• Archives of Plastic Surgery
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• v.43 no.1
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• pp.59-65
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• 2016

Background In East Asia, the foot is the most common site of cutaneous melanoma. The purpose of this study was to investigate the differences between cutaneous melanoma of the foot and melanomas of other sites. Methods We studied 52 patients who underwent surgical treatment for cutaneous melanoma of the foot from September 2000 to January 2015. Through a retrospective review of their medical records, we collected data relating to their sex, age, histopathological subtype, Clark level, tumor thickness, lymph node involvement, stage, and survival rate, and we compared these parameters to those of 61 patients treated for melanoma of other sites. Moreover, we analyzed the surgical procedures, complications, and mortality rates associated with cutaneous melanoma on various parts of the foot. Results Melanoma of the foot differed from other melanomas only in the histopathological subtype. Other clinical features, including survival rate, did not differ significantly between the two groups heel was the most common site of melanoma of the foot (22 cases, 42.3%). The method of reconstruction varied depending on the region involved. Conclusions A comparison of melanoma of the foot to other melanomas showed that melanoma of the foot was associated with a significantly different distribution of histological subtypes. Consistent with previous findings, we found that the acral lentiginous subtype was the most common among melanomas of the foot. Furthermore, in contrast with previous studies, we did not find a worse prognosis or lower survival rate for melanoma of the foot in comparison with other melanomas.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.615-618
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• 2008

Purpose: Pyoderma gangrenosum is a rare cutaneous ulcerative disease. First described in 1930, the condition is characterized by progressive ulceration with deeply undermined purple-red edge. The lower extremities are most commonly affected but other parts of the skin and mucous membranes may also be involved. Although medical treatments with topical wound therapy are commonly used, surgical intervention is still controversial. In this paper, we report an atypical case of pyoderma gangrenosum which was characterized by extensive soft tissue breakdown. Methods: A 27-year-old male patient was referred to our institution with a $7{\times}8cm$ sized deeply undermined ulceration with pus-like discharge and fever. Incision and drainage was performed at another clinic 3 days prior to admission to our institution. After a thorough physical examination and the MRI review, a diagnosis of necrotizing faciitis was made. Accordingly, fasciotomy and debridement was performed. However, the wound enlarged progressively and the patient remained highly febrile for 9 days after the treatment. Septic screening did not reveal any occult infection. After a secondary review of the case, the initial diagnosis of necrotizing fasciitis was rejected and changed to pyoderma gangrenosum. With the use of dexamethasone intravenously, the wound improved dramatically and the fever was eliminated. Steroid mediation was tapered with duration of 1 month. The wound was stabilized and subsequently covered with split-thickness skin graft. Results: Split-thickness skin grafting with 1 : 1.5 mesh was successfully taken. Conclusion: Initial clinical features of pyoderma gangrenosum are very similar to that of necrotizing fasciitis. High fever and progressive ulceration with severe pain could invite earlier surgical approach. The advancing wound margins (the well defined violaceous, undermined border and necrotic ulcer base) and lack of isolation of pathogenic organism was used to make the correct diagnosis of pyoderma gangrenosum. We achieved a good result with proper medication and split-thickness skin graft.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.499-502
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• 2006

Purpose: Grave's disease is an autoimmune disease with chronic and systemic features. It affects the orbital fat and muscle bringing about defect in extrinsic eye motility, diplopia, optic nerve defect and lid retraction. In patients with lagopthalmos and resulting facial deformity, treatment can be done by rectus muscle recession or filling with various material. Autogenous auricular cartilage graft is often used and synthetic material such as synthetic acellular dermis, polyethylene meshs are also used for filling of the depressed area. Nevertheless, autogenous auricular cartilage grafts are difficult to utilize and synthetic materials sometimes result in protrusion or infection. Therefore, hard palate mucosa was considered as an alternative. We report two cases of patients with lower eyelid retraction corrected with autogenous hard palate mucosa. Methods: We performed this operation in two patients of Graves' ophthalmopathy. The capsulopalpebral fascia was incised and elevated through an incision on the conjunctiva. Then, the harvested hard palate mucosa was sutured to the inferior border of the tarsus and covered with the conjunctiva. Results: The lower eyelid retraction was corrected successfully. No hypertrophy or deformation of the transplanted hard palate mucosa was noted 6 months after the surgery. Conclusions: From the results above, we may conclude that the hard palate mucosa serves as an ideal spacer for the curvature and the inner lining in lower lid retraction. Hard palate mucosa is as sturdy as the autogenous cartilage but is much easier to utilize. It can be also used for lid retraction after lower lid aesthetic surgeries or traumas.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.287-294
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• 2011

Purpose: Reduction malarplasty is one of the common aesthetic procedures performed in the Orient. We have analyzed effective operative methods according to the pivot point for the osteotomy and reposition of the zygoma for reduction malarplasty after confirming the shapes of the individual zygomas. Methods: Thirty-six patients had been received malarplasty over the last 10 years. The average follow-up period was 16 months. We categorized the patients into three groups according to their prominent appearance features. Group I had a prominently protruded zygomatic body, group II had a prominently protruded zygomatic arch, and group III had a prominently protruded body and zygomatic arch. In the group I, two parallel oblique osteotomies on the body, the middle portion was removed, and with the zygomatic arch as the pivot point, the body was repositioned inwards. In the group II, the zygomatic body and arch osteotomy is performed, with the body as the pivot point, and the arch is depressed medially. In the group III, using the two aforementioned methods, the zygoma was repositioned medially. In each case, postoperative complications and patients satisfaction over the surgery were surveyed. Results: Each group had 25, 5 and 12 patients respectively. No significant complications were found except for one patient who experienced a non-union of zygomatic bone. In the case of group I, four patients underwent a secondary operation. Conclusion: Reduction malarplasty is popular as an effective facial contouring surgery. In order to obtain more effective results,however, the zygomatic shape should be identified, and appropriately repositioned by different operative technique according to pivot points.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.273-278
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• 2011

Purpose: It has always been an aspiration for Asians to look more balanced and feminine, considering their facial features regarding relatively flat midface with marked prominences of the zygoma. Many studies have been dealt in this subject. However, the authors would like to emphasize the concept and introduce the technique of repositioning of the malar complex to a cosmetically beneficial point and stationing it on proper position by fixation on zygoma body and arch. Methods: From January 1998 to December 2007, this method was performed in 50 patients of mild to moderate prominence and malposition of the malar complex. A simplified technique of lateral orbital osteotomy and oblique osteotomy on zygomatic arch through intraoral and preauricular incision was developed. Then, liberal malar complex can be moved to a supero-posterior direction and repositioned to a more cosmetically beneficial point. To maintain the stationed position and to protect from vector affected by the attached masticating muscle to zygomatc bone, fixation was done on both zygoma body and arch. Results: We have obtained satisfactory results using this procedure without any observable complications. The advantages of this procedure are proper exposure, inconspicuous scar, safe, more natural contour, improved stability, and shorter healing time. Conclusion: The authors suggest that reduction malarplasty should be approached with underlying concept of repositioning and fixation. In mild moderate malar prominent cases, our technique will provide with maintenance of aesthetic concept, equal to the malar reduction performed under coronal approach and provide with more natural facial contour with stability even with less invasive surgical approach.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.395-398
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• 2007

Purpose: Elastofibroma is a rare benign tumor that is characterized histologically by the presence of abnormal elastic fibers within a stroma of fibroadipose tissue. Usually it is slow-growing, solid, ill-defined mass occurring chiefly in elderly woman and arising from the soft tissue around the inferior angle of the scapula. Methods: We experienced a representative case of elastofibroma. A 73-year-old women complained of a soft-tissue mass, which measured $6{\times}6cm$, at the inferior angle of the left scapula, which had been found incidentally 4 months before. When the arm was elevated, the mass projected out beneath the scapula. The entire mass was resected with a tumor-free margin. Results: The resected tumor appeared to be nonencapsulated, fibrous and white mass, and it contained yellow fatty streaks. We confirmed that the histopathologic diagnosis of this tumor was elastofibroma. Follow-up examination revealed no evidence of local recurrence for 10 months. Conclusion: This entity is rarely reported in Korea. However, more patients could be diagnosed if physicians pay more careful attention to clinical and radiological features of elastofibroma. Moreover, recognizing the benign nature of this lesion is important to avoid an unnecessary operation.

• Archives of Plastic Surgery
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• v.36 no.2
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• pp.233-236
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• 2009

Purpose: Spindle cell lipoma(SCL) is an uncommon subcutaneous soft tissue neoplasm that arises in the shoulder and posterior neck of older male patients. The imaging appearance of SCL is not pathognomonic and can display some features overlapping with liposarcoma. We report a case of SCL on the posterior neck. Method: The patient is a 50 - year - old man with a slowly enlarging subcutaneous mass on the right side of posterior neck. Computed tomographic imaging revealed a 7.0 cm sized, well - circumscribed, heterogenous and fatty mass with enhanced solid components. Whole body Fluorine - 18 Fluorodeoxyglucose Positron emission tomogram(FDG PET-CT) showed little increase of FDG uptake on the right posterior neck and there was no distant metastasis. Results: The mass was surgically removed. The resection margin was free of tumor on frozen biopsy. Histopathologic examination indicated spindle cell lipoma consisting of a mixture of mature adipocytes and uniform spindle cells within a matrix of mucinous material. Conclusion: Although CT image of solidtary mass in posterior neck is similar with the one of liposarcoma, we should consider that it may be a spindle cell lipoma if PET-CT and other systemic studies reveal no distant metastasis. And we should perform fine needle aspiration to differentiate SCL from malignant lesions.

• Archives of Plastic Surgery
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• v.34 no.2
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• pp.261-264
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• 2007

Purpose: Extranodal marginal zone B cell lymphoma of MALT type represents approximately 8% of non-Hodgkin's lymphomas and this lymphoma is present in extranodal sites. Although the presentation of this lymphomain in stomach is usually associated with H. pylori infection in 95% of cases, MALT lymphoma found in soft tissue has been reported very rarely in the field of plastic surgery. We report a case of MALT lymphoma in the submandibular gland without any involvement of other organs such as the stomach. Methods: A 49-year-old man complained of a huge neck mass sized about $10{\times}12cm$. It started about 2 years ago and grew rapidly for the late 6 months. It was of hard nature with erythematous skin overlying it. Under the diagnosis of possible malignant lymphoma or sarcoma, radical resection was performed and the defect was reconstructed using transverse rectus abdominis musculocutaneous free flap. Results: The mass was well demarcated from the normal tissue, $11{\times}10.5{\times}10cm$ in size and whitish-gray color. Immunohistochemical analysis demonstrated that the tumor cells were LCA(+), CD20(+), CD3(-) and CD5(-). The tumor was diagnosed as extranodal marginal zone B cell lymphoma. The patient was treated with prophylactic radiation therapy after surgery, there was no complication for 1 year. Conclusion: We reported that very rare form of MALT lymphoma in 49-year-old male patient was experienced with clinical characteristics, histologic features and references.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.473-476
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• 2010

Purpose: Torus palatinus is a bony prominence at the middle of the hard palate. The size varies from barely discernible to very large, from flat to lobular. This oral exostosis is not a disease or a sign of disease, but if large, may be a problem. So, we present the clinical and histopathologic features and applied therapy and provide a comprehensive review of the rare case of the symptomatic exostoses. Methods: A 37-year-old woman had slowly growing exophytic nodular mass of the bone that arises the midline suture of the hard palate. The patient was concerned about discomfort associated with movement of her tongue and about frequent irritation of the palatal mucosa during mastification of the hard food. The patient had a large, unilobulated torus palatinus. It extended from the area adjacent to the canine to a point beyond the junction with the soft palate. The mass was oblong in shape, measuring about 3 cm long, 2 cm wide, and 0.8 cm in height. Results: Before surgical intervention a CT was obtained for the sake of estimating the thickness of the bone between the exostoses and the maxillary antrum and floor of the nose. The surgical procedure was performed with the patient under general anesthesia. Removal of the exostosis was performed after midline mucoperiosteal incision with osteotome and diamond burr. Histologic finding revealed decalcified dense bony tissue, the presence of lacunae, and normal osteocytes. Conclusion: Surgical removal is recommended when one or more of the following condition exist: interference with the construction of prosthesis, interference with oral function, irritation or pathology of the overlying tissue, inability of the patient to maintain proper oral hygiene, and fear of malignancy or other psychologic trauma. We report a rare case of the torus arising in hard palate with symptoms.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.663-666
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• 2009

Purpose: Primary malignant lymphomas of the salivary glands are uncommon. The parotid gland was most frequently involved, followed by the submandibular gland, minor salivary gland and sublingual gland. The most common subtype is mucosa - associated lymphoid tissue(MALT) lymphoma. We experienced a case of salivary MALT lymphoma involving parotid gland duct, so report a case with a review of the literature. Methods: A 65 year old female presented with a palpable mass on the left side of her cheek. There was no clinical or laboratory evidence of pre - existing autoimmune disease. Preoperative facial and neck CT with contrast showed $2.1{\times}1.7cm$ sized, ill defined, homogeneous low density mass near left masseter muscle, and no evidence of other enlarged lymph nodes. Results: At operation, a yellowish oval shaped mass was found slightly adhered to middle portion of the parotid gland duct, meaduring $2{\times}1.5{\times}0.7cm$. Microscopic finding showed that centrocyte - like cells, monocyte B cells and plasma cells were diffusely infiltrated. Immunophenotyping was preformed on fixed section. The majority of the small cells were immunoreactive for the B cell marker CD20. Based on the typical histological findings supported by immunostaining, the mass was defined as MALT lymphoma. Conclusion: We report that very rare case of MALT lymphoma involving parotid gland duct in 65 year old female patient was experienced with clinical characteristics, histologic features and references.