• Korean Journal of Head & Neck Oncology
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• v.40 no.1
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• pp.49-53
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• 2024

Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma, with an incidence of about 0.8% to 5% per million people per year, accounting for 1% of soft tissue sarcomas. In its early stage, DFSP is typically found as a violet or pinkish macule or patch, and it can develop into a palpable mass with ulceration or bleeding. The standard treatment for DFSP is wide local excision of the tumor with a 2- to 3-cm negative margin, and radiation therapy or chemotherapy can be conducted with surgical treatment. A 35-year-old man had a palpable mass on the left side of his occipital scalp without color change, ulceration, or bleeding, which typically are present in malignancy. A magnetic resonance imaging (MRI) scan showed a 3-cm homogenous enhanced mass without adhesion between the scalp and the mass. Unexpectedly, a biopsy revealed the round mass to be DFSP. A wide excision and rotation of the scalp flap were performed. The patient recovered without any complications and received adjuvant radiotherapy at a dose of 60 Gray (Gy) for six weeks. There was no recurrence through six months of follow-up. Here we report this unique case of DFSP with atypical presentation.

• Archives of Plastic Surgery
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• v.51 no.1
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• pp.36-41
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• 2024

Background Among breast reconstruction methods, implant-based breast reconstruction has become the mainstream. However, periprosthetic infection is still an unresolved problem. Although published articles have revealed that limited use of antibiotics is sufficient to reduce infection rates, the number of surgeons still preferring elongated usage of antibiotics is not less. The aim of our study is to validate the appropriate duration of antibiotic use to reduce infection rate after implant-based breast reconstruction. Methods A retrospective study reviewed medical record of 235 patients (274 implants for reconstruction) who underwent prepectoral direct to implant breast reconstruction using acellular dermal matrix wrapping technique. Infection rates were analyzed for the patients administered postoperative prophylactic antibiotics until drain removal and those who received only perioperative prophylactic antibiotics for 24 hours. Results Of the 274 implants, 98 who were administered prophylactic antibiotics until drain removal had an infection rate of 3.06% (three implants) and 176 who received prophylactic antibiotics no longer than 24 hours postoperatively had an infection rate of 4.49% (eight implants). A total of 11 patients diagnosed with postoperative infection clinically, 8 were salvaged by antibiotic treatment, and 3 had implant removal and replacement with autologous flap. Postoperative antibiotic prophylaxis duration had no statistically significant effects in the risk of infection (p = 0.549). Conclusion The duration of prophylactic antibiotics after surgery was not related to infection risk. Further study with a large number of patients, randomized control study, and route of antibiotics is needed.

• Journal of Periodontal and Implant Science
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• v.42 no.3
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• pp.105-109
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• 2012

Purpose: Soft tissue recessions frequently cause esthetic disharmony and dissatisfaction. Compared with soft tissue coverage around a tooth, the coverage of an implant site is obviously unpredictable. Particularly in the cases of thin mucosa, a significant greater amount of recession takes place compared to thick mucosa. To overcome this problem, this case report demonstrates a two-step mucosal dehiscence coverage technique for an endosseous implant. Methods: A 33-year-old female visited us with the chief complaint of dissatisfaction with the esthetics of an exposed implant in the maxillary left cental incisor region. A partial-thickness pouch was constructed around the dehiscence. A subepithelial connective tissue graft was positioned in the apical site of the implant and covered by a mucosal flap with normal tension. At 12 months after surgery, the recipient site was partially covered by keratinized mucosa. However, the buccal interdental papilla between implant on maxillary left central incisor region and adjacent lateral incisor was concave in shape. To resolve the mucosal recession after the first graft, a second graft was performed with the same technique. Results: An esthetically satisfactory result was achieved and the marginal soft tissue level was stable 9 months after the second graft. Conclusions: The second graft was able to resolve the mucosal recession after first graft. This two-step approach has the potential to improve the certainty of esthetic results.

• Archives of Plastic Surgery
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• v.41 no.2
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• pp.171-173
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• 2014

Preoperative perforator marking for deep inferior epigastric artery perforator flaps is vital to the success of the procedure in breast reconstruction. Advances in imaging have facilitated accurate identification and preselection of potentially useful perforators. However, the reported imaging accuracy may be lost when preoperatively marking the patient, due to 'mapping errors', as this relies on the use of 2 reported vectors from a landmark such as the umbilicus. Observation errors have been encountered where inaccurate perforator vector measurements have been reported in relation to the umbilicus. Transcription errors have been noted where confusing and wordy reports have been typed or where incorrect units have been given (millimetres vs. centimetres). Interpretation errors have also occurred when using the report for preoperative marking. Furthermore, the marking process may be unnecessarily time-consuming. We describe a bespoke template, created using an individual computed tomography angiography image, that increases the efficiency and accuracy of preoperative marking. The template is created to scale, is individually tailored to the patient, and is particularly useful in cases where multiple potential suitable perforators exist.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.12 no.3
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• pp.57-62
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• 1990

Many alloplastic materials have been used as the bony substitute in large bony defects caused by fracture, periodontitis, & cyst, etc. Nowadays Hydroxyapatite(HAP) is the most usable material as the bony substitute. The reasonable properties of HAP are nontoxic, biocompatible to host tissues & have osteoconductivity. Other bioceramic materials are recommended as the bony substitute with high success rate. We have studied the clinical use of HAP as the bony substitute in the defected area caused by cyst. The reasonalbe & successful results are obtained. The results were as followed. 1. Better prognosis was obtained in the case of HAP & bone mixed graft than HAP graft only. And the best prognosis was obtained in the case of iliac bone graft. 2. Better prognosis was obtained in Mx. than in Mn. 3. It seems that the soft tissue ingrowth into the HAP granule play an important role in the success of the HAP graft. 4. Though the flap covering the HAP granules was perforated, the relative good prognosis was obtained by re-suturing the perforeated site.

• Korean Journal of Head & Neck Oncology
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• v.11 no.2
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• pp.158-166
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• 1995

Planning of the skin incision is one of the most important point for safe removal of the head and neck cancer. The fact that so many types of incisions exist is strong testimony that there is hardly one incision that fits all situation. Factors that influence the choice are adequate exposure, changeability to other types of neck dissection, optimal exposure of the primary site and/or opposite side of the neck, and safety of the neck flap and cosmesis. Laryngeal and hypopharyngeal carcinomas are the most common tumor of the head and neck, even though there are so many diverse situation exist, there must be an optimal approach to each case. From 1992 to 1994 surgical approaches used for laryngeal and hypopharyngeal carcinoma at the Severance Hospital were reviewed. Types of surgical approaches, its pitfall, advantage and disadvantages were reviewed.

• Journal of Periodontal and Implant Science
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• v.26 no.1
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• pp.133-142
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• 1996

Ten intrabony defects in 10 patients were treated by flap surgery including root surface debridement and placement of an expanded polytetrafluoroethylene(ePTFE) membrane. The membranes were removed after 4-6 weeks. This study was performed to examine the retrived ePTFE membrane by scanning electron microscopy(SEM) for bacterial contamination and adherent connective tissue elements, and to compare it with clinical conditions. The cervical portion of the membrane, which in most cases had become partially exposed to the oral cavity, had a bacterial deposit. Small bacterial colonies and a scatter of single cells in some instances extended into the apical portion of the membrane. Fibroblast-like cells, erythrocytes and fibrous structures were seen in the apical portion of the membrane. Outer surface of membrane tends to more bacterial contamination than inner surface(p<0.01), and upper portions more than lower portions(P<0.01). Comparison of ultrastructural findings and clinical conditions revealed that extent of bacterial contamination of the membrane correlated with gingival inflammation and extent of membrane exposure, but it was not significant statistically. The results suggested that gingival inflammation and membrane exposure affect periodontal regeneration by the use of ePTFE membrane.

• Journal of Korean Society for Quality Management
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• v.34 no.4
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• pp.40-50
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• 2006

The authors aimed to analyze the quality improvement efficiency of wound dressing with 2-octyl cyanoacrylate(2-OCA) in stereotactic image guided linear or sigmoid incisions in a cohort of consecutive craniotomy patients, and to compare clinical results with those of iodine-dressing and silk sutured patients underwent conventional craniotomy surgery with large pedicle flap incisions without stereotactic guidance. In methods, 26 patients were involved as the study group at one hospital. We retrospectively compared their results with those of 38 consecutive control patients at the same unit. The suggested new medical material, 2-octyl cyanoacrylate(2-OCA), resultantly decreased or prevented the contaminated fluid influx from scalp outside. The mean infection rate for the control group (7.89%) was relatively higher than that of the study group (3.85%). In addition, the use of stereotactic image guided craniotomy was significant to reduce operation time, to simplify operative procedures and to decrease potential risk factors.

• Korean Journal of Bronchoesophagology
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• v.11 no.2 s.22
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• pp.10-15
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• 2005

식도와 인두 재건은 연하작용을 원활하게하고 발선기능을 보존하면서 위험부담이 가장 절은 술식을 선택하는 것이 원칙이다. 술식의 선택에 고려되어야 할 주요 인자는 결손부위의 크기, 창상의 상태, 술전 방사선치료 여부, 환자의 전신상태 등이다. 부분인두결손에는 유경근피판(pedicled myocutaneous flap)이나 유리피판이 적합하며 방사선 치료를 받은 경우는 유리피판이 유리하다. 흉곽입구 상부에 국한된 인두와 식도의 전체둘레결손에는 전완부, 외측 대퇴부, 공장의 유리피판이 좋다. 전완부는 피판이 다루기 쉽다는 장점이 있지만 공여부에 합병증이나 미용상의 문제가 있고 외측 대퇴부는 공여부의 문제는 매우 적으나 피판의 사용이 전완부에 비하여 약간 제한적이다. 공장은 허혈에 약하고 공여부 합병증이 다른 피판에 비해 불리하다. 저자의 경험으로는 흉곽상부에 국한된 결손의 재건에 환자가 비만하거나 대퇴부에 털이 많은 경우는 전완부 유리피판이 좋고 그렇지 않으면 외측 대퇴부 유리피판을 선택하는 것이 좋다고 생각된다. 흉곽입구 하방까지 연장된 결손이나 식도전적출술로 인한 결손에는 위전위술이 가장 적합하다. 방사선치료 등으로 창상에 혈관보호가 요구되는 경우는 대흉근피판이 유용하다. 앞으로 새로운 재건술의 개발이 이어지겠지만 모든 환자에게 맞는 이상적인 재건술은 없다. 재건술마다의 장단점과 제약점을 파악하고 환자의 조건에 따라 가장 적절한 재건술을 선택하는 것이 중요하다.

• Journal of Periodontal and Implant Science
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• v.42 no.6
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• pp.256-260
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• 2012

Purpose: Actinomycosis is an uncommon chronic granulomatous disease that presents as a slowly progressive, indolent, indurated infiltration with multiple abscesses, fistulas, and sinuses. The purpose of this article is to report on a case of actinomycosis with clinical findings similar to periodontitis. Methods: A 46-year-old female presented with recurrent throbbing pain on the right first and second molar of the mandible three weeks after root planing. Exploratory flap surgery was performed, and the bluish-gray tissue fragment found in the interproximal area between the two molars was sent for histopathology. Results: The diagnosis from the biopsy was actinomycosis. The clinical and radiographic manifestations of this case were clinically indistinguishable from periodontitis. The patient did not report any symptoms, and she is scheduled for a follow-up visit. Conclusions: The present study has identified periodontitis-mimicking actinomycosis. Actinomycosis should be included in the differential diagnosis in cases with periodontal pain and inflammation that do not respond to nonsurgical treatment for periodontitis. More routine submissions of tissue removed from the oral cavity for biopsies may be beneficial for differential diagnosis.