A 53-year-old female presented with a 2-year history of an enlarging hyperpigmented plaque on her left foot, which was later accompanied by yellowish, foul-smelling discharge, tenderness, and pain (5/10). A biopsy in Thailand confirmed acral lentiginous melanoma. Following surgical site dehiscence and lesion recurrence, she underwent further examination at Southern Philippines Medical Center. A skin punch biopsy revealed atypical melanocytes, leading to Mohs micrographic surgery. After confirming negative tumor margins, a successful skin punch graft was performed, resulting in full wound healing with no recurrence.

Acral lentiginous melanoma, though rare, is most common in Asians and often presents in areas like the soles, palms, and subungual regions. Mohs micrographic surgery, offering precise margin control, ensures cure rates comparable to traditional excision while sparing more tissue, crucial for areas like the foot. Skin punch grafting, in this case, provided faster wound healing and a high graft survival rate, highlighting its effectiveness in dermatologic surgery.

In conclusion, acral lentiginous melanoma’s subtle presentation often delays diagnosis, but combining Mohs surgery with skin punch grafting offers significant therapeutic benefits—ensuring tissue preservation, faster recovery, and improved graft outcomes.

OBJECTIVE: To review the advances in methods for reconstructing nipple projection based on tissue graft support. METHODS: The literature related to nipple projection reconstruction based on tissue graft support was reviewed and summarized in terms of the advantages and disadvantages of various tissue grafts and the improved nipple projection results. RESULTS: Loss of nipple projection is a common cause of decreased patient's satisfaction. Reconstructing nipple projection based on tissue graft support is a more common clinical method and can be done with autologous and allogeneic tissues. Autologous tissue grafts include dermis, adipose tissue with dermis, adipose tissue, ear cartilage, rib cartilage, and contralateral nipple tissue. Autologous tissue grafts are easy to obtain and have no immune rejection, but may lead to donor area damage and prolong the surgical time for tissue collection. Allogeneic tissue grafts include acellular dermal matrix, lyophilized rib cartilage, and extracellular matrix collagen, and decellularized nipple tissue. Allogeneic tissue grafts do not cause additional donor area damage, are highly malleable, and can be designed to be utilized according to the recipient area, but the high cost often limits the development of this technique. CONCLUSION There is no gold standard regarding tissue graft-assisted nipple projection reconstruction techniques, and there are advantages and disadvantages to both autologous and allogeneic tissue grafts. Surgeons should choose the appropriate graft based on the actual condition of the patient.
Humans ; Adipose Tissue ; Autografts ; Costal Cartilage ; Nipples/surgery* ; Transplants

The existing shortage of local donor corneas in our institution (University Malaya) and Malaysia, in general, prompted us to attempt the use of one donor cornea for two transplantation procedures; Descemet Stripping Endothelial Keratoplasty (DSEK) in a case of a pseudophakic bullous keratopathy (PBK) with underlying Fuchs endothelial dystrophy (FED) and lamellar patch graft in a case of limbal dermoid. The donor cornea was divided into anterior and posterior lamellae manually. The anterior corneal button was used as a patch graft for anterior lamellar keratoplasty in a 6-year-old patient with limbal dermoid, and the posterior corneal button was used for a DSEK procedure in a 68-year-old patient with corneal decompensation. Both patients had a stable and good visual outcome throughout a 1-year postoperative period. This allows the use of one corneal tissue by more than one recipient to overcome the shortage in donor corneas.
Transplants

BACKGROUND: Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. We conducted real-world analysis of HBV prophylaxis after LT in the Korean population.METHODS: Korean Organ Transplantation Registry (KOTRY) database and additionally collected data (n = 326) were analyzed with special reference to types of HBV prophylaxis.RESULTS: The study cohort comprised 267 cases of living-donor LT and 59 cases of deceased-donor LT. Hepatocellular carcinoma (HCC) was diagnosed in 232 (71.2%) of these subjects. Antiviral agents were used in 255 patients (78.2%) prior to LT. HBV DNA was undetectable in 69 cases (21.2%) and detectable over wide concentrations in the other 257 patients (78.8%) prior to LT. Polymerase chain reaction analysis of the store blood samples detected HBV DNA in all patients, with 159 patients (48.9%) showing concentrations > 100 IU/mL. Post-transplant HBV regimens during the first year included combination therapy in 196 (60.1%), hepatitis B immunoglobulin (HBIG) monotherapy in 121 (37.1%), and antiviral monotherapy in 9 (2.8%). In the second post-transplant year, these regimens had changed to combination therapy in 187 (57.4%), HBIG monotherapy in 112 (34.4%), and antiviral monotherapy in 27 (8.3%). Trough antibody to hepatitis B surface antigen titers > 500 IU/mL and >1,000 IU/mL were observed in 61.7% and 25.2%, respectively. The mean simulative half-life of HBIG was 21.6 ± 4.3 days with a median 17.7 days. Up to 2-year follow-up period, HCC recurrence and HBV recurrence developed in 18 (5.5%) and 6 (1.8%), respectively. HCC recurrence developed in 3 of 6 patients with HBV recurrence.CONCLUSION: Combination therapy is the mainstay of HBV prophylaxis protocols in a majority of Korean LT centers, but HBIG was often administered excessively. Individualized optimization of HBIG treatments using SHL is necessary to adjust the HBIG infusion interval.
Antiviral Agents ; Carcinoma, Hepatocellular ; Cohort Studies ; DNA ; Follow-Up Studies ; Half-Life ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B ; Hepatitis ; Humans ; Immunoglobulins ; Korea ; Liver Transplantation ; Liver ; Organ Transplantation ; Polymerase Chain Reaction ; Recurrence ; Transplants

BACKGROUND: This study aimed to assess the outcome of stem cell transplantation (SCT), including overall survival (OS), failure-free survival (FFS) and graft-versus-host disease (GvHD)-free/failure-free survival (GFFS), and to analyze prognostic factors in children with aplastic anemia (AA).METHODS: From 1991 to 2018, 43 allogeneic SCT recipients were enrolled in the study to investigate the demographic characteristics, survival outcomes and prognostic factors.RESULTS: With the median follow-up of 7.1 years, the estimated 10-year OS, FFS, GFFS were 86.0%, 60.5%, and 51.2%, respectively. Matched related donors (MRD, n = 28) showed better 10-year OS than unrelated donors (n = 15) (96.4% vs. 66.7%; P = 0.006). Engraftment failure was seen in 13 patients (30.2%). Donor-type aplasia was seen in 13.8% (4/29) after fludarabine (Flu)-based conditioning (Flu-group), while in 42.6% (6/14) after cyclophosphamide (Cy)-based regimen (Cy-group) (P = 0.035). Six patients died. The 10-year OS in Cy-group was 92.9% (n = 14, all MRD), while that of Flu-group was 82.1% (n = 29; P = 0.367). But Flu-group tended to have better FFS and GFFS than Cy-group, although Flu-group had less MRDs (41.4% vs. 100%; P = 0.019), and higher proportion of previous immunosuppressive treatment (IST; 62% vs. 21.4%, P = 0.012). In MRD transplants, OS was similar between Flu-group (100%, n = 14) and Cy-group (92.9%, n = 14), while FFS (100.0% vs. 42.9%; P = 0.001) and GFFS (85.7% vs. 35.7%; P = 0.006) were significantly better in Flu-group. Stem cell sources, irradiation in the conditioning, and method of GvHD prophylaxis did not significantly influence the outcome.CONCLUSION: This study reviewed SCT outcomes for pediatric AA with changes of transplant strategies over the last 25 years. The FFS and GFFS were higher in Flu-group than in Cy-group, especially in matched related transplantation. Graft failure including donor-type aplasia remains troublesome even with Flu-based conditioning. Further refinement of transplant strategies to ensure better quality-of-life should be pursued.
Anemia, Aplastic ; Child ; Cyclophosphamide ; Follow-Up Studies ; Graft vs Host Disease ; Humans ; Methods ; Stem Cell Transplantation ; Stem Cells ; Tissue Donors ; Transplants ; Unrelated Donors

We performed a revisionary open reduction and internal fixation for treating nonunion of the mid-shaft of the left clavicle with an autogenous cancellous bone graft. On postoperative day 4, the patient presented with neurologic deficits in the left upper extremity. We removed the implant and made a superior angulation to decompress the brachial plexus. At 6 months postoperatively, callus bridging and consolidation were visible and all hand and elbow functions were fully recovered. Our case suggests that brachial plexus neuropathy may be caused by stretching and compression after reduction and straightening of the nonunion site around adhesions or scar tissue. Therefore, care should be taken whether there are the risk factors that can cause brachial plexus neuropathy when revision surgery is performed for treating nonunion of a clavicle shaft fracture.
Bony Callus ; Brachial Plexus Neuropathies ; Brachial Plexus ; Cicatrix ; Clavicle ; Elbow ; Hand ; Humans ; Neurologic Manifestations ; Risk Factors ; Transplants ; Upper Extremity

PURPOSE: To report a patient with a pseudophakic bullous keratopathy (PBK) who underwent Descemet's membrane stripping endothelial keratoplasty (DSEK) with manual preparation of the donor corneal graft.CASE SUMMARY: A 61-year-old female presented with visual disturbance in her right eye. Five months prior, she was treated with phacoemulsification and intraocular lens exchange surgery of the right eye, and a very severe corneal edema was revealed by slit-lamp examination. We diagnosed PBK and planned DSEK with manual preparation of a donor corneal graft because of the non-availability of a microkeratome or a femtosecond laser. After making the corneal graft using an artificial anterior chamber, crescent knife and cornea dissector, the keratoplasty proceeded using the graft. Three months after surgery, her graft was well-maintained on the right eye. The patient's visual acuity was 0.3, and the corneal endothelial cell count was 1,844/mm².CONCLUSIONS: Manual preparation of the donor corneal graft for DSEK is suitable as a second choice treatment method when the availability of surgical devices is limited.
Anterior Chamber ; Cornea ; Corneal Edema ; Corneal Transplantation ; Descemet Membrane ; Endothelial Cells ; Female ; Humans ; Lenses, Intraocular ; Methods ; Middle Aged ; Phacoemulsification ; Tissue Donors ; Transplants ; Visual Acuity

Congenital Abnormalities ; Contracture ; Erectile Dysfunction ; Humans ; Informed Consent ; Male ; Penile Induration ; Penile Prosthesis ; Penis ; Rehabilitation ; Sensation ; Standard of Care ; Surgeons ; Transplants

Cornea ; Corneal Transplantation ; Diagnosis ; Graft Rejection ; Graft Survival ; Humans ; Keratoplasty, Penetrating ; Methods ; Outcome Assessment (Health Care) ; Retrospective Studies ; Risk Factors ; Tissue Donors ; Transplants

PURPOSE: The purpose of this retrospective study was to evaluate the method using the S-reamer and gel-type graft material by the success rate and survival rate.MATERIALS AND METHODS: Implantation period was from 2008 to 2014, Follow check up year is 2019. There were 59 patients and 117 implants. All implants were placed in the posterior maxilla with the sinus lift. The patients population consisted of 34 men and 25 women, ranging from 19 to 75 years. The residual bone heights were from 1 mm to 6 mm. Sinus was perforated with S-reamer without membrane tearing and gel type bone graft material was used for membrane lifting and filling the space. all implants were placed simultaneously. Panoramic X-ray was taken. After 5 – 6 months healing period, final prostheses were restored. After more 5-years implant surgery, Panoramic X-ray was obtained and X-ray analysis and clinical examination were performed. Success criteria was referred to a Buser's success critera. All implants were classified to success implant, survival implant, failed implant. A success implant was satisfying success criteria, a survival implant was a implant that was acute infection with suppuration and bone loss, a failed implant was a implant that was mobile, removed.RESULTS: Five implants were removed, and 4 implants had infected with bone loss. Survival rate was 95.7% and success rate was 92.3%.CONCLUSION: This retrospective study presented that this method with S-reamer and gel-type graft material was a successful treatment without membrane tear in the condition of 1-6 mm residual bone height.
Female ; Humans ; Lifting ; Male ; Maxilla ; Membranes ; Methods ; Prostheses and Implants ; Retrospective Studies ; Suppuration ; Survival Rate ; Tears ; Transplants