Recurrent scalp compromise following deep brain stimulation (DBS) implantation remains a challenging reconstructive problem, particularly in patients with chronic infection and repeated revision procedures. We present an acellular dermal matrix (ADM)-assisted salvage strategy using rotational scalp flap coverage with adjunctive calvarial recession for preservation of exposed DBS hardware. After debridement and subperiosteal flap elevation, ADM was applied over the exposed hardware as a biologic reinforcement layer prior to tension-free closure. Adjunctive calvarial recession was performed to reduce hardware prominence. Postoperative computed tomography demonstrated decreased hardware projection, and stable wound healing without recurrent dehiscence or infection was maintained during follow-up. This combined approach may represent an effective salvage option for recurrent DBS scalp compromise while preserving functional neuromodulation hardware.

Background: Axillary osmidrosis is a disease characterized by axillary malodor. The conventional treatment method of subdermal excision uses Metzenbaum scissors. Recently, subdermal excision using the Versajet system was introduced. However, it is an expensive surgical tool, and a recent study demonstrated a higher frequency of axillary skin necrosis with the Versajet. We propose a novel, cost-effective, and safe subdermal excision method that utilizes an electrosurgical tip cleaner (ETC). Methods: Our retrospective cohort study included 27 patients who underwent subdermal excision from June 2012 to November 2021. The patients were classified into three groups according to the surgical method: Metzenbaum scissors, Versajet, and ETC. The operation time, hospitalization cost, and postoperative complications were investigated. Results: The number of patients in the Metzenbaum scissors, Versajet, and ETC groups was seven, eleven, and nine, respectively. The mean operation time and hospitalization cost were significantly different among the three groups (P<0.05). The longest mean operation time was observed in the Metzenbaum scissors group (112.9±23.6 minutes), followed by the ETC and Versajet groups (76.4±27.1 and 64.2±24.8 minutes, respectively). The most expensive method was the Versajet ($2,346.1±517.7), followed by the ETC and Metzenbaum scissors ($1,391.8±317.7 and $1,279.6±287.5, respectively). No postoperative complications were observed. Conclusions The ETC is a novel method of subdermal excision, comparable to Metzenbaum scissors or Versajet. Therefore, it is recommended for situations where it is necessary to consider both the time and cost of surgery.

Reconstruction of submental defects is a challenge that needs to be approached carefully, since many important anatomical structures are located in this small space. Both aesthetic and functional outcomes should be considered during reconstruction. In this report, we describe a case where a superficial branch of the transverse cervical artery (STCA) perforator propeller flap was applied for coverage of the submental area. An 85-year-old woman presented with a 3-cm ovoid mass on her submental area. We covered the large submental defect with a STCA rotational flap in a 180° propeller pattern. The flap survived well without any complications at 1 year of follow-up. A STCA propeller flap is a useful surgical option in reconstruction for defect coverage of the submental area.

Iatrogenic electrical burns that occur from the use of a defibrillator, a paddle-type cardiac shock device, have been reported in various forms. Electrical burns are usually conducted directly through the skin and are more damaging than scald burns or contact burns. A transcutaneous cardiac pacing device is a patch-type cardiac shock device that automatically delivers a shock when an abnormal heart rhythm is detected. We introduce a unique case of iatrogenic electrical burns caused by the transcutaneous pacing patch of a cardiac shock device. Electrical energy was converted into a spark due to foreign bodies deposited around the patch, resulting in damage to the peripheral area of the skin.

Background/Aims: Abnormal psychological profiles are frequently found in patients with functional gastrointestinal disorders (FGIDs). The present study aimed to evaluate the psychological profiles of FGID patients with irritable bowel syndrome (IBS), and IBS phenotypes. Methods: In 608 FGID patients, including 235 with IBS, have filled a Rome III questionnaire and the French version of the Minnesota Multiphasic Personality Inventory 2. Data analysis was performed using univariate analysis and multivariate logistic regression. Results: This study shows that IBS patients have abnormal psychological profiles with more significant symptom exaggeration and decreased test defensiveness than non-IBS patients. They have a significantly higher score for all clinical scales. Logistic regression analysis showed in IBS patients a decrease of body mass index (P= 0.002), and test defensiveness score K (P= 0.001) and an increase of Hypochondriasis (P< 0.001) and Masculinity-Femininity scale (P= 0.018). By comparison with non-IBS patients, IBS-constipation, IBS-diarrhea, and mixed IBS patients have increased Hypochondriasis value and Depression score, mixed IBS patients have higher Psychasthenia score and higher Hypomania score. No item was significantly different in the IBS-unspecified group. Conclusions This study shows that IBS patients have different psychological profiles than other FGID patients and that psychological characteristics are associated with IBS phenotypes except for patients with unsubtyped IBS.

BACKGROUND: Parotidectomy is the treatment of choice in many parotid tumors. Due to the extensive nature of the procedure, unfavorable complications such as gustatory sweating, surgical site depression are common. Various techniques using fascia, muscle or AlloDerm have been developed but debate still remains regarding its availability and affordability. We applied a newly developed acellular dermal matrix (Insuregraf) to the parotidectomy field to act as a physical barrier and to provide adequate filling effect for prevention of functional and aesthetic complications. METHODS: From March 2010 to March 2017, 30 patients with parotid tumors underwent superficial parotidectomy. Twenty patients underwent only superficial parotidectomy. Ten patients had Insuregraf applied to the surgical site after superficial parotidectomy. We evaluated the incidence of Frey’s syndrome, surgical site depression, and patient satisfaction rate in both groups. RESULTS: The incidence of Frey’s syndrome was lower in the Insuregraf group (0 vs. 2). Surgical site depression was also lower in the Insuregraf group (2 vs. 20). Satisfaction score for facial contour in Insuregraf group was 9.2 out of 10, which was comparable to 6.2 out of 10 in the control group. CONCLUSION: Application of Insuregraf after superficial parotidectomy is an effective surgical procedure to prevent complications such as Frey’s syndrome and surgical site depression. This technique is affordable and safe with no immune reactions. Above all this surgical method should be considered as an option for patients who are concerned about the contour of the face after surgery.
Acellular Dermis ; Architectural Accessibility ; Collagen ; Depression ; Facial Asymmetry ; Fascia ; Humans ; Incidence ; Methods ; Parotid Neoplasms ; Patient Satisfaction ; Sweating, Gustatory

Anesthesia ; Burn Units ; Burns ; Comorbidity ; Debridement ; Hand ; Humans ; Keratinocytes ; Seoul ; Wound Healing ; Wounds and Injuries

Cicatrix ; Coinfection ; Eucalyptus ; Follow-Up Studies ; Humans ; Pigmentation ; Pliability ; Pruritus ; Sensation ; Silicon ; Silicones ; Skin Transplantation ; Skin ; Thigh ; Tissue Donors ; Transplant Donor Site ; Transplants ; Wound Healing