Dupuytren contracture after acute traumatic hand injury in an adolescent: A case report.

Dupuytren's disease is a fibroproliferative disease that affects the palmar hand, causing progressive, permanent, and symptomatic flexion contracture of the digits. It is a disorder of polygenetic and multifactorial origin, usually affecting middle-aged males. Dupuytren's disease developing as a result of hand trauma in younger ages is rarely reported. In this case, we present a 14-year-old male patient with Dupuytren's disease following acute traumatic injury. We performed the fasciectomy and Z-plasty with full thickness skin graft. He recovered completely additional injection of triamcinolone for one year.

Giant lipoma in the index finger of the dominant hand of a swimmer: A case report.

Lipoma is a very common benign tumor that occurs in areas of adipose tissue and is commonly found on the whole body, although its occurrence in the hand and finger is rare. Giant lipoma, defined as over 5 cm long in diameter, is a rare benign tumor of abundant soft tissue in the finger. A 24-year-old male patient presented with a giant lipoma on the volar aspect of the index finger of his right hand. Magnetic resonance imaging (MRI) showed an encased multilobulated mass that measured 7.1x1.2x2.3 cm, and histopathological examination revealed lipoma without malignant transformation. Surgical resection of the tumor with a longitudinal and zig-zag incision of the palm was performed exposing the mass surrounding the palmar digital branch of the median nerve. The mass was completely removed, and neurorrhaphy was performed via the microscope to repair the damaged neurovascular bundle. At four months of postoperative follow-up, the patient was completely recovered with no finger paresthesia or limitation of range of motion. As a professional swimmer, the patient has experienced no subsequent difficulty in swimming due to his finger.

Undifferentiated Pleomorphic Sarcoma of a Chronic Burn Scar of the Knee With Lymph Node Metastasis.

Malignant transformation of chronic burn scars are usually toward cutaneous lineages, including squamous cell carcinoma, basal cell carcinoma, and malignant melanoma. Sarcomas are less common. Undifferentiated pleomorphic sarcoma(UPS) is a subtype of soft tissue sarcoma with storiform-pleomorphic cells of uncertain origin, and has sparingly been reported to arise from burn scars. The majority are localized lesions probably due to the spatial distance of mesenchymal cells from the epithelium. The authors describe a rare case of UPS of the chronic burn scar of his knee with ipsilateral femoral and external iliac lymph node metastasis.

The Oblique Extended Reverse First Dorsal Metacarpal Artery Perforator Flap for Coverage of the Radial-Volar Defect of the Proximal Interphalangeal Joint in the Index Finger: A Case Report.

The dorsal metacarpal artery perforator flap is a flap that rises from the hand dorsum. Owing to its reliability and versatility, this flap is used as a workhorse for finger defect. However, to cover the radial-volar defect of the proximal interphalangeal joint (PIPJ) of the index finger, a longer flap is required than before. Here, we introduce the oblique extended reverse first dorsal metacarpal artery (FDMA) perforator flap to cover the radial-volar aspect defect of the index finger. A 45-year-old man got injured to the radial-volar defect of PIPJ of the left index finger caused by thermal press machine. The wound was 2 × 1 cm in size, and the joint and bone were exposed. We used FDMA perforator from anastomosis with palmar metacarpal artery at metacarpal neck. Since the defect was extended to the volar side, the flap was elevated by oblique extension to the fourth metacarpal base level. The fascia was included to the flap, and the flap was rotated counterclockwise. Finally, PIPJ was fully covered by the flap. Donor site was primarily closed. After 12 months of operation, the flap was stable without complication and limitation of range of motion. The oblique extended reverse FDMA perforator flap is a reliable method for covering the radial-volar defect of the PIPJ of the index finger. This flap, which also has an aesthetic advantage, will be a good choice for hand surgeons who want to cover the PIPJ defect of the index finger using a nonmicrosurgical option.

Neck Pain Caused by Giant Dorsal Lipoma.

Giant lipomas are uncommon in the neck or craniofacial region. A 55-year-old male presented with a large pendulous mass arising from the dorsal aspect of his neck, which he had known about for 20 years. Discomfort during sleeping, frequent headaches, and chronic neck pain were his chief complaints. Computed topography revealed a well-circumscribed lipomatous lesion. A decrease in cervical spine lordosis was noted on sagittal x-rays. Surgical excision with local flap coverage was performed. The specimen weighed 2800 g. The patient reported immediate resolution of neck pain, and complete resolution of headaches following surgery. An increase in the degree of lordosis was seen in sagittal x-rays. Histopathological results confirmed the diagnosis of lipoma. Although most giant dorsal neck lipomas are benign, they may be a cause for neck pain, headaches and degenerative changes in the cervical spine, undermining the quality of life. Such symptoms should be assessed, and removal recommended.

Big data analysis of the risk factors and rates of perioperative transfusion in immediate autologous breast reconstruction.

Patients undergoing autologous breast reconstruction (ABR) are more likely to require perioperative transfusions due to the increased intraoperative bleeding. In addition to the mastectomy site, further incisions and muscle dissection are performed at the donor sites, including the back or abdomen, increasing the possibility of transfusion. The purpose of this study was to evaluate perioperative transfusion rates and risk factors according to the type of ABR through analysis of big data. Patients who underwent total mastectomy for breast cancer between 2014 and 2019 were identified. The patients were divided into mastectomy only and immediate ABR groups. The transfusion rate was 14-fold higher in the immediate ABR group (16.1%) compared to the mastectomy only group (1.2%). The transfusion rate was highest with the pedicled transverse rectus abdominis myocutaneous flap (24.2%). Performance of the operation in medical institutions located in the provinces and coronary artery disease (CAD) were significant risk factors for the need for transfusion. The perioperative transfusion risk among patients undergoing immediate ABR was related to the flap type, location of medical institution, and CAD. Based on the higher transfusion rate in this study (16.1%) compared to previous studies, the risk factors for the need for transfusion should be determined and evidence-based guidelines should be developed to reduce the transfusion rates.

Apocrine tubular adenoma on the palm: A case report.

RATIONALE: Tubular apocrine adenoma (TAA) is a very rare benign neoplasm of the apocrine gland. The typical anatomical locations are mostly hair-bearing areas, where normal apocrine glands are abundant. PATIENT CONCERNS: We report the case of a 40-year-old patient with a tubular apocrine adenoma on a non-hair-bearing area. DIAGNOSES: Ultrasonography showed a 0.4-cm-sized hypoechoic nodule in the subcutaneous plane of the left palm at the fourth carpometacarpal joint level. INTERVENTIONS: Surgical resection was performed and histopathological examination revealed lobules of well-differentiated dilated tubular structures at the dermis level. OUTCOMES: At 1 year of postoperative follow-up, the patient was completely recovered without signs of recurrence. LESSONS: Diagnosis of TAA can be misleading due to its unusual location and inconspicuous appearance. Immunohistochemistry for epithelial membrane antigen and gross cystic disease fluid protein-15 is crucial for the proper diagnosis. Complete excision is recommended to prevent recurrence.

Propeller posteromedial thigh perforator flaps for coverage of extensive perineal defects.

BACKGROUND: Reconstruction of perineal defect is challenging. The goal of reconstruction is to maintain normal function with good esthetic outcomes. Coverage of the perineal defect is often difficult with one loco-regional flap when the size of defect is very extensive. In this article, clinical applications of the propeller posteromedial thigh perforator (PMTP) flap for extensive perineal defects were described. PATIENTS AND METHODS: Eight patients underwent perineal reconstruction with propeller PMTP flaps from March 2013 to December 2018. The average age of the patients was 65 years (range: 52-80 years). The causes of the defects included infection and skin cancers. The perforator was a branch of deep femoral artery. The flap was harvested as a perforator-based flap and rotated 180° to the defect area (propeller flap design). RESULTS: The average flap size was 256.5 cm2 (range: 136-400 cm2 ) and average follow-up period was 22.4 months (range: 6-48 months). All flaps survived after surgery without major complications. The donor sites were all primarily closed and the patients were all satisfied during the follow-up period. CONCLUSION: The propeller PMTP flap is an adequate new option for reconstructing extensive perineal defects. The flap avoids the need for microanastomosis and replaces the defect with similar tissue.

Chondrocutaneous posterior auricular artery perforator free flap for single-stage reconstruction of the nasal tip: a case report.

Full-thickness nasal tip reconstruction is a challenging process that requires provision of ample skin and soft tissue, and intricate cartilage structure that maintains its architecture in the long term. In this report, we describe reconstruction of a full-thickness nasal tip and ala defect using a posterior auricular artery perforator based chondrocutaneous free flap. The flap consisted of two lay ers of skin covering conchal cartilage, and was based on a perforating branch of the posterior auricular artery. A superficial vein was secured at the posterior margin. The donor perforator was anastomosed to a perforating branch of the lateral nasal artery. The superficial vein was connected to a superficial vein of the surrounding soft tissue. The donor healed well after primary closure. The flap survived without complications, and the contour of the nasal rim was sustained at follow-up 6 months later. As opposed to combined composite reconstructions using a free cartilage graft together with a small free flap or pedicled nasolabial flap, the posterior auricular artery perforator free flap encompasses all required tissue types, and is similar in contour to the alar area. This flap is a useful option in single-stage reconstruction of nasal composite defects.

A propeller superficial transverse cervical artery perforator flap for defect coverage of the submental area: a case report.

Reconstruction of submental defects is a challenge that needs to be approached carefully, since many important anatomical structures are located in this small space. Both aesthetic and functional outcomes should be considered during reconstruction. In this report, we describe a case where a superficial branch of the transverse cervical artery (STCA) perforator propeller flap was applied for coverage of the submental area. An 85-year-old woman presented with a 3-cm ovoid mass on her submental area. We covered the large submental defect with a STCA rotational flap in a 180° propeller pattern. The flap survived well without any complications at 1 year of follow-up. A STCA propeller flap is a useful surgical option in reconstruction for defect coverage of the submental area.

Angiolymphoid hyperplasia with eosinophilia attached to the masseter muscle.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign vascular tumor. The pathogenesis of ALHE is unknown; however, it may be linked to local trauma. ALHE predominantly occurs in areas of the preauricular region, forehead, and scalp; the masseter area is rarely involved. A 49-year-old man was referred for a mass in the right cheek region that was felt 2 months prior. Physical and imaging examination results suggested the presence of a benign tumor. Thus, surgical excision was performed. Pathologic findings confirmed an unexpected diagnosis of ALHE. This case was interesting, since the mass occurred at an unusual site with a misdiagnosis of an epidermal inclusion cyst.

A giant solitary vellus hair cyst on the nasal root.

Eruptive vellus hair cyst is a rare lesion of the vellus hair follicles as a result of developmental abnormality. This cyst is usually found in children, adolescents, and young adults most commonly involving the chest, upper and lower extremities, and abdomen. Herein, we introduce a 22-year-old male patient with a mass of nasal root, growing since childhood. The mass has grown over the years, causing the protruding of the nasal root contours, leading to decline in the patient's aesthetic and mental quality of life. In response, we performed complete resection of the mass, which pathologically was a vellus hair cyst. The patient is now satisfied with his appearance and there was no local recurrence during follow up.

A Systematic Review of the National Breast Implant Registry for Application in Korea: Can We Predict "Unpredictable" Complications?

Background and Objectives: Since silicone breast implants were introduced to the market several decades ago, the safety of breast implants has remained controversial. Recently, several studies have explored breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) and breast implant illness (BII). Several countries have developed national breast implant registries to improve the safety and quality of breast implant surgery. We performed a systematic review of the current status of national breast implant registries and propose a pilot form of an appropriate breast implant registry model for Korea. Materials and Methods: The systematic review was conducted in accordance with the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) pro forma". PubMed and Google Scholar databases were searched to identify all articles containing information on national breast implant registries. We limited the search to articles written in the English language from 2010 to 2020. Articles were reviewed by two independent authors. Results: A total of 63 articles related to national breast implant registries, registry principles and national breast implant registry annual reports were identified. After reviewing the literature, 25 national breast implant registry-related articles were included in the full-text synthesis. Currently, four countries, The Netherlands, Australia, Sweden, and the UK, have breast implant registries with well-formed sources for big data. Overall, similarities in data points were detected for three categories: implant-related complications, operation details, and device information. However, there were differences for each registry in terms of governance, funding, and capture rate. Conclusion: After reviewing other countries' experiences, tentative datasets for the Korean Breast Implant Registry (K-BIR) were developed. The K-BIR can improve the quality of breast implant surgery in Korea by providing datasets on overall processes and outcome measures with quality indicators and risk adjustment factors. This approach will register characteristics of patients and monitor breast implants, complications, and surgical procedures to improve the outcomes of breast implant surgery in Korea. In addition, it can be used as a track-and-trace system with automated notifications to patients in the event of a product recall or other safety concerns related to a specific type of implant.

Necrotizing fasciitis of the masticator space with osteomyelitis of the mandible in an edentulous patient.

Necrotizing fasciitis (NF) is a rapidly progressive necrosis of the subcutaneous tissue and fascia, caused by bacterial infection. Usually presenting in the extremities, trunk, or perineum, it is uncommon in the craniofacial or cervical area. Cervicofacial NF is a potentially fatal infection, which should be managed with early detection and intervention. Most cases have a primary odontogenic source of infection, especially when the masticator space is involved. We report a case of masticator space NF that developed without odontogenic origin in a 78-year old female who was treated with prompt surgical drainage and intravenous antibiotics.

Subpectoral Implantation of Cardiovascular Implantable Electronic Device: A Reasonable Alternative for the Conventional Prepectoral Approach.

BACKGROUND: The prepectoral implantation technique has been the standard procedure for cardiovascular implantable electronic device (CIED). However, it cannot be performed in such patients with thin skin or patients with cosmetic concerns. This study was designed to demonstrate the feasibility and safety of the subpectoral compared to the prepectoral approach. METHODS: We conducted a retrospective, nonrandomized comparison of the prepectoral (234 cases) and subpectoral approach (32 cases) in patients who received CIED implantation at a tertiary center between July 2012 and May 2015. We compared lead characteristics, procedure time and complications between the subpectoral and prepectoral approach. RESULTS: In the subpectoral group, two complications were observed, whereas six complications were found in the prepectoral group (2/32 vs. 6/234, respectively, p=0.25). In the subpectoral group, one patient developed wound infection and the others were safely conducted without any complications. In the prepectoral group, two patients developed hemopericardium, three developed pocket hematoma requiring surgical revision, and one developed a pneumothorax. Procedure time in the subpectoral group took longer than that in the prepectoral group (150±50 min versus 91±49 min, p=0.06). In lead characteristics, there were no significant differences between the two groups. CONCLUSION: The subpectoral approach is technically feasible and non-inferior to the prepectoral approach, in the aspect of complication and lead characteristics, but seemed to take more procedure time. The subpectoral approach is a more reasonable choice for selected patients in whom the prepectoral approach is not feasible or in individuals who have cosmetic concerns.

Acellular dermal matrix (Insuregraf) in the prevention of Frey's syndrome and surgical site depression after parotidectomy.

BACKGROUND: Parotidectomy is the treatment of choice in many parotid tumors. Due to the extensive nature of the procedure, unfavorable complications such as gustatory sweating, surgical site depression are common. Various techniques using fascia, muscle or AlloDerm have been developed but debate still remains regarding its availability and affordability. We applied a newly developed acellular dermal matrix (Insuregraf) to the parotidectomy field to act as a physical barrier and to provide adequate filling effect for prevention of functional and aesthetic complications. METHODS: From March 2010 to March 2017, 30 patients with parotid tumors underwent superficial parotidectomy. Twenty patients underwent only superficial parotidectomy. Ten patients had Insuregraf applied to the surgical site after superficial parotidectomy. We evaluated the incidence of Frey's syndrome, surgical site depression, and patient satisfaction rate in both groups. RESULTS: The incidence of Frey's syndrome was lower in the Insuregraf group (0 vs. 2). Surgical site depression was also lower in the Insuregraf group (2 vs. 20). Satisfaction score for facial contour in Insuregraf group was 9.2 out of 10, which was comparable to 6.2 out of 10 in the control group. CONCLUSION: Application of Insuregraf after superficial parotidectomy is an effective surgical procedure to prevent complications such as Frey's syndrome and surgical site depression. This technique is affordable and safe with no immune reactions. Above all this surgical method should be considered as an option for patients who are concerned about the contour of the face after surgery.

Eccrine porocarcinoma on the cheek.

Eccrine porocarcinoma is a rare malignant tumor arising from the intraepidermal ductal portion of the eccrine sweat gland. It develops either spontaneously or from a long standing benign eccrine poroma. This entity usually affects older people and is commonly located on the lower extremities, the trunk, and the head. We report a case of eccrine porocarcinoma on the left cheek in an 85-year-old male. In our case, the tumor was treated with wide excision and postoperative adjuvant radiation therapy. The patient recovered well without local recurrence and distant metastasis during the 14-month follow-up period. Wide excision and postoperative adjuvant radiation therapy can be considered as a safe and effective treatment option in treating patients with eccrine porocarcinoma.

Intraparotid facial nerve schwannomas.

Schwannoma is a benign tumor rarely found in the head and neck and much less commonly found in the intraparotid facial nerve. It is a slow-growing encapsulated tumor originating from the Schwann cells or axonal nerve sheath. It can occur anywhere along the course of the facial nerve. Patients may present with symptoms of facial palsy, but the most common presenting symptom is an asymptomatic swelling. Diagnosis is usually difficult before surgical removal and histopathological examination. We report a rare case of intraparotid facial nerve schwannoma in a 57-year-old female who had sustained a mass of the right preauricular area for 3 years. She reported no pain or facial muscle weakness. Enhanced computed tomography findings revealed the impression of pleomorphic adenoma. However, intraoperative gross findings were not characteristic of pleomorphic adenoma, and a frozen biopsy was performed resulting in the impression of a nerve sheath tumor. We performed an extracapsular surgical excision without parotidectomy. Permanent histopathology and immunohistochemistry reports diagnosed the mass as schwannoma. There were no complications including facial palsy after surgery. No recurrence was found at 6 months after surgery.