• Archives of Plastic Surgery
• /
• v.33 no.5
• /
• pp.663-665
• /
• 2006

Purpose: Dermatofibroma is a lesion several millimeters to several centimeters in size, arising from dermis or subcutaneous tissue, mostly at extremities of a middle aged female. It is a benign fibrous tumor that to our knowledge metastasis have not been reported and may recur only locally. Here we report a rare case of 36-year-old female with dermatofibroma arising from back and metastasized to both lungs. Methods: We performed an en-block elliptical mass excision for skin lesion and metastatectomy for multiple nodules of both lungs. Results: Histologically, the tumors of both lungs and skin lesion showed dilated cystic airspaces which were lined by respiratory epithelium with underlying layers of tumor cells. The tumor cells were composed of plump to spindled fibrohistiocytic cells arranged in storiform growth pattern. There were no cellular pleomorphism, atypical mitosis, and necrosis. These are the specific features of a dermatofibroma and we could examined the histologic findings of skin and lungs identical. Thus, this indicates that dermatofibroma of back was metastasized to both lungs. Conclusion: We report this case to notice that dermatofibroma is a benign tumor but it rarely metastasizes.

• Archives of Craniofacial Surgery
• /
• v.19 no.2
• /
• pp.127-130
• /
• 2018

Mastocytosis is a rare disease which occurs in both children and adults, and it can manifest as a solitary or multiple skin lesions. Both can cause cutaneous or systemic symptoms. Because of the heterogeneity of clinical presentation of mastocytosis and its rare prevalence, it can be hard to suspect the mastocytosis at the first time. Most solitary mastocytomas are about 1-5 cm in diameter and have features of brownish-yellow, minimally elevated plaques with a smooth shiny surface. This article presents a case of solitary mastocytoma which occurred in neonate and that we treated through surgical excision. In histopathological examination, it consisted of c-kit-positive mast cells. Although pediatric cutaneous mastocytosis might regress spontaneously, clinicians should keep in mind that it could be associated with systemic mastocytosis which involves hematopoietic system.

• Archives of Plastic Surgery
• /
• v.33 no.3
• /
• pp.269-275
• /
• 2006

This study is to provide details of the unique anatomical features on the alar lobule region in Korean nose. We hypothesized that the anatomy of this area differs according to the shape of the alar lobule. Based on the prominence and roundness of alar lobules, they were classified into horizontal and vertical types. A total of 20 fresh cadaver noses(10 for each type) were dissected. The anatomical differences between the horizontal and vertical types were investigated by gross and histologic studies. The alar lobule is composed of three layers, i.e., external skin, muscle, and vestibular skin. Profound differences between the two alar lobule types were evident in terms of the volume of the dilator naris anterior muscle, the insertion of the dilator naris posterior muscle, and the thickness of the external skin at the lateral end of the alar circumference. The horizontal type has a greater volume of dilator naris anterior muscle, an additional insertion of the dilator naris posterior muscle, and thicker external skin at the lateral end of the alar circumference than the vertical type. The Korean nose differs anatomically and morphologically from the Caucasian nose. This study shows that there are anatomic differences between the horizontal and vertical types of alar lobules in Korean nose.

• Archives of Plastic Surgery
• /
• v.33 no.1
• /
• pp.124-126
• /
• 2006

Pachydermodactyly is a rare distinct form of fibromatosis characterized by acquired, asymptomatic dense fibrosis and fibroblastic proliferation around one or more proximal interphalangeal joints. Intralesional triamcinolone injection may be helpful in improving the clinical appearance. A 20-year-old unemployed female patient gave a four years history of progressive swelling of the fingers affecting predominantly the proximal interphalangeal joints of index fingers of left hand and index, middle fingers of right hand. There was no pain and tenderness. Physical examination, complete blood count, antinuclear antibody, rheumatoid factor were unremarkable and radiograph of both hands showed soft tissue swelling only without bony abnormality. We excised the redundant soft tissue from the both sides of proximal interphalangeal joint with longitudinal elliptical fashion. After operation, the fingers of the patient showed marked improvement cosmetically. There were no motor or sensory changes. Pachydermodactyly was first reported in 1996 in Korea. Histologic features include an increased dermal accumulation of collagen and occasionally an increased number of fibroblast. We report for one patient with pachydermodactyly treated with longitudinal elliptical excision and obtained an improvement of clinical appearance.

• Archives of Craniofacial Surgery
• /
• v.19 no.3
• /
• pp.222-226
• /
• 2018

A 70-year-old male with a history of diabetes mellitus, hypertension, and coronary stent insertion visited our hospital 7 days after biting his lower lip. Swelling and inflammation had worsened despite debridement and antibiotic treatment. On the 8th hospital day, fungal infection with Candida albicans and superimposed bacterial infection with Klebsiella pneumoniae were found on tissue culture. Extensive necrosis resulted in a defect of approximately 3/4 of the entire lower lip and a full-layer skin defect from the vermilion to the gingivobuccal sulcus at the right corner of the mouth. To correct drooling, incomplete lip sealing, and trismus, staged reconstruction was performed with consideration of cosmetic and functional features. The treatment process using staged reconstruction and antifungal treatment for an extensive lower lip defect caused by fungal stomatitis is described.

• Archives of Plastic Surgery
• /
• v.34 no.1
• /
• pp.134-136
• /
• 2007

Purpose: Erysipelas is a bacterial infection of the dermis and hypodermis, mostly of streptococcal origin, and erysipelas of upper extremity following breast cancer treatment has never been reported in the Korean literature. Methods: 39-year-old female presented to our hospital complaining of fever and painful swelling of her left upper extremity. She had a history of breast cancer and was treated with breast conserving surgery with axillary lymph node dissection, chemotherapy, and radiation. On physical examination, her left upper extremity showed vesicle, bullae, local heatness and erythema with well-defined margin. With these distinctive features of a skin lesion, we gave a diagnosis of erysipelas and started treatment with intravenous antibiotics. Results: Resolution of the signs and symptoms of erysipelas occurred after 7 days of treatment. Conclusion: The diagnosis of erysipelas with distinctive feature of skin lesion is essential and we emphasize that the prevention of any trauma are very important in these patients for prophylactic measures.

• Archives of Plastic Surgery
• /
• v.48 no.6
• /
• pp.646-650
• /
• 2021

Head and neck reconstruction poses unique challenges in rehabilitating surgical defects in terms of integrity, function, and form. The radial forearm free flap (RFFF) has been widely used for defect coverage, especially in the head and neck area, but its versatility allows it to be used for soft-tissue reconstruction in various parts of the body. The vascular features of the flap are quite constant and reliable. Nevertheless, abnormalities of the forearm vascular tree have been described over the decades. We report a case of intraoral reconstruction after verrucous carcinoma recurrence in a 74-year-old woman with an unusual forearm flap, which we called the median forearm free flap, based on a median branch of the radial artery that was preoperatively detected using handheld Doppler ultrasonography. The distally located skin paddle was predominantly supplied by the aberrant median vessel with its perforators. The flap was thus safely harvested with this atypical pedicle. Successful reconstruction of the intraoral defect was achieved, with an uneventful postoperative course.

• Archives of Plastic Surgery
• /
• v.51 no.1
• /
• pp.2-13
• /
• 2024

Background Although osteotomy is commonly performed in rhinoplasty, it is difficult for less experienced surgeon to understand mechanism of the procedure. The primary goal of this study is to improve understanding of nasal osteotomy in Asians by considering the surface aesthetics and anatomy of the nose as well as their relationships with the surgical procedure. Methods Surface aesthetics, anatomic considerations, kinetics of medial and lateral osteotomy, fracture levels of osteotomy were discussed in detail by reviewing the previous publications and 18 years of our experience. Moreover, the technical details of osteotomy were explained and personal tips for performing successful osteotomy were described. Results Dorsal and lateral aesthetic lines, dorsal and basal widths are main characteristics related to the surface aesthetics of nose to perform the osteotomy. In addition, these features are different in Asian population due to the anatomic difference with Caucasians, which makes the procedure difficult and requires more attention to perform osteotomy. Conclusion Because osteotomy is one of the most traumatic and invasive part of the rhinoplasty, it is crucial for the rhinoplasty surgeon to understand the relationship between surface aesthetics and osteotomy techniques to produce consistent and reproducible results.

• Archives of Plastic Surgery
• /
• v.48 no.5
• /
• pp.503-510
• /
• 2021

Facial feminization surgery (FFS) incorporates aesthetic and craniofacial surgical principles and techniques to feminize masculine facial features and facilitate gender transitioning. A detailed understanding of the defining male and female facial characteristics is essential for success. In this first part of a two-part series, we discuss key aspects of the general preoperative consultation that should be considered when evaluating the prospective facial feminization patient. Assessment of the forehead, orbits, hairline, eyebrows, eyes, and nose and the associated procedures, including scalp advancement, supraorbital rim reduction, setback of the anterior table of the frontal sinus, rhinoplasty, and soft tissue modifications of the upper and midface are discussed. In the second part of this series, bony manipulation of the midface, mandible, and chin, as well as soft tissue modification of the nasolabial complex and chondrolaryngoplasty are discussed. Finally, a review of the literature on patient-reported outcomes in this population following FFS is provided.

• Archives of Plastic Surgery
• /
• v.47 no.4
• /
• pp.333-339
• /
• 2020

Background The purpose of this study was to compare the anatomical features of the internal mammary vessels (IMVs) at the second and third intercostal spaces (ICSs) with regard to their use as recipient vessels in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. Methods A total of 38 consecutive DIEP breast reconstructions in 36 patients were performed using IMVs as recipient vessels between March 2017 and August 2018. The intraoperative findings and postoperative complications were analyzed. Anatomical analyses were performed using intraoperative measurements and computed tomography (CT) angiographic images. Results CT angiographic analysis revealed the mean diameter of the deep inferior epigastric artery to be 2.42±0.27 mm, while that of the deep inferior epigastric vein was 2.91±0.30 mm. A larger mean vessel diameter was observed at the second than at the third ICS for both the internal mammary artery (2.26±0.32 mm vs. 1.99±0.33 mm, respectively; P=0.001) and the internal mammary vein (IMv) (2.52±0.46 mm vs. 2.05±0.42 mm, respectively; P<0.001). Similarly, the second ICS was wider than the third (18.08±3.72 mm vs. 12.32±2.96 mm, respectively; P<0.001) and the distance from the medial sternal border to the medial IMv was greater (9.49±2.28 mm vs. 7.18±2.13 mm, respectively; P<0.001). Bifurcations of the IMv were found in 18.4% of cases at the second ICS and in 63.2% of cases at the third ICS. Conclusions The IMVs at the second ICS had more favorable anatomic features for use as recipient vessels in DIEP flap breast reconstruction than those at the third ICS.