• Archives of Plastic Surgery
• /
• v.49 no.6
• /
• pp.724-728
• /
• 2022

Various flaps are used to reconstruct skin and soft tissue defects of the vulva following resection of malignancies. Whenever possible, reconstruction using local flaps is the standard treatment. Here, we describe vulvar defect reconstruction using keystone flaps. Standard keystone flaps are based on randomly located vascular perforators. However, we designed a keystone flap that includes perforators of three named arteries (the anterior labial artery of the external pudendal artery, cutaneous branches of the obturator artery, and posterior labial artery of the internal pudendal artery) and the pudendal nerve, which accompanies the internal pudendal artery. Four patients with squamous cell carcinoma and extramammary Paget's disease of the vulva underwent radical vulvectomy and keystone flaps including perforators of three arteries. Depending on the morphology of the defects, keystone flaps were used with different designs. For elliptical and unilateral vulvar defects, a standard keystone flap was designed, and for defects on both sides of the vulva, a double opposing keystone flap was used. For oval defects, the omega variant keystone flap was designed, and when the morphology of the defect needed rotation of the flap, a rotational keystone flap was designed. All the patients showed good function and sensation, with an acceptable cosmetic appearance.

• Archives of Craniofacial Surgery
• /
• v.21 no.1
• /
• pp.69-72
• /
• 2020

Hemangioma is a benign vascular tumor that grows by endothelial cell hyperplasia. It occurs most frequently in the head and neck region. Nose reconstruction is tricky because of its unique three-dimensional structure and different tissue components. We report a case of successful reconstruction of near-total nose defect using the paramedian forehead flap combined with a nasolabial flap, immediately after excision of nasal hemangioma. A 49-year-old male patient was presented with a huge mass at the nose. Preoperative magnetic resonance imaging showed prominent vascular channels extending to the forehead and cheek. Complete resection of the mass was performed, which resulted in an eccentric defect. The right paramedian forehead flap and the left nasolabial flap were designed and transferred to the defect. Flap division was performed 1 month later. The patient is satisfied with the overall appearance and did not develop any functional deficit.

• Archives of Plastic Surgery
• /
• v.47 no.6
• /
• pp.528-534
• /
• 2020

Split-thickness skin grafting (STSG) is the gold standard for coverage of acute burns and reconstructive wounds. However, the choice of the donor site for STSG varies among surgeons, and the scalp represents a relatively under-utilized donor site. Understanding the validity of potential risks will assist in optimizing wound management. A comprehensive literature search was conducted of the PubMed database to identify studies evaluating scalp skin grafting in human subjects published between January 1, 1964 and December 31, 2019. Data were collected on early and late complications at the scalp donor site. In total, 27 articles comparing scalp donor site complications were included. The selected studies included analyses of acute burn patients only (21 of 27 articles), mean total body surface area (20 of 27), age distribution (22 of 27), sex (12 of 27), ethnicity (5 of 27), tumescent technique (21 of 27), depth setting of the dermatome (24 of 27), number of harvests (20 of 27), mean days of epithelization (18 of 27), and early and late complications (27 of 27). The total rate of early complications was 3.82% (117 of 3,062 patients). The total rate of late complications was 5.19% (159 of 3,062 patients). The literature on scalp skin grafting has not yet identified an ideal surgical technique for preventing donor site complications. Although scalp skin grafting provided superior outcomes with fewer donor site complications, there continues to be a lack of standardization. The use of scalp donor sites for STSG can prevent early and late complications if proper surgical planning, procedures, and postoperative care are performed.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.40
• /
• pp.2.1-2.7
• /
• 2018

With the development of computer-aided design/computer-aided manufacturing (CAD/CAM) technology, it has been possible to reconstruct the cranio-maxillofacial defect with more accurate preoperative planning, precise patient-specific implants (PSIs), and shorter operation times. The manufacturing processes include subtractive manufacturing and additive manufacturing and should be selected in consideration of the material type, available technology, post-processing, accuracy, lead time, properties, and surface quality. Materials such as titanium, polyethylene, polyetheretherketone (PEEK), hydroxyapatite (HA), poly-DL-lactic acid (PDLLA), polylactide-co-glycolide acid (PLGA), and calcium phosphate are used. Design methods for the reconstruction of cranio-maxillofacial defects include the use of a pre-operative model printed with pre-operative data, printing a cutting guide or template after virtual surgery, a model after virtual surgery printed with reconstructed data using a mirror image, and manufacturing PSIs by directly obtaining PSI data after reconstruction using a mirror image. By selecting the appropriate design method, manufacturing process, and implant material according to the case, it is possible to obtain a more accurate surgical procedure, reduced operation time, the prevention of various complications that can occur using the traditional method, and predictive results compared to the traditional method.

• Archives of Craniofacial Surgery
• /
• v.16 no.1
• /
• pp.24-28
• /
• 2015

Background: Acute auriculocephalic angle refers to an ear with helix that is spaced closely to the cranium. An increasing number of patients with acute auriculocephalic angle wish to undergo corrective operation for aesthetic purposes. However, there is a paucity of data regarding acute auriculocephalic angle. This paper proposes a treatment protocol for patients with acute auriculocephalic angle. Methods: We performed a retrospective analysis of patients undergoing acute auriculocephalic angle (4 patients, 6 ears). Patient records were reviewed for demographic data as well as auricular measurements at preoperative, immediate postoperative and final follow-up evaluations. Results: All of the patients were men with a mean age of 36.5 years (range, 23-52 years). The mean follow-up period was 47.5 months (range, 28-60 months). Postoperative auriculocephalic angle was close to the normal auriculocephalic angle ($25^{\circ}-30^{\circ}$) without notable scars. Moreover, the patients had minimal contractions of the skin flaps without any hematoma or relapse. Conclusion: We propose the following three treatment protocols for patients with acute auriculocephalic angle: the posterior auricular muscle should be sufficiently released, the mastoid area should be augmented using implants, the skin should be repositioned with a superior auricular flap.

• Archives of Plastic Surgery
• /
• v.39 no.1
• /
• pp.18-24
• /
• 2012

Background : Infection caused by rapidly growing mycobacteria (RGM) is not uncommon, and the prevalence of RGM infection has been increasing. Clinical diagnosis is difficult because there are no characteristic clinical features. There is also no standard antibiotic regimen for treating RGM infection. A small series of patients with RGM infections was studied to examine their treatments and outcomes. Methods : A total of 5 patients who had developed postoperative infections from January 2009 to December 2010 were retrospectively reviewed. Patients were initially screened using a mycobacteria rapid screening test (polymerase chain reaction [PCR]-reverse blot hybridization assay). To confirm mycobacterial infection, specimens were cultured for nontuberculous mycobacteria and analyzed by 16 S ribosomal RNA and rpoB gene PCR. Results : The patients were treated with intravenous antibiotics during hospitalization, and oral antibiotics were administered after discharge. The mean duration of follow-up was 9 months, and all patients were completely cured of infection with a regimen of a combination of antibiotics plus surgical treatment. Although none of the patients developed recurrence, there were complications at the site of infection, including hypertrophic scarring, pigmentation, and disfigurement. Conclusions : Combination antibiotic therapy plus drainage of surgical abscesses appeared to be effective for the RGM infections seen in our patients. Although neither the exact dosage nor a standardized regimen has been firmly established, we propose that our treatment can provide an option for the management of rapidly growing mycobacterial infection.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.12 no.3
• /
• pp.74-80
• /
• 1990

This is to report a case of surgical and orthodontic of posterior scissor bite, deep bite and gummy smile by the segmental osteotomies. The surgical thechnics procedures used are Peterson's mandibular posterior segmental osteotomy, modified $K{\ddot{o}}le$ technic for mandibular anterior segment and Wunderer's maxillary anterior segmental osteotomy. The results are as follows : 1) Peterson's mandibular posterior segmental osteotomy could be achieved by the buccal approach with some difficulties in accessbility. 2) Upper and lower anterior segmental osteotomies were followed separately to correct the deep curve of Spee, deep bite and gummy smile in shortened period. 3) All alveolar segments were immobilized in preplanned position by the prefabricated palatal and lingual resin splint, therefore intermaxillary fixation was not necessary.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.36 no.5
• /
• pp.219-223
• /
• 2014

During surgical procedures, unexpected material, including surgical instruments and tissue segments, may get lost in the surgical field. Most of these should be immediately removed to prevent further complications, such as vital organ irritation, infection, and inflammatory pseudo-tumor formation. However, it is not always easy to define the exact location of the foreign body, especially if the item is very small and/or it is embedded in the soft tissue of the head and neck region. Intraoperative real-time radiological imaging with C-arm fluoroscopy can be useful to trace the three-dimensional location of small and embedded foreign bodies in the oral and maxillofacial area. We describe an unusual case of an embedded micro-screw in the intrinsic tongue muscle that had been dropped into the sublingual space during a lower alveolar bone graft procedure. The lost foreign body was accurately identified with C-arm fluoroscopy and safely removed without any further complications.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.37
• /
• pp.21.1-21.8
• /
• 2015

Computer Assisted Simulation Surgery (CASS) is a reliable method that permits oral and maxillofacial surgeons to visualize the position of the maxilla and the mandible as observed in the patient. The purpose of this report was to introduce a newly developed strategy for proximal segment management according to Balanced Orthognathic Surgery (BOS) protocol which is a type of CASS, and to establish the clinical feasibility of the BOS protocol in the treatment of complex maxillo-facial deformities. The BOS protocol consists of the following 4 phases: 1) Planning and simulation phase, 2) Modeling phase, 3) Surgical phase, and 4) Evaluation phase. The surgical interventions in 80 consecutive patients were planned and executed by the BOS protocol. The BOS protocol ensures accuracy during surgery, thereby facilitating the completion of procedures without any complications. The BOS protocol may be a complete solution that enables an orthognatic surgeon to perform accurate surgery based on a surgical plan, making real outcomes as close to pre-planned outcomes as possible.

• Archives of Plastic Surgery
• /
• v.43 no.4
• /
• pp.321-327
• /
• 2016

There are many women who want larger and brighter eyes that will give a favorable impression. Surgical methods that make the eye larger and brighter include double eyelidplasty, epicanthoplasty, as well as lateral canthoplasty. Double eyelidplasty produces changes in the vertical dimension of the eyes, whereas epicanthoplasty and lateral canthoplasty create changes in the horizontal dimension of the eyes. Epicanthoplasty, a surgical procedure which enlarges the eye horizontally, is performed at the inner corner of the eye, whereas lateral canthoplasty enlarges the outer edge of the eye. In particular, if the slant of the palpebral fissure is raised and the horizontal dimension of the palpebral fissure is short, adjusting the slant of the palpebral fissure through lateral canthoplasty can achieve an enlargement of eye width and smoother features. Depending on the patient's condition, even better results can be achieved if this procedure is performed in conjunction with other procedures, such as double eyelid-plasty, epicanthoplasty, eye roll formation surgery, fat graft, and facial bone contouring surgery. In this paper, the authors will introduce in detail their surgical method for a cosmetic lateral canthoplasty that lengthens the lateral canthal angle and corrects the outer tail of the eyes, in order to ease the unfavorable impression.