• Archives of Plastic Surgery
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• v.32 no.3
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• pp.327-334
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• 2005

This study was designed to investigate the effect of the surgical delay in the prefabricated cutaneous flap. Abdominal skin flaps (n=40), $4.5{\times}6.0cm$ in size, were created by the subcutaneous implantation of a saphenous vascular tissue in the male Sprague-Dawley rats. In the groups 1 and 2, the pedicle was skeletonized. In the groups 3 and 4, perivascular muscle cuff or gracilis fascia was retained, respectively. Six weeks later, each flap was elevated as an island flap and reposed in place. All flaps of the group 2 had a 72-hours of delay period. Five days after the flap repositioning, estimation of flap viability, microangiographies, and histological evaluation of vessel development were performed. The groups 2 and 3 showed higher viability in flap survival. The dilated choke vessels and fully developed vascular network were observed in the flap of the group 2, but not typically seen in the other groups. New vessels around the implanted pedicle were more developed in the group 2. Amount of the vessels in the mid-portion of the flap was significantly increased in the groups 2 and 4. In conclusion, the delay procedure enhanced the viability, and its effect was dependent on the new vessel formation around the implanted pedicle.

• Archives of Plastic Surgery
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• v.39 no.6
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• pp.619-625
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• 2012

Background After skin tumor excision on the face, extremities, or trunk, the choice of treatment for a skin defect is highly variable. Many surgeons prefer to use a local flap rather than a skin graft or free flap for small- or moderately-sized circular defects. We have used unilateral or bilateral V-Y advancement flaps, especially on the face. Here we evaluated the functional and aesthetic results of this technique. Methods All of the patients were pathologically diagnosed with squamous cell carcinoma (SCC), basal cell carcinoma (BCC), or malignant melanoma or premalignant lesion (Bowen's disease). Thirty-two patients underwent V-Y advancement flap repair (11 unilateral and 21 bilateral) from January 2007 to June 2011. We analyzed the patients' age and satisfaction, and location and size of defect. The patients were followed up for 6 months or more. Results There were 22 women and 10 men. The ages ranged from 47 to 93 years with a mean age of 66 years. The causes were SCC in 15 cases, BCC in 13 cases, malignant melanoma in 1 case, Bowen's disease in 2 cases, and another cause in 1 case. The tumor locations were the face in 28 patients, and the scalp, upper limb, and flank each in one patient. All of the flaps survived and the aesthetic results were good. Postoperative recovery was usually rapid, and no complication or tumor recurrence was observed. Conclusions The V-Y advancement flap is often used not only for facial circular defects but also for defects of the trunk and extremities. Its advantages are less scarring and superior aesthetic results as compared with other local flap methods, because of less scarification of adjacent tissue and because it is an easy surgical technique.

• Archives of Plastic Surgery
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• v.47 no.4
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• pp.317-323
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• 2020

Background Microtia with constricted features is characterized by a short helical length of variable severity, upper antihelical or scaphal deficiency, and a downfolded upper ear. No consensus has been reached regarding the most appropriate surgical method for this condition. In this study, we aimed to introduce a simple and safe surgical method for the correction or reconstruction of upper helix ear deformities. Methods Between February 2011 and June 2014, eight patients with microtia with constricted upper helix ear deformity underwent reconstruction of the ear deformity. The upper ear helical framework was constructed by carving and curving the eighth rib cartilage harvested from the ipsilateral chest wall, covering this cartilage with a superficial temporal fascial flap, and adjusting the skin graft to align with the ear contour. To evaluate their satisfaction, patients were asked to complete a questionnaire regarding ear shape, symmetry, position, color, and overall outcome scored on a 5-point scale at 12 months postoperatively. Results None of the patients experienced severe complications in the reconstructed ear. The preoperative and postoperative vertical ear length ratios were 0.88 and 1.02, respectively. And the mean patient satisfaction scores for shape, symmetry, position, color, and overall outcome were 4.2, 4.5, 4.7, 4.4, and 4.6 out of 5 points, respectively. All patients expressed a high level of satisfaction at 12 months postoperatively. Conclusions Our technique provides a good alternative method for the reconstruction of moderate constricted upper helix ear deformities in patients who meet the surgical indications with satisfactory outcomes and few complications.

• Archives of Plastic Surgery
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• v.51 no.2
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• pp.208-211
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• 2024

Intraneural hematoma is a rare disease that results in an impaired nerve function because of bleeding around the peripheral nerve, with only 20 cases reported. Trauma, neoplasm, and bleeding disorders are known factors for intraneural hematoma. However, here we report atypical features of asymptomatic and spontaneous intraneural hematoma which are difficult to diagnose. A 60-year-old woman visited our clinic with the complaint of a palpable mass on the right calf. She reported no medical history or trauma to the right calf and laboratory findings showed normal coagulopathy. Ultrasonography was performed, which indicated hematoma near saphenous vein and sural nerve or neurogenic tumor. We performed surgical exploration and intraneural hematoma was confirmed on sural nerve. Meticulous paraneuriotomy and evacuation was performed without nerve injury. Histological examination revealed intraneural hematoma with a vascular wall. No neurologic symptoms were observed. In literature review, we acknowledge that understanding anatomy of nerve, using ultrasonography as a diagnostic tool and surgical decompression is key for intraneural hematoma. Our case report may help establish the implications of diagnosis and treatment. Also, we suggested surgical treatment is necessary even in cases that do not present symptoms because neurological symptoms and associated symptoms may occur later.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.19 no.2
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• pp.135-142
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• 1997

Despite the current accomplishments with the repair of cleft lips, the surgical management of the nasal deformity remains a functional and aesthetic dilemma for patients, their families, and reconstructive surgeons. Recent improvements in the understanding and technical execution of te primary cleft lip repair have significantly reduced secondary sequelae and the consequent need for secondary surgical correction. But, secondary surgical corrections are necessary according to numerous factors. Such factors include the secondary surgical corrections are necessary according to numerous factors. Such factors include the severity of the initial deformity, the surgical plan, precision of execution of the primary repair, and success of the postoperative management. We preformed the secondary correction of cleft lip and palate in 11 patients via various methods. In conclusion, primary repair of cleft lip and palate patients is the most important to prevent the secondary deformities, and most of cleft lip and palate with secondary deformities must be treated with combined cheiloplasty and rhinoplasty.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.107-110
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• 2006

Malignancy in a chronic pressure sore is rare among Marjolin's ulcers. Carcinomas arising in pressure sores are highly aggressive and usually fatal. Although carcinomas in pressure sores are generally well-differentiated squamous carcinomas, they can show quite an aggressive course and do not respond either to chemotherapy or radiotherapy. The mortality rate is high despite wide surgical resection. Extensive surgical excisions with wide surgical margins are necessary and elective lymph node dissection should be considered for optimal therapy. We report a squamous carcinoma arising in a pressure sore. The related literature was reviewed.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.798-802
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• 2011

Purpose: A wart is caused by epidermal infection with the human papilloma virus. Although wart naturally disappears in some cases, it require treatment because of pain, aesthetic problem, and the possibility of malignant change. Conventional non-surgical treatment cannot be a fundamental solution for the pain and has such disadvantages as frequent recurrence and difficulties in achieving a satisfactory outcome. A surgical procedure was performed on patients with wart and the procedure had a good outcome. Methods: We investigated the gender, age, lesion site, mean treatment duration, and presence or absence of recurrence in 21 patients with a wart within the period of January 2007 to July 2011. For local lesions, primary closure, including subcuticular suture after the excision, was performed. If the defect size was too big to do primary closure, we performed rotation flap. For wide multiple lesions, a split thickness skin graft was performed. Results: Among the 21 patients, 12 patients were male and 9 patients were female, and their mean age was 42 years (SD=17.38, range: 11~75 years). The lesion site was the foot in 10 patients, the hand in 8 patients, the face in 2 patients, and the scalp in 1 patient. The mean treatment duration was 13.5 days (SD=4.36, range: 6~15 days) for the primary closure or rotation flap, and 18.5 days (SD=2.12, range: 17~20 days) for the skin graft. 20 patients were cured without recurrence. No recurrence was observed in the patients who underwent primary closure or rotation flap. One of the two patients who underwent a skin graft of their wart that had covered their entire palm had local recurrence in part of her finger tips. Conclusion: We performed surgical procedure on recalcitrant wart. As a results, we can treat it with short treatment duration, low recurrence rate and less scarring and get high patient satisfaction.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.1
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• pp.72-82
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• 2008

Various surgical approaches in the mandibular condyle fracture have been reported and many advantages of intraoral reduction were also introduced. But there are still controversies about surgical method of condylar fractures up to date. To establish the surgical approach protocol of condylar fracture, from May 2001 to December 2004, total 65 patients with 74 fractures of the mandibular condyle were reviewed during 2 years, retrospectively. All cases were classified according to the treatment considering factors, such as the level of fracture, degree and direction of displacement of fractured segment, patient’s age and gender, surgical approach methods, and their complications. Especially, advantages and surgical limitations of extraoral surgical approach, such as direct reduction and fixation via submandibular approach, Nam’s method, and endaural approach, were compared with those of intraoral surgical approach, such as direct intraoral reduction with transbuccal fixation or right angle driver system, and intraoral reinsertional approach after extraoral fixation of fractured fragment. The guidelines of surgical approach of condylar fracture based on our clilnical retrospective experiences and literature reviews can be suggested.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.44.1-44.6
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• 2015

Background: The present study introduces the design and fabrication of a simple surgical guide with which to perform genioplasty. Methods: A three-dimensional reconstruction of the patient's cranio-maxilla region was built, with a dentofacial skeletal model, then derived from CT DICOM data. A surgical simulation was performed on the maxilla and mandible, using three-dimensional cephalometry. We then simulated a full genioplasty, in silico, using the three-dimensional (3D) model of the mandible, according to the final surgical treatment plan. The simulation allowed us to design a surgical guide for genioplasty, which was then computer-rendered and 3D-printed. The manufactured surgical device was ultimately used in an actual genioplasty to guide the osteotomy and to move the cut bone segment to the intended location. Results: We successfully performed the osteotomy, as planned during a genioplasty, using the computer-aided design and computer-aided manufacturing (CAD/CAM) surgical guide that we initially designed and tested using simulated surgery. Conclusions: The surgical guide that we developed proved to be a simple and practical tool with which to assist the surgeon in accurately cutting and removing bone segments, during a genioplasty surgery, as preoperatively planned during 3D surgical simulations.

• Archives of Plastic Surgery
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• v.47 no.1
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• pp.108-109
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• 2020