Background: The en bloc sliding gluteus maximus myocutaneous flap was introduced to preserve the vasculature, muscular integrity, sensory innervation, and normal gluteal contour with a midline scar in sacrococcygeal pressure ulcer reconstruction. However, its critical disadvantages include incomplete detachment of the origin of the gluteus maximus and central tension of the closed wound due to round ulcer excision. Therefore, we reviewed the surgical anatomy and applied modifications to achieve sufficient flap mobilization and to decrease complications. Methods: After fusiform or rocket-shaped ulcer excision, submuscular flap elevation was initiated by completely detaching the origin of the gluteus maximus, including the posterior iliac crest, followed by comprehensive lateral submuscular dissection in the gluteal space while preserving the neurovascular pedicles. Bony protrusions were tangentially resected from the lower sacrum and upper coccyx. After en bloc medial advancement of the bilateral flaps, defects were closed in layers, with muscle ligament fixation at the midline. Results: Twenty-nine patients underwent surgery for sacrococcygeal pressure ulcers (primary, n=22; recurrent, n=7). Transverse width of the excised ulcers was 5–12 cm (final defect, 7–15 cm). During the follow-up period (6 months to 7 years), no early postoperative complications or late aesthetic or functional discomfort occurred; however, intermittent skin sloughing occurred in four cases and one coccygeal sore recurrence occurred. The recurrent ulcer was treated using the same surgical method, with no recurrence after 2 years. Conclusion This modification can be successfully used for the reconstruction of primary and recurrent sacrococcygeal pressure ulcers.

Background: Surgical scars subjected to excessive tension tend to widen and become hypertrophic due to strong mechanical stretching forces. In this study, we evaluated the clinical outcomes of combined intraoperative and postoperative long-term tension reduction techniques for the revision of scars subjected to excessive tension. Methods: In total, 64 cases (62 patients) underwent scar revision and were followed for 6 months or more. The long-term tension reduction technique included intraoperative subcutaneous fascial and deep dermal closure using nonabsorbable nylon sutures and postoperative long-term skin taping for 3 to 8 months. The final scars were objectively evaluated using our Linear Scar Evaluation Scale (LiSES, 0-10 scale), which consisted of five categories: width, height, color, texture, and overall appearance. Results: All 64 cases healed successfully, without early postoperative complications such as infection or dehiscence. The follow-up period ranged from 6 months to 6 years. The LiSES scores ranged from 5 to 10 (mean: 8.2). Fifty-one cases (79.6%) received a score of 8 to 10, which was assessed as “very good” by the evaluator. Two cases with a score of 5 (3%) showed partial hypertrophic scars at the last follow-up visit. All patients were highly satisfied with their final outcomes, including the two patients who experienced partial hypertrophic scars. Conclusions A combination of intraoperative and postoperative long-term tension reduction techniques can achieve the goal of long-term dermal support and satisfactory aesthetic outcomes for scar revision in areas subjected to excessive tension.

Background: In inferomedially rotated zygomatic fractures sticking in the maxillary sinus, it is often difficult to achieve complete reduction only by conventional intraoral reduction. We present a new intraoral reduction technique using a Kirschner wire and its clinical outcome. Methods: Among 39 inferomedially impacted zygomatic fractures incompletely reduced by a simple intraoral reduction trial with a bone elevator, a Kirschner wire (1.5 mm) was vertically inserted from the zygomatic body to the lateral orbital rim in 17 inferior-dominant rotation fractures and horizontally inserted to the zygomatic arch in nine medial-dominant and 13 bidirectional rotation fractures. A Kirschner wire was held with a wire holder and lifted in the superolateral or anterolateral direction for reduction. Following reduction of the zygomaticomaxillary fracture, internal fixation was performed. Results: Fractures were completely reduced using only an intraoral approach with Kirschner wire reduction in 33 cases and through an additional lower lid or transconjunctival incision in six cases. There were no surgical complications except in one patient with undercorrection. Postoperative 6-month computed tomography scans showed complete bone union and excellent bone alignment. Four patients experienced difficulty with upper lip elevation; however, these problems spontaneously resolved after manual tissue lump massage and intralesional steroid (Triamcinolone) injection. Conclusions We completely reduced infraorbital rim fractures, zygomaticomaxillary buttresses, and zygomaticofrontal suture fractures in 84% of patients through an intraoral approach alone. Intraoral Kirschner wire reduction may be a useful option by which to obtain effective and powerful reduction motion of an inferomedially rotated zygomatic body.

BACKGROUND: Accessory auricles (AAs) are common congenital anomalies. We present a new classification according to location and shape, and propose a system for coding the classifications. METHODS: This study was conducted by reviewing the records of 502 patients who underwent surgery for AA. AAs were classified into three anatomical types: intraauricular, preauricular, and buccal. Intraauricular AAs were divided into three subtypes: intracrural, intratragal, and intralobal. Preauricular AAs were divided into five subtypes: precrural, superior pretragal, middle pretragal, inferior pretragal, and prelobal. Buccal AAs were divided into two subtypes: anterior buccal and posterior buccal. AAs were also classified according to their protrusion pattern above the surrounding surface: pedunculated, sessile, areolar, remnant, and depressed.Pedunculated and sessile AAs were subclassified as spherical, ovoid, lobed, and nodular, according to their body shape. Cartilage root presence and family history of AA were reviewed. A coding system for these classifications was also proposed. RESULTS: The total number of AAs in the 502 patients was 1,003. Among the locations, the superior pretragal subtype (27.6%) was the most common. Among the protrusion patterns and shapes, pedunculated ovoid AAs were the most common in the preauricular (27.8%) and buccal areas (28.0%), and sessile lobed AAs were the most common in the intraauricular area (48.7%). The proportion of AAs with a cartilage root was 78.4%, and 11% of patients had a family history. The most common type of preauricular AA was the superior pretragal pedunculated ovoid AA (13.2%) with a cartilage root. CONCLUSIONS: This new system will serve as a guideline for classifying and coding AAs.
Cartilage ; Classification* ; Clinical Coding ; Embryology ; Humans

A sialocele is a subcutaneous cavity containing saliva, most often caused by facial trauma or iatrogenic complications. In subcondylar fractures, most surgeons are conscious of facial nerve injury; however, they usually pay little attention to the parotid duct injury. We report the case of a 41-year-old man with a sialocele, approximately 5×3 cm in size, which developed 1 week after subcondylar fracture reduction. The sialocele became progressively enlarged despite conservative management. Computed tomography showed a thin-walled cyst between the body and tail of the parotid gland. Fluid leakage outside the cyst was noted where the skin was thin. Sialography showed a cutting edge of the inferior interlobular major duct before forming the common major duct that seemed to be injured during the subcondylar fracture reduction process. We decided on prompt surgical treatment, and the sialocele was completely excised. A duct from the parotid tail, secreting salivary secretion into the cyst, was ligated. Botulinum toxin was administrated to block the salivary secretion and preventing recurrence. Treatment was successful. In addition, we found that parotid major ducts are enveloped by the deep lobe and extensive dissection during the subcondylar fracture reduction may cause parotid major duct injury.
Adult ; Botulinum Toxins ; Facial Nerve Injuries ; Humans ; Intraoperative Complications ; Mandibular Fractures ; Parotid Gland ; Recurrence ; Saliva ; Sialography ; Skin ; Surgeons ; Tail

BACKGROUND: In 2011, two roads in a residential area in Seoul were found to be contaminated with the radionuclide cesium-137 (137Cs). In response to public concerns, an epidemiological study was conducted. METHODS: The standardized cancer incidence ratios in the affected and neighboring regions were calculated based on the central cancer registry. Households in the region were sampled using the random stratified sampling technique, and questionnaires were administered to family members, via home visit and via students in elementary to high schools. Information on duration of residency and frequency of use of the roads was applied to calculate cumulative radiation exposure dose from the roads, alongside with the reported 137Cs contamination amounts. Information on past medical history, perceived risk, anxiety and psychological stress was also obtained. Of the 31,053 residents, 8,875 were analyzed. To examine possible associations between radiation exposure and health problems, logistic regression adjusted for covariates were performed with consideration of the sampling design, population weight and stratification. RESULTS: No significant association was found between self-informed diseases, including cancers, and estimated radiation exposure dose. According to an increase of radiation level, a significant increase in anxiety in all and a decline in the psychosocial wellbeing of the adults was noted. The risk perception level was higher in the elderly, females, the less educated, and the highest exposed individuals. CONCLUSION: This study provides a basis for risk communication with residents and community environmental health policy.
Adult ; Aged ; Anxiety ; Environmental Health ; Epidemiologic Studies ; Family Characteristics ; Female ; House Calls ; Humans ; Incidence ; Internship and Residency ; Logistic Models ; Radiation Exposure ; Seoul ; Stress, Psychological

Lymphangioma is a congenital malformed lymphatic tumor that rarely involves the tongue. In our clinic, a 10-year-old female presented with lymphangioma circumscriptum involving the right two-thirds of the tongue. We administered an intralesional combination injection of triamcinolone, bleomycin, and bevacizumab as a treatment. Almost complete remission after combination therapy was achieved without complications such as edema, swallowing difficulties or recurrence. Bevacizumab, an inhibitor of vascular endothelial growth factor, was effective for the treatment of lymphangioma of the tongue in this case. No recurrence was noted at the 1-year follow up.
Bevacizumab* ; Bleomycin* ; Child ; Deglutition ; Edema ; Female ; Follow-Up Studies ; Humans ; Lymphangioma* ; Recurrence ; Tongue* ; Triamcinolone ; Vascular Endothelial Growth Factor A

Titanium micro-mesh implants are widely used in orbital wall reconstructions because they have several advantageous characteristics. However, the rough and irregular marginal spurs of the cut edges of the titanium mesh sheet impede the efficacious and minimally traumatic insertion of the implant, because these spurs may catch or hook the orbital soft tissue, skin, or conjunctiva during the insertion procedure. In order to prevent this problem, we developed an easy method of inserting a titanium micro-mesh, in which it is wrapped with the aseptic transparent plastic film that is used to pack surgical instruments or is attached to one side of the inner suture package. Fifty-four patients underwent orbital wall reconstruction using a transconjunctival or transcutaneous approach. The wrapped implant was easily inserted without catching or injuring the orbital soft tissue, skin, or conjunctiva. In most cases, the implant was inserted in one attempt. Postoperative computed tomographic scans showed excellent placement of the titanium micro-mesh and adequate anatomic reconstruction of the orbital walls. This wrapping insertion method may be useful for making the insertion of titanium micro-mesh implants in the reconstruction of orbital wall fractures easier and less traumatic.
Conjunctiva ; Humans ; Orbit ; Orbital Fractures ; Plastics ; Reconstructive Surgical Procedures ; Skin ; Surgical Instruments ; Surgical Mesh ; Sutures ; Titanium*

BACKGROUND: In the surgical correction of prominent ear, a technique known as percutaneous adjustable closed otoplasty (PACO), which does not involve skin incision, undermining, or cartilage manipulation, has been developed to resolve problems including hematoma, infection, contour deformities, prolonged use of a compressive dressing, and hospitalization. We modified this procedure to make it more practical and accessible and to achieve better results. In this article, we introduce our modifications and demonstrate the clinical applicability of the modified procedure to patients with hardened auricular cartilage. METHODS: Two adult patients with prominent upper ears underwent closed otoplasty in an outpatient setting. Based on the anatomical features of the patients, three lines for traction sutures were designed on the scapha and counter scapha. Tab incisions were made at all predetermined puncture sites. Three antihelix-forming sutures (4-0 nylon) were put in place via percutaneous punctures. The sutures were performed from the counter scapha to the postauricular sulcus subcutaneously, using an 18-mm empty curved needle. The sutures were scraped over the mastoid bone such that they were anchored to the mastoid periosteum. After determining an adequate auriculocephalic distance, the sutures were tied at the postauricular sulcus. A slight overcorrection was made to compensate for post-surgical relapse. RESULTS: We observed no complications such as hematoma, infection, contour deformities, epithelial inclusion cyst formation, suture extrusion, or dimples on the scapha. At a long-term follow-up examination, the patients had well-defined antihelical folds and were satisfied with the aesthetic results of the procedure. CONCLUSIONS: We propose our technique as a reliable treatment option for the correction of prominent ear.
Adult ; Bandages ; Cartilage ; Congenital Abnormalities ; Ear Auricle ; Ear Cartilage ; Ear* ; Follow-Up Studies ; Hematoma ; Hospitalization ; Humans ; Mastoid ; Needles ; Otologic Surgical Procedures ; Outpatients ; Periosteum ; Punctures ; Recurrence ; Skin ; Sutures ; Traction

PURPOSE: Finger immobilization by Kirschner-wire (K-wire) insertion may be used for postoperative stability after release of scar contracture. K-wire insertion through the phalangeal bone requires drilling and can result in joint and/or tendon injury or pain during wire removal. To prevent these problems, we inserted the K-wire through the soft tissue. METHODS: Seventy-five fingers of 45 patients who underwent reconstruction of scar contracture of the fingers were immobilized by K-wire. After contracture release, just before skin grafting and/or local flap surgery, in full extension of the finger, a K-wire was inserted manually from the fingertip to the proximal phalanx or metacarpal bone through the soft tissue under the phalangeal bone, along the longitudinal axis on the volar side. If the graft site did not have enough soft tissue or the K-wire was felt on the recipient bed, the K-wire was inserted on the dorsal side of the finger. K-wires were manually removed two weeks after surgery. RESULTS: In most cases, the time to insert the K-wire was 2-3 minutes per finger, and immobilization and stability was maintained for two weeks. In two fingers, the K-wire came out prematurely during wound care; this did not affect the overall outcome. There were no complications due to K-wire insertion or pain during removal. CONCLUSION: Finger immobilization by K-wire insertion through soft tissue is simple to perform, leads to stable immobilization, has no adding procedure. This method is useful for temporary finger immobilization in full extension.
Axis, Cervical Vertebra ; Cicatrix* ; Contracture* ; Fingers* ; Humans ; Immobilization* ; Joints ; Skin Transplantation ; Tendon Injuries ; Transplants ; Wounds and Injuries