• Archives of Plastic Surgery
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• v.34 no.6
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• pp.785-791
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• 2007

Purpose: Paraffin has been used to augment depressed nasal contour for many years by illegally. Reported complications of nasal paraffinoma were skin thinning, displacement of nasal profile, redness, chronic inflammation and malignant change to skin cancer. The current authors report results of the secondary rhinoplasty after excision of nasal paraffinoma. Methods: Through the open rhinoplasty incision, paraffinoma was removed under direct vision. Saline irrigation and meticulous hemostasis were performed. Simultaneously, the secondary depressed nasal deformity was corrected with autogenous dermofat graft harvested from inferior gluteal fold. The dermofat was fixed to the nasofrontal area with bolster suture, and the interdormal area of the tip. Results: A total of 13 patients underwent secondary augmentation with autogenous dermofat graft after removal of paraffinoma from 2000 to 2004. The mean follow-up period was 15 months. There were no postoperative complications. All patients were satisfied with their surgical results. However, there were 10 to 20 percent resorption of the grafted dermofat. Conclusion: It is suggest that autogenous dermofat be one of good materials for the correction of the secondary deformity after removal of nasal paraffinoma. In addition, autogenous dermofat graft presented easy harvesting and manipulation for transfer, high survival rate by firm fixation to the recipient site and stable surgical results.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.53-62
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• 2011

Purpose: Even though Augmentation rhinoplasty is very popular surgical procedure, it is not easy to obtain ideal materials for augmentation. Many different synthetic materials are used but frequent complications are seen such as infection, extrusion, deform, and dislocation. Autologous tissues were used for augmentation rhinoplasty. We used dermofat graft and fat injection in augmentation rhinoplasty minimizing these problems. Methods: From 2006 to 2009, we used autologous tissues in augmentation rhinoplasty in 40 patients, 20 patients with dermofat graft and other 20 patients were treated with fat injection only. Dermofats were harvested from sacral area. gluteal fold, groin and preexisting scar tissue. Dermofats were inserted with small stab wound and fat tissues were injected as Coleman's technique. The patients were followed up 6 months to 5 years. Results: Most of the patients were satisfied in shape and height the nose. Early complications such as hematoma, infection and seroma were not found. Secondary fat injection was performed in 3 patients (15%) of dermofat graft group instead of 7 patients (35%) of fat injection only group. Conclusion: We obtained satisfactory results in augmentation rhinoplasty with dermofat graft and fat injection. Secondary fat injections were more often in fat injection group than dermofat graft group. Dermofat graft and fat injection could be another alternative technique for augmentation rhinoplasty and fat injection could be a secondary adjunctive treatment for undercorrection due to absorption.

• Archives of Plastic Surgery
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• v.32 no.6
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• pp.787-790
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• 2005

While no scar can be completely erased, most linear facial scars can result in a relatively good scar after revision. However, in case of round shaped depressed scar, the scar is often lengthened following an incisional technique. This study focuses on the technique of dermofat graft harvested from the adjacent scars for correction of depressed scars. 18 patients having multiple facial scars with a depressed scar among 375 patients who had undergone scar revision were treated from June 2003 to May 2004. Dermofat was harvested from the adjacent linear scar, then it was deepithelialized, reshaped, and grafted to the depressed scar through a small incision. Cosmetic results were generally good. Complications were overcorrection in 4 patients; hyperpigmentation occured in 1 patient. However, 13 patients were satisfied with the results. The advantages of our technique are as follows: it does not require additional operation; dermofat graft has low absorbable rate; it can maintain the volume with an adequate texture.

• Archives of Plastic Surgery
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• v.37 no.3
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• pp.250-255
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• 2010

Purpose: Pincer nail is a relatively rare deformity characterized by an increase in transverse curvature along the longitudinal axis of the nail. This curvature commonly increases from proximal to distal end of nail, leading to pinching, curling, and distortion of the underlying soft tissue and resulting frequently in severe pain. Numerous surgical procedures have been reported. Preserving the width of the nail in the correction of the pincer nail is very important for functional and aesthetic reasons. We report the results of the correction of the pincer nail using autogenous dermofat graft with a good result. Methods: From May 2006 to September 2008, dermofat graft was performed in 6 patients with pincer nail. Patients were four women and two men, and the average age was 51. The affected digits were the unilateral great toes in four patients and the unilateral thumbs in two patients. Average follow-up period was 13 months. Surgical procedure was removal of nail using an elevator to avoid damage to the nail bed. An incision was created in distal portion of hyponychium. Paronychium was dissected from distal phalanx by periosteal elevator through incision of hyponychium and tunnel was made. Then dermofat grafts harvested from inguinal area were inserted into the tunnel. Finally, a silicone sheet was inserted eponychial fold for prevention of synechia. Objective assessment was evaluated by use of the width index and height index. Results: All patients reported resolution of the pain and soft tissue pinching sensation that they had before the operation. There was good adherence between the nail plate and the underlying nail bed. The nails have regrown and were corrected in a normal and flattened appearance. The width index and height index were improved. Conclusion: The autogenous dermofat graft seems to provide an effective treatment of the pincer nail with preservation of the nail matrix.

• Archives of Plastic Surgery
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• v.32 no.4
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• pp.485-490
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• 2005

Fingertip is the end of tactile organ and the part of hand most frequently injured. Fingertip injuries should be evaluated on an individual basis considering patient's overall physical condition, medical history, etiology, time of injury, and anticipated future hand use, and accordingly one of various methods of reconstruction should be selected. Complications after the reconstruction of fingertip injuries have been reported as pain, hypersensitivity, numbness, distal paresthesia, cold intolerance, and atrophy. From January to December 2002, dermofat grafts were performed on 15 patients to correct painful fingertips after injury. The thickness of the soft tissue of fingertip was measured both preoperatively and postoperatively with simple X-ray. To evaluate the improvement of pain, visual analogue scale(VAS) was used through the direct interview with patients. The average of postoperative follow-up period was 10.9 months. The average of increased soft tissue thickness ratio was 88.4%(2.3mm to 3.8mm). The average of preoperative VAS was 7.6, and postoperative VAS was 3. Dermofat graft on fingertip needs a further long-term follow-up study for the absorption ratio of dermofat, however, this procedure is simple and could be done under local anesthesia, and would be a useful alternative procedure to correct painful fingertips with the soft tissue atrophy after injury.

• Archives of Craniofacial Surgery
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• v.21 no.2
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• pp.92-98
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• 2020

Background: Posttraumatic acquired facial deformities require surgical treatment, with options including scar revision, fat grafts, implant insertion, and flap coverage. However, each technique has specific advantages and disadvantages. Methods: From 2016 to 2018, 13 patients (eight with scar contracture and five with a depressed scar) were treated using dermofat grafts from the groin. The harvested dermofat was then inserted into the undermined dead space after the contracture was released, and a bolster suture was done for fixation considering the patient's contour and asymmetry. A modified version of the Vancouver Scar Scale and satisfaction survey were used to compare deformity improvements before and after surgery. Results: In most cases, effective volume correction and an aesthetically satisfactory contour were maintained well after dermofat grafting, without any major complications. In some cases, however, lipolysis proceeded rapidly when inflammation and infection were not completely eliminated. A significant difference was found in the modified Vancouver Scar Scale before and after surgery, with a p-value of 0.001. The average score on the satisfaction survey was 17.07 out of 20 points. Conclusion: A dermofat graft with the groin as the donor site can be considered as an effective surgical option that is the simplest and most cost-effective method for the treatment of acquired facial deformities with scar contracture.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.475-480
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• 2009

Purpose: To correct the facial asymmetry and to achieve symmetry and balance, not only the soft tissue restoration of deficits but also creation and facial contour line such as mandible border and angle is important. Micro fat graft has limitation such as high resorption rate and somewhat limited ability to emphasize the rigid bony characteristics of the mandible angle due to its innate soft consistency. We have investigated the advantages of dermal fat graft over micro fat graft to correct asymmetry of the lower face in patients who had undergone mandibular reconstruction or distraction, using comparative analysis. Methods: Total of 12 patients were enrolled in our study: 6 micro fat graft and 6 dermal fat graft. Postoperative results were compared and analyzed at immediate postoperative period and more than 1 year later in each group with photographs, and analysised with image J program. Result: No complications were noted both in the micro fat type and the dermal fat type of procedures such as fat necrosis or micro calcifications. All of the patients who received micro fat graft, however had considerable amount of fat resorption after the procedure which led to two additional fat graft procedures. Although minor contour obliteration due to contracture was seen in patients who had undergone dermal fat graft procedure, no definite resorption was found even after more than one year follow-up. Results of dermal fat graft patients were satisfactory in terms of mandible angle symmetry. Secondary revision was necessary in one case due to overcorrection using dermal fat graft. Conclusion: The dermal fat graft has many advantages over the conventionally more popular micro fat graft to correct asymmetry of the lower face following mandible reconstruction owing to its lower resoption rate, more effective in emphasizing the natural curvilinear anatomical contours of the mandible angle and body and lower complication rates such as fat necrosis or micro calcifications.

• Archives of Plastic Surgery
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• v.34 no.1
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• pp.64-69
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• 2007

Purpose: The key of treatment in syndactyly is to separate the fused digits safely, and to create a normal web space with enough cutaneous coverage. Despite many techniques have described the correction of syndactyly, skin graft still remains the annoying one. We designed the pentagonal flap from hand dorsum to reconstruct the web space reliably and try to minimize the need for skin graft. Methods: Between July 2003 and August 2005, six cases of syndactyly were corrected at UCLA Medical Center and Hallym University Sacred Heart Hospital using dorsal pentagonal flap for web space reconstruction and straight incisions for the sides of digits to minimize the need for skin graft. The proximal edge of the pentagonal flap was designed in V shape to allow for easy closure of the donor site after advancement. The pentagonal flap was advanced volarly with the underlying dermofat tissues to form a digital web. In some cases, skin defects were unavoidable and covered with full thickness skin graft from the inguinal area. Results: Syndactyly were seen in 4 cases of Apert syndrome, 1 postburn scar webbing with PIP joint contracture and 1 recurrence after the incomplete reconstruction. In all Apert syndrome, straight line incision was used along the sides of the fingers and skin graft was needed. But, in 2 cases of incomplete type, we could save the need for skin graft only for the correction of syndactyly. We could get a good looking web space without any complications such as flap or graft loss. Conclusion: As a modification of Sherif's V-Y dorsal metacarpal flap, we believe pentagonal flap could be one of the easiest and safest way to reconstruct the web space of syndactyly in functional and cosmetic standpoint.

• Archives of Craniofacial Surgery
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• v.18 no.3
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• pp.166-171
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• 2017

Background: Localized scleroderma is characterized by a thickening of the skin from excessive collagen deposits. It is not a fatal disease, but quality of life can be adversely affected due to changes in skin appearance, joint contractures, and, rarely, serious deformities of the face and extremities. We present six cases of localized scleroderma in face from our surgical practice. Methods: We reviewed six localized scleroderma cases that were initially treated with medication and then received follow-up surgery between April 2003 and February 2015. Six patients had facial lesions. These cases presented with linear dermal sclerosis on the forehead, oval subcutaneous and dermal depression in the cheek. Results: En coup de sabre (n=4), and oval-shaped lesion of the face (n=2) were successfully treated. Surgical methods included resection with or without Z-plasty (n=3), fat graft (n=1), dermofat graft (n=1), and adipofascial free flap (n=1). Deformities of the affected parts were surgically corrected without reoccurrence. Conclusion: We retrospectively reviewed six cases of localized scleroderma that were successfully treated with surgery. And we propose an algorithm for selecting the best surgical approach for individual localized scleroderma cases. Although our cases were limited in number and long-term follow-up will be necessary, we suggest that surgical management should be considered as an option for treating scleroderma patients.

• Korean Journal of Head & Neck Oncology
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• v.3 no.1
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• pp.37-54
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• 1987

The aim of surgery for all parotid masses is directed toward total removal of the tumor with adequate safe margins of adjacent normal tissue and preservation of the facial nerve whenever possible. Reconstructive procedures following parotidectomy for benign or low grade malignant lesions are most commonly necessary if soft tissue deficits appear at the angle of the mandible below the earlobe as a major cosmetic deformity. This is a report of Z4 cases with a diagnosis of parotid tumor who were treated using various surgical procedures at Department of Plastic and Reconstructive Surgery, Hanyang University Hospital over the period of 4 years from January, 1983 to December, 1986. Among 24 cases, 11 cases were reconstructed by Sternocleidomastoid muscle flap at the same time that extirpative surgery is outlined. The advantage of Sternocleidomastoid muscle flap is the coverage of the facial nerve, so adhesion between the facial nerve and skin was prevented. Absorption and loss of bulk was not found such as dermofat graft. It was a simple method. Neither donor site defect nor sternocleidomastoid muscle deformity was developed. Sternocleidomastoid muscle flap have been found satisfactory in maintaining filled-out soft tissue hollows with good result cosmetically and functionally.