On the diagnosis and treatment of cutaneous and soft tissue tumours misdiagnosed as scars: Lessons from four cases.

Some types of skin and soft tissue tumours may be misdiagnosed as scars because of the scar-like manifestation or the history of injury. It is generally believed that injuries will activate wound healing, ultimately ending in fibrosis. Because of the tumour-promoting properties of both the microenvironment of the wound and the wound-healing process that may go awry, there is a likelihood that injuries may trigger tumour growth. From 2012 to 2016, we treated four patients who underwent unsuccessful treatments because of the misdiagnosis of scars or keloids. Upon the pathological diagnoses of skin and soft tissue tumours in the four cases, extended resection of the tumours was performed. Recurrence was not observed up to the last follow up. Since then, soft tissue tumours have much greater visibility and are considered during diagnosis if a wound is presented with the atypical appearance of scar after injuries. Under these circumstances, biopsy should be conducted.

Using Levator Aponeurosis to Create Physiologically Natural Double Eyelid: A New Reconstruction Technique Based on Three Key Factors in Double Eyelid Formation.

BACKGROUND: Double eyelidplasty has 3 key factors: motor power, connecting tissue, and skin adhesion. OBJECTIVE: To create natural double eyelid, new anatomy structure should be rebuilt according to physiological double eyelid in these 3 aspects. METHODS: Levator aponeurosis is used as "connecting tissue" to transmit dynamic "motor power" of levator muscle to upper eyelid, and "skin adhesion" is induced between levator aponeurosis and skin in a plane manner. Postoperation evaluation includes stability of double eyelid, asymmetry, double fold curve, and scar formation. RESULTS: A total of 119 patients were operated on in this study. Two hundred fourteen eyes (89.9%) showed good fold curve and 13 eyes (5.5%) showed fair results. No scar on the upper eyelid was encountered, 24 patients (20.2%) had fair scar formation and 89 patients (74.8%) had no prominent scar. CONCLUSIONS: This novel surgical technique utilized pretarsal levator aponeurosis as the connecting material to bridge levator muscle and upper eyelid skin; by establishing a direct force transmission mechanism, palpebral crease is created in a more natural way in terms of anatomy and physiology. Furthermore, skin adhesion is formed between levator aponeurosis and dermis in a planar manner, allowing for more stable palpebral crease and more preserved orbicularis oculi in situ, thereby minimizing eyelid scar formation.

Classification and reconstruction of posttraumatic ear deformity.

The diversity of posttraumatic auricular deformity caused by various factors often makes reconstruction exacting for the surgeon. During the past 10 years (from 2001 to 2010), a total of 60 patients (75 ears) were treated. The etiology of the deformities included burns (n = 35), traffic accidents (n = 10), cuts during fight (n = 8), and human bite injuries (n = 7). Based on previously published ones, we set a classification taking into consideration the involved tissue components, size of defects, and status of surrounding soft tissues, which categorized posttraumatic auricular deformities into 5 types. Different reconstruction modalities used for each type are described and discussed with examples. During follow-up, the degree of patients' satisfaction was high, and most reconstructed ears were accepted, barring a few complications. It must be admitted that achieving satisfactory outcome in the treatment of posttraumatic ear deformity similar to that of microtia is difficult, especially in the presence of extensive scar. Our 10-year experience suggested that proper classification and careful selection of techniques would be helpful.