• Archives of Craniofacial Surgery
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• v.21 no.3
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• pp.161-165
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• 2020

Background: Microstomia is defined as a condition with a small sized-mouth that results in functional impairment such as difficulty with food intake, pronunciation, and poor oral hygiene and cosmetic problems. Several treatment methods for microstomia have been proposed. None of them are universally applicable. This study aims at analyzing the cases treated at our institution critically reviewing the pertinent literature. Methods: The medical records of all microstomia patients treated in our hospital from November 2015 to April 2018 were reviewed retrospectively. Of these, all patients who received surgical treatment for microstomia were included in the study and analyzed for etiology, chief complaint, surgical method, and outcomes. The functional outcomes of mouth opening and intercommissure distance before and after the surgery were evaluated. The cosmetic results were assessed according to the patients' satisfaction. Results: Five patients with microstomia were corrected. Two cases were due to scar contracture after chemical burn, two cases derived from repeated excision of skin cancer, and one patient suffered sequela of Stevens-Johnson syndrome. The following surgical methods were applied: one full-thickness skin graft on the buccal mucosa, three buccal mucosal advancement flaps after triangular excision of the mouth corner, and one local buccal mucosal flap. Mouth opening was increased by 6.0 mm, and the intercommissure distance improved by 7.2 mm on average. Follow-up was 9.6 months (range, 5-14 months). Cosmetic assessment was as follows: two patients found the results excellent, three judged it as good. Conclusion: Microstomia has several causes. In order to achieve optimal functional recovery and aesthetic improvement it is important to precisely evaluate the etiologic factors and the severity of the impairment and to carefully choose the appropriate surgical method.

• Archives of Plastic Surgery
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• v.37 no.6
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• pp.763-768
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• 2010

Purpose: Reconstruction of soft tissue defect using tissue expander can provide better flap which is more similar to surrounding tissue in color, skin texture and hair compared to other methods. Many pediatric patients need reconstruction of soft tissue defect because of giant congenital nevi, congenital or acquired malformations and burn scars. Reconstruction using tissue expander is adequate to minimize dysmorphism in these patients. We intended to assess outcomes of using tissue expander in pediatric patients by retrospective study. Methods: Total cases were 168 of pediatric patients who received soft tissue reconstruction using tissue expander by the same surgeon from February, 1982 to May, 2009. All patients who received soft tissue reconstruction were under 10 years old. Mean age was 4.3 years old, the youngest 13 months, the oldest 8 years. Eightynine cases were male and 79 cases were female. Most common cause was giant hairy nevi (67 cases, 39.9%), secondary cause was burn scar/scar contracture (61 cases, 36.3%). Trunk (38 cases, 22.6%) was most common anatomical location. Results: Soft tissue defects were successfully covered using tissue expander in 149 cases (88.7%) without major complications. There was infection on 8 cases (4.7%) and we treated by adequate antibiotics in these cases. There were tissue expander folding or valve displacement on 5 cases (3%). Conclusion: Usage of tissue expander is useful on pediatric patients because tissue expansion is rapid on children and there are less secondary contractures on operation site than full thickness skin graft. Because of psychological stress due to tissue expander, operation should be performed before school age.

• Journal of the Korean Burn Society
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• v.22 no.2
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• pp.53-57
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• 2019

Dichloromethane is widely used as a solvent in paint removers. Unlike inhalation injury, contact injury caused by dichloromethane is not well known. Two patients who had undergone skin grafting to treat chemical burn of the hand caused by dichloromethane exposure were evaluated, and a literature review was done. Two healthy men aged 37 and 40 years visited our hospital with chief complaints of pain on the hands due to dichloromethane exposure. The patients had not worn protective clothing. Multiple bullae were initially noted. On the next day, fluctuation in bullae and purulent discharge were observed, and central eschar change was noted. On the 18th day after the burn, escharectomy and full-thickness skin graft were performed. Therefore, workers who use dichloromethane should wear protective clothing at workplaces. If exposed to the chemical, the worker should be instructed to do a quick wash and visit the hospital.

• Archives of Craniofacial Surgery
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• v.10 no.2
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• pp.138-141
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• 2009

Purpose: Squamous cell carcinoma of the scalp sometimes exhibits unusually aggressive behavior. We report a case of extradordinarily aggressive squamous cell carcinoma of the scalp with invasion into the skull and dura mater. Method: The patient is a 38-year-old man with two cystic masses on the occipital area. He was diagnosed as squamous cell carcinoma in that region and have undergone surgical resections including cortical osteotomy of the skull, several years ago. On this occasion, 3-dimensional computed tomographic imaging revealed an erosive lesion on the occipital bone and magnetic resonance imaging showed two cystic masses invasion into the skull and dura mater. Results: He has undergone wide resection of the masses and cranioplasty with dural repair. Histopathologic examination indicated squamous cell carcinoma with moderate differentiation of the masses, bone marrow and dura mater. Conclusion: Squamous cell carcinoma on the scalp can readily penetrate the full thickness of the cranium and invade the dura mater, sagittal sinus and brain. We suggest wide resection of the scalp and split thickness skin graft with sentinel lymph node biopsy, following by postoperative radiation therapy.

• Journal of Chest Surgery
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• v.31 no.6
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• pp.629-633
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• 1998

Implantation of malignant cells along the needle aspiration tract is an extremely rare potential complication following a percutaneous fine needle aspiration biopsy of a lung carcinoma. The dissemination of malignant cells by a needle aspiration biopsy may convert an operable and potentially curable lesion into a fatal disease. We report two cases of chest wall implantation of carcinoma of the lung after a thin needle aspiration biopsy. A fifty-five year old male was successfully treated by a radical full-thickness excision of the chest wall and immediate reconstruction with the latissimus dorsi musculocutaneous island flap. A sixty-eight year old female was treated with a partial-thickness excision of the chest wall and skin graft due to superimposed infection and ulceration of the metastatic chest wall carcinoma. One case lived for 31 months up to November 1994, and the other's condtion has been uneventful for 3 months up to now.

• Archives of Plastic Surgery
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• v.34 no.1
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• pp.77-80
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• 2007

Purpose: Purpura fulminans is a rare but rapidly progressive, serious, often life-threatening disorder in childhood, which is complicated with septic shock or disseminated intravascular coagulopathy during acute infection. It occurs first as acute-onset petechial rash, and spreads rapidly into full thickness skin and soft tissue necrosis. In the past, it had high mortality rate, up to 80%, but recently, survival rate has increased due to early diagnosis, and rapid advancement of critical care and antibiotics. From our experiences of PF management, we would like to review the pathophysiology and suggest the surgical treatment guideline about meningococcal induced purpura fulminans. Methods: Two cases of purpura fulminans over the last 3 years were reviewed retrospectively about reconstructive management. After they were treated resuscitative management initially by the critical intensive care, reconstructive surgery was performed by plastic surgeon as soon as the patients were vitally and mentally stable. Results: There were 6 procedures in case 1, and 3 procedures in case 2. The mean delayed period from admission with sepsis to the first surgical debridement was 24 days and 42 days, respectively. Total hospitalization period was 103 days and 69 days, respectively. All of them were treated with debridement and split thickness skin graft, but delayed debridement was superior to early one in the point of preserving much more tissues. Conclusion: From our experience, we suggest that conservative therapy to the wounds appears to be the best tool in the initial vitally unstable period in order to preserve as much tissues and functions as possible if no active inflammation and compartment syndrome are detective.

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.401-407
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• 2011

Purpose: A number of flap for nipple reconstruction have been well described in the literature. However, most of these techniques do not permit the reconstruction of a projecting nipple and all are hampered to some extent by long-term loss of nipple projection. The objective of this study is to evaluate the long-term result and clinical efficacy of nipple reconstruction using skate flap technique after breast reconstruction. Methods: A retrospective chart review was carried out on 23 patients who underwent 25 nipple reconstructions. In those patients with greater than 10 mm nipple projection, reconstruction with skate flap and full-thickness skin graft and/or tattooing was performed. Maintenance of nipple projection was then carefully assessed over one-year follow-up. The following factors were analyzed: type of breast reconstruction, type of areola reconstruction, followup period, decrease in nipple projection, complication, and whether secondary nipple reconstruction was necessary and/or performed. Results: Breast reconstructions were performed in 17 patients with free transverse rectus abdominis musculocutaneous flap, 3 patients with extended latissimus dorsi musculocutaneous flap, and 3 patients with expander and implant. The mean follow-up after nipple reconstruction was 17 months. Mean loss of projection were $17.0{\pm}13.99%$, $25.0{\pm}12.70%$, $30.0{\pm}12.57%$ and $30.8{\pm}12.49%$ at 3, 6, 9 months and over one year, respectively. The greatest decrease in projection was noted in the first 3 months following surgery. Conclusion: These results indicated that nipple reconstruction with skate flap showed about 70 percent of the projection achieved over one year postoperation. Therefore, the skate flap may be a reliable method of nipple reconstruction in those patients with greater than 10 mm nipple projection.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.2
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• pp.141-147
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• 2005

Purpose: The most important thing in curing Malignant melanoma is surgical excision, operating method is wide excision. The author et al. studied 5-year survival rate of each stage and appropriate surgical margin after operating wide excision and immuno-chemotherapy. Materials and methods: From March 1995 to August 2003, wide excision and immunochemotherapy were operated to 35 patients (17 males and 18 females) who were diagnosed as malignant melanoma and followed up. Excision was done around 2 cm from edge of tumor regardless of the size or effected degree of the skin, and flap or full thickness skin graft was used for skin deficit that was not covered after excision. As for immuno-chemotherapy, method that prescribes 400 mg of dacarbazine (DTIC) and 3 million IU of interferone-${\alpha}$ in combination was used. Immuno-chemotherapy was operated to patients in over stage III. We used AJCC stage that was revised in 2002. Local recurrence, local metastasis and distant metastasis were investigated for these patients as well as the 5-year survival rate of each stage. Results: Most frequently 15 cases(42.8%) occurred in foot, 5 cases(14.2%) occured in ankle, 2 cases(5.7%) in leg, 2 cases(5.7%) in thigh and 5 cases(14.2%) in hand. The incidence of each stage were 8 cases(22.8%) in IA, 9 cases(25.7 %) in IB, 4 cases(11.4%) in IIA, 2 cases(5.7%) in IIB, 1 cases(2.8%) in IIIA, 2 cases(5.7%) in IIIB, 2 cases(5.7%) in IIIC and 7 cases(20.0%) in stage IV. 5-year survival rate of each stage were 94.1% in stage I, 66.8% in stage II, 40% in stage III and 14.3% in stage IV. Conclusion: 5-year survival rate of stage IV was low in malignant melanoma. In treatment of malignant melanoma, staging before operation is important as operation methods are different from each stage. We recommend wide excision which remove around 1~3 cm from margin of tumor up to each thickness.