• Archives of Plastic Surgery
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• v.35 no.6
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• pp.743-747
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• 2008

Purpose: Malignant changes of Marjolin's ulcer arising from chronic burn scar are rare. The majority of them are squamous cell carcinoma and basal cell carcinoma. Malignant fibrous histiocytoma is a deep seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. Methods: We report a 58-year-old male patient who was admitted due to $3.5{\times}5cm$ chronic ulceration of anterior chest wall on the center of old burn scar. His scar had been occurred by boiling oil and treated with conservative treatment 45 years ago. Preoperative punch biopsy showed suspicious malignant changes and contrast enhanced chest CT showed well-defined, irregular shape enhancing lesion on anterior chest wall without intrathoracic metastasis. Results: The tumor was widely excised and defect was covered with skin graft without infection, necrosis and any other complication. The pathologic findings are compatible with malignant fibrous histiocytoma(storiform - pleomorphic type). The patient underwent 3 cycles of chemotheraphy. Although distant metastasis to the lung developed 6 months later and the patient died 9 month later, there was no local reoccurrence. Conclusion: Aggressive and early excision is needed because malignant fibrous histiocytoma has characteristics of high malignancy with a propensity for early and distant spread. Furthermore, the patient's education about disease entity and postoperative regular follow-up for local recurrence or metastasis is very important. To prevent malignancy from secondly healing burn scar, early skin graft is recommended for patients with deep second degree burn.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.197-200
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• 2008

Purpose: A congenital lacrimal sac fistula is unusual and consists of a dimple opening below the medial canthal tendon that leads to the lacrimal sac. This anlage ducts occur when the lacrimal anlage cells proliferate and canalize rather than involute. And, the anomaly is usually not associated with any systemic abnormalities. Also congenital cleft of the earlobes is rarely seen among congenital ear anomalies. Therefore, we report rare case with symptomatic bilateral lacrimal fistula with the ear cleft. Methods: A 4-year-old boy was admitted with aggravated chronic maxillary sinusitis, recurrent chronic dacryocystitis, and epiphora. He had two minor anomalies including bilateral lacrimal fistula originated in lacrimal tear sac and unilateral transverse ear cleft. The patient had been operated with fistulectomy and perioperative antibiotics. A small vertical ellipse is made around the opening with sharp dissection. The tract is excised using the probe as the guide. Another probe is placed through the lower canaliculus to prevent the damage. A suture ligature of 6-0 Maxon is placed around the deepest point of the tract, which is then excised. Additional sutures are placed in the tissues to form a tight closure to prevent reestablishment of the fistula. The skin is closed with 6-0 Black Silk. Results: The patient recovered well without any complications such as infection, epiphora, and obstruction of lacrimal sac. Conclusion: Our case illustrates bilateral lacrimal anlage ducts in a patient with unilateral congenital ear cleft. We recommend careful evaluation of lacrimal system in these patients, especially bilateral case and other congenital anomalies. Finally, we recommend excision of the ducts when epiphora, infection, or chronic skin irritation occur.

• Archives of Plastic Surgery
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• v.42 no.1
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• pp.40-45
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• 2015

Background The eyelid and canthal areas are common locations for cutaneous tumors. The medial canthus includes, among many other apparatuses, the canthal tendon and lacrimal canaliculi, and its characteristic thin and supple skin is hard to mimic and restore using tissue from other regions. Accordingly, reconstruction of the canthal area can prove challenging for surgeons. Although various methods, such as skin grafts and local flaps from adjacent regions, have been utilized for reconstructive purposes, they present known disadvantages. However, we were able to successfully reconstruct both lateral and medial canthal area defects by using orbicularis oculi myocutaneous island flaps. Methods Our study included seven patients who underwent medial or lateral canthal region reconstruction, using orbicularis oculi myocutaneous island flaps, between 2011 and 2014, following either cutaneous tumor excision or traumatic avulsion injury. Results Five patients had basal cell carcinoma, one had squamous cell carcinoma of the eyelid, and one had sustained a traumatic avulsion injury of the eyelid and canthal area. Entire flap loss was not observed in any patient, but one-a heavy smoker-showed partial flap loss, which healed with secondary intention and yielded acceptable results. Donor site morbidity was not observed, and all patients were satisfied with their surgical outcomes. Conclusions The canthal regions can be successfully reconstructed with orbicularis oculi myocutaneous island flaps. These flaps offer several key advantages, including similarity in texture, color, and thickness to the recipient site and a negligible incidence of donor site morbidity.

• The Journal of Internal Korean Medicine
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• v.28 no.3
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• pp.655-661
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• 2007

Malignant melanoma is rare in Asians and one of the poorer prognostic diseases. Malignant melanoma accounts for only a small ratio of all skin cancers, but it causes the greatest number of skin cancer - related deaths worldwide. Melanoma incidence has continued to increase worldwide and in Korea, like other countries, the number of patients has increased compared with previous cancer incidence data. In this case report, we describe a case of a malignant melanoma patient who showed neck node metastasis (right supraclavicular area) after wide excision of facial melanoma 2 years before the diagnosis of relapse. The patient refused to get conventional western medical treatment including chemotherapy and the size of cancer increased over the 5 months of clinical follow-up. After 4 months of traditional Korean medical treatment using allergen-removed Rhus verniciflua Stokes(A-RVS), however, the size of cancer mass decreased and the patient showed no side effects. Further study will be needed in order to determine the long-term effect of allergen-removed Rhus verniciflua Stokes on patients with malignant melanoma.

• Archives of Craniofacial Surgery
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• v.13 no.1
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• pp.76-79
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• 2012

Purpose: Sebaceous epithelioma (sebaceoma) is a benign tumor with sebaceous differentiation. It presents primarily as a yellowish papule or nodule on the face and scalp. It must be differentiated from basal cell carcinoma and other appendageal tumors. We report a giant sebaceous epithelioma on the scalp and describe the immunohistochemical character of the cells in sebaceous epithelioma to epithelial membrane antigen (EMA). Methods: A 55-year-old-man who presented with 5-cm-diameter 2-cm-height, round shape exophytic ulcerated tumor on his head presented for treatment. The patient had noticed the lesion 40 years prior as a small yellowish plaque and 18 months ago, the plaque started to grow progressively larger. We excised the lesion with 1 cm resection margin, considering the possibility of malignancy because this lesion grossly resembled basal cell carcinoma (BCC). The defect was repaired with the use of a splitthickness skin graft. Results: When we excised the lesion, the margin was clear. Histology showed nodules that consisted of an admixture of basaloid cells and mature adipocytes lacking an organized lobular architecture. Strong expression of EMA on mature adipose cells confirmed the differential diagnosis from BCC with sebaceous differentiation because of the absence of a nuclear palisade pattern and cleft-like spaces on the hematoxylin and eosin (H&E) section. Conclusion: We treated the giant sebaceous epithelioma on the scalp with surgical excision and a split-thickness skin graft. It is important to know that the diagnosis of sebaceous epithelioma should be made based on the histologic pattern of the H&E section. Immunohistochemistry with EMA can help to confirm the differential diagnosis between sebaceous epithelioma and BCC.

• Tuberculosis and Respiratory Diseases
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• v.61 no.6
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• pp.573-577
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• 2006

Dermatofibrosarcoma protuberans (DFPS) is a locally aggressive skin tumor with a very low incidence in the general population. This tumor has a remarkable tendency to recur, However, a metastasis is rare. We report a case of DFPS with a pulmonary metastasis in 28-year-old man. The pulmonary metastasis developed 5 years after a complete resection of the primary skin tumor. We reviewed the clinical manifestations and treatment of DFPS, and highlight the need for a long-term follow-up examination for metastases after a wide excision of these lesions.

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.415-420
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• 2011

Purpose: The reconstruction of a soft tissue defect of the heel pad can be challenging. One vital issue is the restoration of the ability of the heel to bear the load of the body weight. Many surgeons prefer to use local flaps or free tissue transfer rather than a skin graft. In this study, we evaluated the criteria for choosing a proper flap for heel pad reconstruction. Methods: In this study, 23 cases of heel pad reconstruction were performed by using the flap technique. The etiologies of the heel defects included pressure sores, trauma, or wide excision of a malignant tumor. During the operation, the location, size and depth of the heel pad defect determined which flap was chosen. When the defect size was relatively small and the defect depth was limited to the subcutaneous layer, a local flap was used. A free flap was selected when the defect was so large and deep that almost entire heel pad had to be replaced. Results: There was only one complication of poor graft acceptance, involving partial flap necrosis. This patient experienced complete recovery after debridement of the necrotic tissue and a split thickness skin graft. None of the other transferred tissues had complications. During the follow-up period, the patients were reported satisfactory with both aesthetic and functional results. Conclusion: The heel pad reconstructive method is determined by the size and soft-tissue requirements of the defect. The proper choice of the donor flap allows to achieve satisfactory surgical outcomes in aesthetic and functional viewpoints with fewer complications.

• Archives of Plastic Surgery
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• v.37 no.6
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• pp.835-838
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• 2010

Purpose: Reconstruction of soft tissue defects in the distal lower leg, especially in the distal third, largely depends on free tissue transfer and local fasciocutaneous flaps. But several local muscle flaps have also been proposed as useful alternative reconstructive manner. In this report, the authors present the successful use of the flexor digitorum longus muscle flaps in the distal lower leg reconstruction. Methods: Case 1: An 81-year-old woman with a dog bite wound in the left distal lower leg was admitted. She had a $10{\times}8\;cm$ wound with tibial exposure along the medial aspect of the leg. Soft tissue reconstruction with a flexor digitorum longus muscle flap and a split-thickness skin graft was performed. Case 2: A 77-year-old woman had a squamous cell carcinoma in the right distal lower leg. After wide excision, a $5{\times}4\;cm$ wound was developed with exposure of the tibia. The flexor digitorum longus muscle flap was transposed and covered with a split-thickness skin graft. Results: The flexor digitorum longus muscle flaps were shown to be useful to cover tibial defects in the distal lower leg. During the follow-up period, no significant donor site morbidity was found. Conclusion: The flexor digitorum longus muscle flap can be used to cover the exposed distal tibia, especially when a free tissue transfer is not an option. The relative ease of dissection and minimal functional deficits were the major advantages of this flap, while the extent of reach into the lower third has a limitation.

• Archives of Plastic Surgery
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• v.37 no.6
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• pp.827-830
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• 2010

Purpose: Congenital spinal dermal sinus tract is a rare lesion connecting skin to deeper structures including neural tissue. It results from the failure of the neuroectoderm to separate from the cutaneous ectoderm in the third to fifth week of gestation. The common locations are the lumbosacral and occipital regions. Sometimes it extends to spinal canal. In this paper we report a case of congenital spinal dermal sinus tract in the coccyx. Methods: A 21-month-old male child born after an uncomplicated full-term pregnancy was admitted to our institute with a midline dermal sinus and a cartilaginous protrusion in the coccygeal region. There were no signs of infection. Neurologic examination showed no functional deficit in both lower limbs. He was treated with complete excision of the tract and an underlying accessory cartilage. Results: The spinal dermal sinus tract was extended from the skin to the coccyx. The stalk was loosely attached to the accessory cartilage of coccyx. At that point, it was dissected from the accessory cartilage and resected. The accessory cartilage was also resected at the bone and cartilage junction. During the follow-up period of 6 months, the wound healed well without any complication nor recurrence. Conclusion: Congenital spinal dermal sinus tract is known as a form of spinal dysraphism. In order to prevent complications, timely surgical intervention including complete resection of sinus tract with correction of associated abnormalities is of utmost importance.

• Archives of Reconstructive Microsurgery
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• v.19 no.2
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• pp.108-111
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• 2010

Purpose: In reconstructing a defect on the dorsum of the hand, there are many cases of extensor tendons exposed or even missing. The repaired or reconstructed tendons need relevant gliding environment for good functional recovery. The anterolateral thigh flap offers a vascular fascial component with large amounts that can be used for covering exposed tendons and we report a unique case of single-stage hand dorsum and gliding surface reconstruction. Methods: A 35-year-old man had severe post-traumatic scarring in his left dorsal hand and coverage of the flap with split-thickness skin graft has been done before. After scarred skin excision and extensor tendon graft for missed part, a free anterolateral thigh adipofascial flap was used to resurface the hand dorsum and to reconstruct a two-layer gliding surface of the extensor tendons. The extensor tendons were wrapped in the fascial component with the fat layer inside. Results: He had an uneventful postoperative course without infection, dehiscence and flap necrosis. Good overall functional recovery and tendon excursion were observed. He was also satisfied with postoperative appearance. Conclusion: A free anterolateral thigh adipofascial flap was used successfully for reconstruction of a two-layer tendon gliding surface to treat a patient with severe scarring in the dorsal hand.