• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.16 no.4
• /
• pp.359-370
• /
• 1994

The reconstruction of major head and neck defects must be an integral part of the overall cancer treatment plan. The priorities of surgical treatment of head and neck tumor are 1) local tumor control, 2) relief of pain, 3) avoidance of difficult dressing, 4) provision of oral continence, and 5) ability to swallow and manage saliva. The recent advances in reconstructive surgery including the development of musculocutaneous flaps and microvascular free tissue transfer have allowed the surgical restoration of head and neck tumor defects that previously were not possible. These techniques have provided the opportunity to undertake larger, more aggressive resection while at the same time permitting functional rehabilitation. The timing of reconstruction demands on the nature of the resection, the ability of the ablative and reconstructive teams to coordinate efforts, the overall health of the patients, the patient's needs and wishes. So, we report to emphasize current methods for restoring major head and neck tumor defects after tumor ablation, reviewing for the reconstructive operations, postoperative complications, and postoperative sequelae etc, of patients from Jan, 1990 to Dec, 1993.

• Archives of Reconstructive Microsurgery
• /
• v.12 no.1
• /
• pp.13-18
• /
• 2003

Fournier's gangrene is a synergistic necrotizing fasciitis of the perineal, perirectal and urogenital area and can be fatal unless treated in early stage. Perianal and urogenital infections are common causes of the disease but it can occur after artificial procedure on perineal area using by surgical instruments. It is mixed aerobic and anaerobic infection and E. coli is the most common causative bacteria. Untill now many investigators have focused on early diagnosis, preserving hemodynamic stability, broad-spectrum systemic antibiotics and treatment of underlying disease in management of Fournier's gangrene. The authors have experienced five patients of chronic liver disease whose necrotizing perineal infections developed spontaneously and treated them aggressively as described above and reconstructed perineal soft tissue defects using by various surgical methods, then we got good results both functionary and cosmetically. From now on, we would better reconstruct soft tissue defect of perineum with skin graft or pedicled flap in early stage when treat Fournier's gangrene, thereafter we can get an ultimate increase in patient's life quality.

• Archives of Plastic Surgery
• /
• v.39 no.6
• /
• pp.663-666
• /
• 2012

Current treatments for hidradenitis suppurativa (HS) include prolonged courses of antibiotics, retinoids, immunosuppressants, and biologics. Severe cases that are resistant to prolonged medical treatment pose a therapeutic challenge. We propose radical excision and lateral thoracic flap reconstruction as a treatment option for such cases. In our experience with two patients, good aesthetic and functional outcomes were achieved, with a high level of patient satisfaction. The availability of suitable flap coverage allows for wide resection of all of the hair-bearing skin, leading to a low incidence of residual disease and subsequent recurrence. Following excision of the affected tissue, the ideal reconstructive method in the axilla provides suitable coverage without unacceptable donor site morbidity and also avoids axillary contractures. A long lateral thoracic flap with delay has excellent coverage with minimal donor tissue sacrifice. With a suitable flap coverage option, the management paradigm of intractable HS should shift from prolonged medical treatment to allow decisive radical excision, which will improve the quality of life for patients.

• Archives of Craniofacial Surgery
• /
• v.21 no.5
• /
• pp.329-333
• /
• 2020

Mucinous cystadenoma, one of the subtypes of cystadenomas, is a rare benign salivary gland tumor. Most of the cases reported tumors presenting as asymptomatic, slow growing, single masses, primarily occurring in the parotid glands, buccal mucosa, and hard palate. This report describes a case of multiple mucinous cystadenomas that presented as subcutaneous swellings in both cheeks, which were mistaken for a benign subcutaneous tumor. A complete surgical excision was performed through an intraoral incision. There were no recurrences or complications. A diagnosis of mucinous cystadenoma was made by histopathological examination. Mucinous cystadenomas are differentiated from other salivary gland tumors based on the pathological findings. A malignant transformation is also possible. Preoperative imaging cannot identify mucinous cystadenomas because of their small size and atypical features, and needle biopsy has its limitations in such salivary gland tumors. Therefore, accurate diagnosis and treatment through surgical excision become important.

• Archives of Plastic Surgery
• /
• v.37 no.1
• /
• pp.67-70
• /
• 2010

Purpose: Nerve sheath myxoma is a rare cutaneous neoplasm originating from the peripheral nerve sheath and divided into three groups : myxoid, cellular and mixed type. There is a controversy on it's origin whether schwannian cell or perineurial differentiation, or anything else. Myxoid nerve sheath myxoma is asymptomatic, soft, papule or nodule in middle-age adults. We report a case of myxoid nerve sheath myxoma on the fingertip. Methods: A 53-year-old woman presented with a painful, $0.4{\times}0.4{\times}0.6\;cm $sized, corn shaped nodule on the left 3rd fingertip. We put into surgical excision and studied it by histopathologically and specific immnohistochemical stain. Results: The tumor has well defined nodules separated by thin fibrous connective tissue with abundant myxoid stroma and were positively stainded for S-100 protein, NSE and GFAP. After surgical treatment it was healed without recurrence. Conclusion: Nerve sheath myxoma is rare neoplasm and located mainly on face, but very rarely on the fingertip. We report a case of painful myxoid nerve sheath myxoma located on the 3rd fingertip.

• Archives of Plastic Surgery
• /
• v.40 no.1
• /
• pp.62-65
• /
• 2013

The philtrum plays a key role in the appearance of the upper lip and nostril sill. Therefore, construction of the philtrum is crucial for attaining a natural appearance of the upper lip. We used a flipping myoplasty of the orbicularis oris muscle on a patient with a flat philtrum in order to effectively reconstruct the philtral dimple and column. A 35-year-old female presented to our department with the complaint of a flat upper lip. A superficial layer of the orbicularis oris muscle on the median aspect of the upper lip was vertically incised and elevated to a thickness of 2 mm. Both sides of the elevated muscle flap were then folded to the lateral sides so that the border could be sutured onto the outer portion of the orbicularis oris muscle. The patient was observed for one year postoperatively. Her philtrum deepened by 1.25 mm, with the central angle of her Cupid's bow improving from a preoperative measurement of $146^{\circ}$ to $128^{\circ}$ postoperatively. In a patient with an indistinct philtrum, a flipping orbicularis oris myoplasty was performed to attain a definite philtral column and a philtral dimple. Natural upper lip movement was maintained, and an aesthetically and functionally satisfactory reconstruction was achieved.

• Archives of Plastic Surgery
• /
• v.38 no.2
• /
• pp.203-206
• /
• 2011

Purpose: Kabuki syndrome is a multiple malformation syndrome that was first reported in Japan. It is characterized by distinctive Kabuki-like facial features, skeletal anomalies, dermatoglyphic abnormalities, short stature, and mental retardation. We report two cases of Kabuki syndrome with the surgical intervention and speech evaluation. Methods: Both patients had velopharyngeal insufficiency and had a superior based pharyngeal flap operation. The preoperative and postoperative speech evaluations were performed by a speech language pathologist. Results: In case 1, hypernasality was reduced in spontaneous speech, and the nasalance scores in syllable repetitions were reduced to be within normal ranges. In case 2, hypernasality in spontaneous speech was reduced from severe level to moderate level and the nasalance scores in syllable repetitions were also reduced to be within normal ranges. Conclusion: The goal of this article is to raise awareness among plastic surgeons who may encounter such patients with unique facial features. This study shows that pharyngeal flap operation can successfully correct the velopharyngeal insufficiency in Kabuki syndrome and post operative speech therapy plays a role in reinforcing surgical result.

• Archives of Craniofacial Surgery
• /
• v.20 no.5
• /
• pp.319-323
• /
• 2019

Cochlear implant extrusion, which is a common complication of cochlear implants, is generally repaired by a well visualized soft-tissue flap. A 61-year-old female patient with a medical history of schizophrenia who had a skin ulcer that caused cochlear implant extrusion, but that would be a stronger statement was referred to our department for removal of the implant and reconstruction of the resultant scalp defect. Accordingly, the broad defect was covered via rotation of a temporoparietal fascia flap (TPFF) using the superficial temporal artery, with the pedicle in the preauricular region as the pivot point. Coverage of TPFF was achieved with a split-thickness skin graft using the scalp as the donor site, which led to a quick recovery after the operation and satisfactory results in terms of aesthetics. This case suggests that a TPFF might be used as a flexible flap with low donor site morbidity for reconstructing cases of cochlear implant extrusion accompanied by a large full-layer scalp defect.

• Archives of Craniofacial Surgery
• /
• v.22 no.5
• /
• pp.280-284
• /
• 2021

Primary cutaneous marginal zone B-cell lymphoma (PCMZL) is an uncommon type of malignant lymphoma that mainly occurs in the trunk and upper extremity, with less frequent incidence observed on the head. Herein, we report the early diagnosis and treatment of a rare case of facial PCMZL in an Asian patient. A 51-year-old man presented with masses on the forehead and nose tip, which he had incidentally discovered 2 months previously. The masses appeared as a papule on the forehead and a patch on the nose. There were no signs of infection or bleeding, and the patient reported no other symptoms. After complete surgical excision, PCMZL was diagnosed based on the permanent biopsy. The histopathological findings revealed lymphoid aggregations with multifocal granulomas. Further treatment and follow-up were conducted at the hematology and oncology department. Despite its rarity in Asian populations, cutaneous lymphoma should be included in the differential diagnosis of facial masses. Early diagnosis and treatment based on a physical examination, imaging study, and excisional biopsy are important for a favorable prognosis.

• Archives of Plastic Surgery
• /
• v.48 no.5
• /
• pp.543-546
• /
• 2021

Despite the extensive use of lithotomy position in several plastic surgery procedures, most reports regarding the related incidence of complications are presented in the urologic, gynecologic, and anesthesiologic fields. We present the case of a 54-year-old male patient. polytrauma patient who underwent internal iliac artery embolization leading to extensive gluteal necrosis requiring: debridement, abdominoperineal resection and composite anterolateral thigh flap reconstruction with prolonged lithotomy position. The patient presented lower limb ischemia briefly after surgical theater. A computed tomography scan revealed the obstruction of the left superficial femoral artery requiring emergency revascularization. Arterial thrombosis is a potentially devastating complication and plastic surgeons should be aware of the possible dangers when performing surgeries in prolonged lithotomy position. Preoperative detection of patients at high risks for developing complications should be performed in order to implement preventive measures and avoid potentially life-threatening sequelae.