the final follow-up.

CONCLUSIONSThe proximal crescentic osteotomy of the first metatarsal bone combined distal soft tissue reconstruction obtained satisfactory results in severe hallux valgus patients with big intermetatarsal angle.

Adult ; Aged ; Dermatologic Surgical Procedures ; methods ; Female ; Hallux Valgus ; surgery ; Humans ; Male ; Metatarsal Bones ; surgery ; Middle Aged ; Osteotomy ; methods

Recently, injectable dermal fillers have become important alternatives to surgical procedures for the correction of facial wrinkles. Bovine collagen is the first approved material for filler injection, and several studies have shown its efficacy. However, the risk of developing an allergic reaction and xenogenic transmission of bovine spongiform encephalopathy remain among its disadvantages. In this randomized, double-blinded, split-face study, we compared the efficacy and safety of a porcine collagen filler (TheraFill(R)) with that of a bovine collagen filler (KOKEN(R)) for nasolabial fold correction. A total of sixty one patients with mild to severe nasolabial fold were randomized to receive TheraFill(R) and KOKEN(R) on contralateral sides of the face. During the 12-month follow-up period, improvement in the Wrinkle-Severity Rating Scale score was slightly higher in TheraFill(R) group than KOKEN(R) group, although the difference was not statistically significant. No serious adverse reactions were observed and both materials were tolerable in most cases. In conclusion, the long-term effect of TheraFill(R) on nasolabial fold correction was comparable to that of KOKEN(R), and it may be a good alternative to bovine collagen filler.
Adult ; Aged ; Animals ; Biocompatible Materials/therapeutic use ; Cattle ; Collagen/adverse effects/*therapeutic use ; Dermatologic Surgical Procedures/*methods ; Double-Blind Method ; Face/surgery ; Female ; Follow-Up Studies ; Humans ; Injections, Intradermal ; Male ; Middle Aged ; Nasolabial Fold/*surgery ; Prospective Studies ; Skin Aging ; Surgery, Plastic/*methods ; Swine ; Treatment Outcome

OBJECTIVETo explore the clinical effect of using dorsal two wing-shaped flap to reconstruct finger web for treatment of congenital syndactyly.

METHODSThis technique has been used in 19 children with congenital syndactyly. At the dorsum, a flap with V-shaped tip and two wing-shaped pedicle were designed and was just sewed up with an anchor-shaped incision at the palm. The web was primarily reconstructed without skin graft at base of fingers. Distal end of fingers were separated by using serrated flap and were closed after removal of fatty tissue. At some cases with tight skin connection. The defect area at lateral and distal end of fingers was closed by small pieces of skin graft.

RESULTSAll the webs were reconstructed primarily without skin graft at the base of fingers. 7 cases with tight skin connection had small pieces of skin graft at lateral and distal end of fingers. Primary healing was achieved in all cases. After 1 to 6 months of follow-up, both the appearance and function were satisfactory without conspicuous scar. The reconstructed finger webs were in normal depth and width.

CONCLUSIONSPrimary web space can be achieved by dorsal two wing-shaped flap without skin graft at base of fingers. It is one of the best choices for treatment of congenital syndactyly.

Adipose Tissue ; surgery ; Child ; Cicatrix ; Dermatologic Surgical Procedures ; methods ; Fingers ; surgery ; Humans ; Skin Transplantation ; Surgical Flaps ; transplantation ; Syndactyly ; surgery ; Wound Healing

OBJECTIVETo investigate the application of medpor and split-thickness skin graft in formation of cranioauricular sulcus during auricular reconstruction with Nagata method.

METHODSThe first stage operation was fulfilled according to the Nagata two-stage method which involves fabrication and grafting of the costal cartilage framework. The second-stage ear elevation operation was undertaken 6 months later to form the cranioauricular sulcus. Split-thickness skin was taken from temporal and accipital area. After releasing the auricular framework and transplanting C shaped medpor at the rear side of framework, the temporaparietal fascia flap was transferred to cover postauricular medpor and framework. Then the split-thickness skin graft was implant on the fascia surface.

RESULTSFrom July 2010 to August 2012, 20 cases (22 ears) were treated. Partial necrosis of temporaparietal fascia flap and framework exposure happened in 1 case. Successful ear reconstruction was achieved in other cases with satisfactory cranioauricular sulcus during the follow-up period of 6-18 months (average, 13 months).

CONCLUSIONSThe application of medpor and split-thickness skin graft in the ear elevation of Nagata method for auricular reconstruction for microtia can achieve satisfactory results. It not only avoids the obvious scar in the donor site due to harvesting full-thickness and intermediate-thickness skin, but also reduces chest trauma due to harvesting costal cartilage.

Costal Cartilage ; transplantation ; Dermatologic Surgical Procedures ; methods ; Ear Auricle ; surgery ; Fascia ; Humans ; Polyethylenes ; therapeutic use ; Skin Transplantation ; Surgical Flaps ; transplantation

The Rejuran(R) is a new filler product made from purified polynucleotides. Here we present data from an animal study and a clinical trial to examine the durability, efficacy and safety of the Rejuran(R) on crow's feet. For the animal study, 25 mice were divided into three groups: Group 1 received phosphate buffered saline (PBS); Group 2 were treated with Yvoire(R); and Group 3 were treated with Rejuran(R). The durability and efficacy of each treatment were assessed by microscopy and staining. In the clinical trial, 72 patients were randomized to receive Rejuran(R) treatment for crow's feet on one side and Yvoire-Hydro(R) on the contralateral side, at a ratio of 1:1. Repeated treatments were performed every two weeks for a total of three times, over a total of 12 weeks' observation. All injections and observations of efficacy and safety were performed by the same two investigators. In the animal study, the Rejuran(R) group showed similar durability and inflammatory response to the Yvoire(R) group. Upon efficacy assessment, the Rejuran(R) group showed the greatest elasticity and collagen composition, and a significant difference in skin surface roughness and wrinkle depth. In the clinical trial, the primary and secondary objective efficacy outcome measure showed no statistical significance between the two groups, and in safety outcomes there were no unexpected adverse effects. Our data suggest that the Rejuran(R), as a new regenerative filler, can be useful to reduce wrinkles, by showing evidence for its efficacy and safety.
Adult ; Animals ; Dermatologic Surgical Procedures/*methods ; Double-Blind Method ; Elasticity/drug effects ; Female ; Humans ; Hyaluronic Acid/adverse effects/*therapeutic use ; Injections, Intradermal ; Male ; Mice ; Middle Aged ; Polynucleotides/adverse effects/*therapeutic use ; Skin ; Skin Aging ; Surgery, Plastic/*methods ; Treatment Outcome ; Wound Healing

Soft tissue augmentation is a process of implanting tissues or materials to treat wrinkles or soft tissue defects in the body. Over the years, various materials have evolved to correct soft tissue defects, including a number of tissues and polymers. Autogenous dermis, autogenous fat, autogenous dermis-fat, allogenic dermis, synthetic implants, and fillers have been widely accepted for soft tissue augmentations. Tissue engineering technology has also been introduced and opened a new venue of opportunities in this field. In particular, a long-lasting filler consisting of hyaluronic acid filler and living human mesenchymal cells called "injectable tissue-engineered soft tissue" has been created and applied clinically, as this strategy has many advantages over conventional methods. Fibroblasts and adipose-derived stromal vascular fraction cells can be clinically used as injectable tissue-engineered soft tissue at present. In this review, information on the soft tissue augmentation method using the injectable tissue-engineered soft tissue is provided.
Adipocytes/transplantation ; Adipose Tissue/cytology ; Biocompatible Materials ; Connective Tissue/*surgery ; Dermatologic Surgical Procedures/*methods ; Face ; Fibroblasts/transplantation ; Humans ; Hyaluronic Acid/therapeutic use ; Injections, Intradermal ; Mesenchymal Stem Cell Transplantation/*methods ; Mesenchymal Stromal Cells ; Skin ; Skin Aging ; Tissue Engineering/*methods

OBJECTIVETo summarize the clinical experience for the reconstruction of upper lip defects in different degrees.

METHODSDifferent treatment methods were selected to reconstruct the upper lip defects according to the subunit, size or location of defects on the upper lip. The therapeutic results were analyzed and compared.

RESULTSFrom Jan. 1998 to Apr. 2012, 243 cases with upper lip defects were treated, including 85 cases of traumatic defects, 110 cases of defects secondary to lip cleft and 48 cases of defects after tumor resection. 48 cases were treated with direct closure, 69 cases with cross-lip flaps, 5 Cases with orbicularis oris muscle flaps, 53 cases with unilateral labial flaps, 42 cases with bilateral labial flaps, 22 cases with lower lip flaps, and 1 case with forehead flap, 1 case with forearm flap and 2 with nasolabial fold flaps. The patients were followed up for 3-18 months with satisfactory results.

CONCLUSIONSSatisfactory results could be achieved for upper lip defects with appropriate treatment methods according to the defects degree and characters.

Cleft Lip ; surgery ; Cosmetic Techniques ; Dermatologic Surgical Procedures ; methods ; Humans ; Lip ; injuries ; surgery ; Mouth Mucosa ; Surgical Flaps ; Treatment Outcome

Adult ; Aged ; Dermatologic Surgical Procedures ; methods ; Facial Asymmetry ; surgery ; Facial Injuries ; surgery ; Humans ; Male ; Maxillary Neoplasms ; radiotherapy ; surgery ; Maxillofacial Prosthesis ; Middle Aged ; Postoperative Complications ; Reconstructive Surgical Procedures ; methods ; Retinal Neoplasms ; radiotherapy ; surgery ; Retinoblastoma ; radiotherapy ; surgery ; Young Adult