• Archives of Craniofacial Surgery
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• v.17 no.4
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• pp.233-236
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• 2016

Scalp defect management is complicated secondary to reduced laxity in the scalp and forehead area. For reconstruction of larger defects with exposed bone and loss of the periosteal layer, free flap reconstruction is one option for single-stage surgery, although the procedure is lengthy and includes the possibility of flap loss. We successfully performed a single-stage reconstruction of a large scalp defect using a combination of artificial dermis, split-thickness skin graft, and full-thickness skin graft following wide excision of a cutaneous angiosarcoma, and present our method as one option for the treatment of large oncologic surgical defects in patients who are poor candidates for free flap surgery.

• Advances in pediatric surgery
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• v.7 no.1
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• pp.7-14
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• 2001

Congenital anomalies of the head and neck region such as preauricular sinus and skin tag, thyroglossal duct cyst, branchial anomaly, cystic hygroma and dermoid cyst are common in pediatric population. It is important for pediatricians and pediatric surgeons to be familiar with the embryology and the anatomical characteristic of these lesions in order to diagnose and treat them properly. Three hundred and nineteen patients with congenital head and neck anomalies treated at Hanyang University Hospital between 1980 and 1999 were reviewed to determine the relative frequency of the anomalies and to analyze the method of management. Eight-four (25.1 %) of 335 lesions were preauricular sinus and skin tag, 81 (24.2 %) were thyroglossal duct cyst, 81 (24.2 %) branchial anomaly, 58 (17.3 %) cystic hygroma and 31 were (9.2 %) dermoid cyst. The male-to-female ratio was 1.4:1. Thyroglossal duct cyst most commonly present at 3-5years, however branchial anomalies commonly are diagnosed in children younger than 1 year. Preauricular sinus showed familial tendency in three patients and was bilateral is 33.8 %. Most head and neck anomalies in children have specific clinical and anatomical characterics. A careful history and physical examination is very useful for diagnosis and proper management. Experienced pediatric surgeons should do the initial surgery since the recurrence rate after incomplete surgical excision can be high.

• Archives of Craniofacial Surgery
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• v.20 no.6
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• pp.392-396
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• 2019

Renal cell carcinoma (RCC) represents 2% to 3% of human cancers and is aggressive, with metastatic capability. The frequent metastatic sites are lung, bone, and liver. Reports of RCC metastatic to skin, and especially scalp are rare. Here we present an 83-year-old woman who was diagnosed with RCC 19 years prior and had a metastatic scalp lesion. An 83-year-old woman presented with a red-to-purple, protruding lesion at the right parietotemporal area. Twenty-three years ago, a right renal mass was incidentally discovered on ultrasound through a routine medical examination. She underwent right nephrectomy for RCC 4 years later. Five months after nephrectomy, new lung nodules were observed. Fifteen years after nephrectomy, metastatic lesions were found in the pelvic bone. She visited dermatology department for evaluation of the new scalp lesion, a year before she first visited our department. Despite chemotherapy, the mass was gradually enlarged. She consulted the plastic surgery department for management of the metastatic RCC was successfully treated with total excision including a 1-cm safety margin, local flap, and STSG coverage. Complete healing was observed, without evidence of recurrence during a 7-month followup. Metastases to the skin are rare, but must be kept in mind because of its high metastatic ability and poor prognosis.

• Archives of Plastic Surgery
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• v.37 no.1
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• pp.79-82
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• 2010

Purpose: Carcinosarcomas are rare neoplasms in which both malignant epithelial and mesenchymal elements are identified. We have found only twenty one cases of primary cutaneous carcinosarcoma in the English language literature. Therefore it has been difficult to diagnosis because its unclear etiology and low frequency. Methods: A 31-year-old young man with a protruding mass on his ankle dorsum was examined. The tumor was $7{\times}6{\times}3\;cm$ sized and arose from a burn scar. The mass was wide excised and applied split thickness skin graft. Characteristic pathologic finding was a mixture of squamous cell carcinoma and malignant fibrous histiocytoma. Results: Three months after the operation, the patient died of multiple metastasis to the liver, lung and finally of sepsis despite adjuvant chemotherapy and adjuvant radiotherapy. Conclusion: If a metastatic cutaneous carcinosarcoma is diagnosed, wide excision is required. There should be more aggressive management to minimize the risk of recurrence. Further research into the etiology and pathophysiology of the disease and a more careful differential diagnosis may allow improvement in treatment.

• Archives of Plastic Surgery
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• v.48 no.3
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• pp.287-292
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• 2021

Background We report the efficacy of a dual-plane approach using a Dufourmentel skin flap with a purse-string suture of the de-epithelized dermis to manage pseudoaneurysm at the vascular access site for hemodialysis. Methods A retrospective analysis was conducted of 61 patients from 2013 to 2018 with pseudoaneurysms at the arteriovenous fistula or graft who were treated with rhomboid excision, vessel repair with a purse-string suture, and a full-thickness Dufourmentel skin flap. The success rate was defined as the probability of complete wound closure and intact vascular access patency without infection or other complications. Results The success rate was 93.4% at 6 months postoperatively. Complications included newly occurring pseudoaneurysms (n=2), wound dehiscence (n=1) and bleeding (n=1). There were no complications such as stenosis or thrombosis from the procedure. Conclusions A dual-plane approach using a Dufourmentel skin flap with a purse-string suture for vessel repair was shown to be a favorable option for managing stable, small (diameter <2 cm) pseudoaneurysms without infection, rapid expansion, or patency issues of the vascular access.

• Archives of Craniofacial Surgery
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• v.10 no.2
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• pp.135-137
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• 2009

Purpose: Nevus comedonicus is a rare disease involving abnormal development of the pilosebaceous unit, clinically appearing confluent clusters of open comedones. It is characterized by follicular epidermic invaginations filled with keratin, with atrophic pilose or sebaceous structures which are open to the lower pole of the invagination. We report a child with inflammatory pustules and cysts correlated to the nevus comedonicus. Methods: A 15-month-old girl was referred for treatment of a nevus comedonicus that has been developed since birth. There were periodic episodes of erythema and swelling of the plaque. The patient had treated previously with retinoid cream for 2 weeks without obvious benefit at dermatology clinic. We excised the nevus comedonicus with Y-shape leaving some lesions. Results: When we incised skin, we could see multiple large whitish cysts beneath the nevus comedonicus. Histopathologic findings showed deep invagination of epidermis filled with keratin plugs, keratinous cyst in the dermis, rudimentary hair follicle. Conclusion: We treated rare nevus comedonicus with multiple large cysts as surgical excision.

• Archives of Plastic Surgery
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• v.42 no.4
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• pp.478-483
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• 2015

Due to the fact that it reliably results in positive outcomes, lymph node flap transfer is becoming an increasingly popular surgical procedure for the prevention and treatment of lymphedema. This technique has been shown to stimulate lymphoangiogenesis and restore lymphatic function, as well as decreasing infection rates, minimizing pain, and preventing the recurrence of lymphedema. In this article, we investigate possible additional benefits of lymph node flap transfer, primarily the possibility that sentinel lymph nodes may be used to detect micrometastasis or in-transit metastasis and may function as an additional lymphatic station after the excision of advanced skin cancer.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.886-889
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• 2011

Purpose: Malignant peripheral nerve sheath tumor without neurofibromatosis type 1 is very rare neoplasm. Development in the superficial soft tissue is exremely rare. Authors experienced one rare case of primary malignant peripheral nerve sheath tumor developed on abdomen. The clinical and histologic findings were described. Methods: An 83-year-old man visited hospital with an $11{\times}6.5{\times}4.5$ cm sized ulcerated and hemorrhagic mass on abdomen. The tumor was localized in abdominal skin and started growing 3 years ago. Results: Wide excision with safety margin of 2 cm and limberg flap was done. The postoperative biopsy revealed a malignant peripheral nerve sheath tumor. There was no evidence of recurrence of tumor for 16 months. Conclusion: Malignant peripheral nerve sheath tumor is an aggressive malignant tumor. An abrupt enlargement of size, ulceration and bleeding are suggestive of malignant chnages of the tumor. We recommand early wide excision with enough safety margin as treatment of malignant peripheral nerve sheath tumor.

• Archives of Plastic Surgery
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• v.39 no.2
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• pp.158-161
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• 2012

Myopericytoma is a benign tumor that is composed of myoid-appearing oval to spindle-shaped cells with a concentric perivascular pattern of growth. The tumor is morphologically heterogeneous and can exhibit a broad histologic spectrum. We describe a case of multiple myopericytoma occurring in the head and neck skin region with involvement of the parotid gland where it is known to occur very rarely. A 40-year-old woman noticed multiple enlarging, painless, round-shaped masses on her left cheek. The patient had experienced a similar lesion of the same area 8 years earlier which was completely excised and the pathological diagnosis was spindle cell type myoepithelioma. On a computed tomographic image, one mass involved the superficial parotid gland and was well encapsulated. Excision of the facial masses and superficial parotidectomy with facial nerve preservation were performed. A diagnosis of myopericytoma was established in light of the immunohistochemical pattern with the histopathological findings. Over the 4-year follow-up period, there was no evidence of recurrence. As many perivascular myoid neoplasms share common morphologic features with myopericytoma, we should consider the differential diagnosis, and confirm the histological findings with appropriate immunohistochemical staining. After identifying myopericytoma, it should be treated with wide surgical excision to prevent local recurrence.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.1
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• pp.419-422
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• 2014

Background: Lymphadenopathy is a common presentation in both benign and malignant diseases which need to be diagnosed without delay. Fine needle aspiration cytology (FNAC) helps us diagnose a disease and follow its course, including the response to therapy. Aim: This study aimed to analyze the clinicopathological features of metastatic lymphadenopathy and the diagnostic utility of FNAC in our setting. Materials and Methods: This two-year prospective study included all the patients with metastatic lymphadenopathy, diagnosed with FNAC. Results: A total of 412 cases (male:female ratio, 1.3:1; age range, 3 to 90 years) were studied. Supraclavicular lymph nodes were involved most commonly (50.5%). The commonest metastatic tumor was squamous cell carcinoma in general (30.1%) and in males (37.6%), and infiltrating ductal carcinoma (25.3%) in females. Lung, with 64 (15.5%) cases followed by esophagus, 60 (14.6%) cases; breast, 49 (11.9%) cases; skin, 32 (7.8%) cases; and stomach, 25 (6.1%) cases were the most common primary sites of malignancy. In 69 patients, excision biopsy was performed. Histopathological findings correlated well with that of cytology in all these cases. Conclusions: FNAC is an important tool in the diagnostic work up of metastatic lymphadenopathy, which in the hands of an experienced and skilful cytopathologist can avoid the need for excision biopsy.