• Archives of Reconstructive Microsurgery
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• v.20 no.2
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• pp.89-95
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• 2011

Purpose: The purpose of this study was to evaluate the clinical results of anterolateral thigh free flap on soft tissue defect following wide excision in malignant soft tissue tumor of lower extremities. Methods: Between February 2005 to April 2010, we followed up 19 cases who were undergoing anterolateral thigh free flap because of soft tissue defect following wide excision of malignant soft tissue tumor in lower extremity, including 9 cases were heel, 5 cases in foot, 3 cases in ankle, 2 cases in knee and leg. We observed that of implanted area's color, peripheral circulation at 3, 5, 7 days after operation and evaluated operating time, amount of hemorrhage, implanted skin necrosis, additional operations, complications. And we also evaluated the oncologic results, including local recurrence, metastasis, and morbidity. Results: Average operation time of wide excision and anterolateral thigh free flap was 7 hour 28 minutes. 18(94.7%) of total 19 cases showed successful engraftment, on the other hand, failure of engraftment due to complete necrosis of flap in 1 case. In 18 cases with successful engraftment, reoperation was performed in 4 cases. Among them, removal of hematoma and engraftment of flap after bleeding control was performed in 3 cases, because of insufficient circulation due to the hematoma. In the remaining 1 case, graft necrosis due to flap infection was checked, and grafted after combination of wound debridement and conservative treatment such as antibiotics therapy, also skin graft was performed at debrided skin defect area. Skin color change was mainly due to congestion with hematoma, flap was not observed global congestion or necrosis except 4 cases which shows partial necrosis on margin that treated with conservative therapy. Conclusions: Anterolateral thigh free flap could be recommended for reconstruction of soft tissue defect following wide excision of malignant soft tissue tumor in lower extremity.

• Archives of Plastic Surgery
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• v.32 no.2
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• pp.245-249
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• 2005

Various surgical procedures have been described for treating osmidrosis axillare. Elimination of the apocrine glands is prime goal. Optimal operative procedure is characterized as follows: minimal axillary scar(which has cosmetic merits), less complications such as hematoma and seroma, short and less painful recuperating period, minimal damage to the skin and low recurrence rate. Three types of incision technique in subdermal shaving method have beeb commoly used. First, single incision method has an advantage of minimal scarring but more recurrence due to incomplete removal of apocrine glands may occur. Second, double incision technique(Bipedicled flap) has advantages of complete excision, low recurrence rate and relatively minimal scarring, but it could cause frequent necrosis of skin and folding of skin flap. Skoog's method is the third method, which makes four flaps by offset cruciate incisions. It is a better technique in aspect of complete excision of apocrine glands and low recurrence rate but has disadvantages such as development of hypertrophic scar or scar contracture in the line that lies perpendicular to natural axillary skin crease. We used a modified procedure which has shorter length in vertical and transverse incision compared with the classic Skoog's method. We dissected further subcutaneous tissue through the diamond-shaped incision and utilize wide operation field that provide adequate excision of subdermal tissue and proper hemostasis. Between 1999 and 2004, we operated 160 osmidrosis axillare in 80 patients in this technique. Most patients obtained satisfactory result with very low complications. Hematoma or seroma 3.1% Infection 0.6% Partial wound disruption 10% Recurrence 1.2%. Modified Skoog's method for treating osmidrosis axillae could be a optimal technique providing wide operation field for adequate excision of apocrine glands and proper hemostasis and leaving relatively inconspicuous scar and low incidence of scar contracture.

• Archives of Reconstructive Microsurgery
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• v.14 no.1
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• pp.70-76
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• 2005

The Z-plasty has been known as a most common surgical treatment of congenital circumferential constriction band syndrome of the hand. There were thirteen patients of congenital circumferential constriction band syndrome of the hand. All patients underwent Z-plasty under microscope. we did microsurgical dissection to minimize vascular, neural and lymphatic injury, and then considering secondary correction and scar contracture, tried to preserve as much subcutaneous fat and skin flap as possible without any excision. There were less skin necrosis and lymphedema as a result of vascular compromise. Using microscope offers several advantages. First, preventing vascular, neural and lymphatic injury. Second, getting an accurate suture approximation. finally, preserving as much subcutaneous fat and skin flap as possible without any excision. The outcome of digit growth and contour can be excellent than we expected. As a results, we believe that correction of congenital circumferential constriction band syndrome of the hand under the microscope have better results.

• Archives of Craniofacial Surgery
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• v.9 no.1
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• pp.27-30
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• 2008

Purpose: It's difficult to treat port wine stain with nodular change in Laser therapy, and many patients with port wine stain suffer from restriction in social activity in case that port wine stain located on face. We present our experience in excision of port wine stain and skin graft in two patients who had port wine stain with nodular change on their faces. Methods: After excision of discolorized skin and nodular changed lesion of port wine stain, thick split thickness skin graft was done. Results: There was no recurred nodular hypertrophy for 3 months and 3 years of follow up periods. Conclusion: Surgical treatments of port wine stain with nodular change can lead significant improvement of lesion and social intercourse.

• Archives of Plastic Surgery
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• v.41 no.4
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• pp.366-373
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• 2014

Background The advent of skin-sparing mastectomy has allowed for the reconstruction of the breast and nipple with improved cosmesis. However, the nipple-areolar complex (NAC) in Asian patients is more pigmented and scars easily. Therefore, commonly described incisions tend to result in poor aesthetic outcomes in Asian patients with breast cancer. Methods We describe an algorithmic approach to skin-sparing mastectomy incisions in Asian patients on the basis of the location of the biopsy scar and the tumor site and size. Four incision types are described: peri-areolar, a peri-areolar incision with a second distant skin paddle, "racquet handle," and peri-areolar with adjacent skin excision. Results 281 immediate breast reconstructions were performed between May 2001 and February 2012 after skin-sparing mastectomy. The mastectomy incisions used included the peri-areolar design (n=124, 44%), peri-areolar design with a second distant skin paddle (n=39, 14%), "racquet handle" (n=21, 7.5%), and peri-areolar design with adjacent skin excision (n=42, 14%). The traditional elliptical incision and other variants where the NAC outline was not preserved were performed in the remaining 55 patients. The average follow-up was 44.7 months during which there was 1 case of total flap loss and 7 cases of partial flap necrosis; all remaining flaps survived. 24% of the patients (68/281) underwent subsequent nipple reconstruction. Conclusions Our algorithm avoids breast incisions that are randomly placed or excessively long and prevents the unnecessary sacrifice of normal breast skin. This allows skin-sparing mastectomy and immediate breast reconstruction to be performed with a consistently achievable aesthetic result in Asian women without neglecting oncological safety.

• Archives of Plastic Surgery
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• v.50 no.1
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• pp.59-62
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• 2023

A 57-year-old man presented with a pigmented papule, 0.4 cm in diameter, on the left lower eyelid. Skin biopsy revealed a basal cell carcinoma, which was excised through a wide excision followed by a full-thickness skin graft (FTSG). Two weeks after the surgery, an erythematous nodule developed in the lower margin of the graft recipient site. The nodule size increased rapidly over 2 weeks, becoming dome-shaped with a central hyperkeratotic plug. A diagnosis of keratoacanthoma (KA) was made, and surgical excision was performed. Histological findings revealed a large, well-differentiated squamous tumor with a central keratin-filled crater and buttress. The human papilloma virus (HPV) genotyping results were negative. Risk factors for KA include trauma, old age, exposure to ultraviolet (UV) radiation, immunosuppression, and HPV infection. KA has most often been reported to develop at the donor site. Although the pathogenesis of KA is unclear, trauma is believed to act as a second insult to a preceding oncogenic insult, such as exposure to UV radiation, resulting in a koebnerization. Herein, we report a case of solitary KA at a FTSG recipient site. This report presents information that may provide guidance during dermatologic surgeries.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.89-92
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• 2011

Purpose: Electrical burn of scalp is uncommon. Much more, chronically exposed dura in unstable burn scar is quite exceptional. Hence, we report a case of chronically exposed dura following electrical burn. Methods: A 63-year-old man presented with an about 40 years history of an ulcerative lesion arising from electrical burn scar with 'squeeze like sensation' around wound. Wound was about $6{\times}8$ cm. Area in the center was $3{\times}3$ cm nonviable dura without sequestrum. Tangential excision with an intraoperative neurosurgical consultation and transposition flap under general anesthesia was done. Intraoperative biopsy was done. The wound was diagnosed as chronic osteomyelitis, not Marjolin ulcer. Flap was taken successfully. But after 5 days, infectious discharge had been appeared during 2 weeks, despite irrigation and drainage. As flap was re-evaluated, we could see remnant necrotic dura. After that, latissimus dorsi muscle free flap with meshed split thickness skin graft was transferred without excision of necrotic dura. Results: Flap was taken successfully. Follow-up at 10 weeks has been uneventful, with good and stable coverage of the wound. Conclusion: It is true that complete excision of devitalized tissue with sagittal sinus obliteration is prerequisite to flap taken. But necrotic dura was tangentially excised instead of total dura excision, because, posterior two-thirds of the sagittal sinus was involved underneath. Muscle is rich in blood vessels and decrease the recipient-site bacterial count effectively. In this case, muscle flap with skin graft without total dura excision is an alternative treatment.

• Journal of Photoscience
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• v.9 no.2
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• pp.186-189
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• 2002

Many of the adverse effects of solar UV exposure appear to be directly attributable to damage to epidermal DNA. In particular, cyclobutane pyrimidine dimers (CPD) may initiate mutagenic changes as well as induce signal transduction responses that lead to a loss of skin immune surveillance and micro-destruction of skin structure. Our approach is to reverse the DNA damage using prokaryotic DNA repair enzymes delivered into skin using specially engineered liposomes. T4 endonuclease V encapsulated in liposomes (T4N5 liposome lotion) enhanced DNA repair by shifting repair of CPD from the nucleotide excision to the base excision repair pathway. Following topical application to humans, increased repair limited UV-induction of cytokines, many of which are immunosuppressive. In a recent clinical study, topical treatment of UV-irradiated human skin with T4N5 liposome lotion reduced the suppression of the nickel sulfate contact hypersensitivity response. Similarly, the photoreactivating enzyme enhances repair by directly reversing CPDs after absorbing activating light. Here also treatment of UV-irradiated human skin with photoreactivating enzyme in liposomes and photoreactivating light restored the response to the contact allergen nickel sulfate. These findings confirm in humans the observation in mice that UV induced suppression of contact hypersensitivity is caused in part by CPDs. We have tested the ability of T4N5 liposome lotion to prevent UV-induced skin cancer in patients with xeroderma pigmentosum (XP), who have an elevated incidence of skin cancer resulting from a genetic defect in DNA repair. Daily use of the lotion for one year in a group of 20 XP patients reduced the average number of actinic keratoses by 68% and basal cell cancers by 30% compared to 9 patients in the placebo control group. Delivery of DNA repair enzymes to skin is a promising new approach to photoprotection.

• Archives of Plastic Surgery
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• v.36 no.6
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• pp.779-783
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• 2009

Purpose: Male hypertrophic nipples can lead to psychological distress and physical discomfort. The authors present a new technique of male nipple reduction and describe its advantages Methods: The neonipple is designed to reduce diameter and height of nipple while preserving the subdermal plexus. After the central wedge excision, additional four triangular section of nipple skin is excised. One of the remaining two flaps is amputated partially and both flaps were approximated using 4 - 0 PDS and 6 - 0 Nylon sutures. Results: Between December of 2007 and January of 2009, 52 nipple reductions were performed in 30 male patients(mean = 29.5 years). Postoperative recovery was rapid and few complications were encountered. The mean diameter of the hypertrophic nipple was $9.1{\pm}2.5mm$(range, 7 to 15 mm). The mean diameter of the neonipple was $5.0{\pm}0.7mm$(range, 4 to 6 mm), with an average reduction of $3.8{\pm}0.6mm$(range, 2 to 11 mm). At follow-up, the neonipple had a natural appearance, with less projection and an inconspicuous scar. Conclusion: The wedge and triangular skin excision and partial amputation are easy to perform and yields consistent results. This technique decreases both the diameter and height of any size nipple and can be modified to meet patient preferences.

• Archives of Craniofacial Surgery
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• v.15 no.1
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• pp.36-39
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• 2014

Leiomyosarcoma is a rare form of soft tissue neoplasm, with only 1% to 5% occurring in the head and neck region. Current recommended treatment suggests surgical excision with a wide lateral margin, but no definite guidelines regarding excisional margin have been established yet. Recently, complete excision with a narrow surgical margin has been recommended, and the authors present a case of cutaneous leiomyosarcoma on the face that was successfully managed by complete removal with a narrow excisional margin. A 74-year-old woman presented with a 3 cm sized, rapidly growing cutaneous mass on her right preauricular area. Preoperative biopsy of the skin lesion suggested a cutaneous leiomyosarcoma. The authors performed complete surgical excision with a 1 cm lateral margin, and the resulting skin defect was repaired with bilateral V-Y advancement local flaps. Histopathology and immunohistochemistry evaluation confirmed a moderately differentiated cutaneous leiomyosarcoma, with negative margin involvement. The patient refused of any additional treatment, but showed no locoregional recurrence during the 1.5 years of postoperative follow-up period. With a regular postoperative follow-up, cutaneous leiomyosarcomas may be successfully treated with a narrow surgical margin.