Tumoral Calcinosis of the Index Finger: A Case Report

Tumoral calcinosis is a type of idiopathic calcinosis cutis which usually occurs around the large joints due to deposition of calcium phosphate, but extremely rare in the fingers which has been reported less than 20 cases in the literature. When it occurs on the fingers, it shows almost normal skin appearance and no specific symptoms except localized tenderness and numbness, therefore it is difficult to differential diagnosis among other common tumors on the fingers. In most cases surgical excision is performed before final diagnosis, and it is easy to misdiagnosis. The patient had mass like lesion which is enlarging for last 2 years at the radial side of the second finger without any trauma history. We prediagnosed the tumoral calcinosis with the simple radiologic test and laboratory tests and performed surgical excision without recurrence. So we report a case of tumoral calcinosis of the radial side of the second finger with brief review of the literature.

Anatomical Characteristics and Surgical Treatments of Pincer Nail Deformity

BACKGROUND: Pincer nail deformity is a transverse overcurvature of the nail. This study aimed to define the anatomical characteristics of pincer nail deformity and to evaluate the surgical outcomes. METHODS: A retrospective review was conducted on 20 cases of pincer nail deformity of the great toe. Thirty subjects without pincer nail deformity or history of trauma of the feet were selected as the control group. Width and height indices were calculated, and interphalangeal angles and base widths of the distal phalanx were measured with radiography. We chose the surgical treatment methods considering perfusion-related factors such as age, diabetes mellitus, kidney disease, and peripheral vascular disease. The zigzag nail bed flap method (n=9) and the inverted T incision method (n=11) were used to repair deformities. The outcomes were evaluated 6 months after surgery. RESULTS: The interphalangeal angle was significantly greater in the preoperative patient group (14.0degrees+/-3.6degrees) than in the control group (7.9degrees+/-3.0degrees) (P<0.05). The postoperative width and height indices were very close to the measurements in the control group, and most patients were satisfied with the outcomes. CONCLUSIONS: We believe that the width and height indices are useful for evaluating the deformity and outcomes of surgical treatments. We used two different surgical methods for the two patient groups with respect to the perfusion-related factors and found that the outcomes were all satisfactory. Consequently, we recommend taking into consideration the circulatory condition of the foot when deciding upon the surgical method for pincer nail deformity.

Epidemiology of Burns in Korea from 2010 to 2014

PURPOSE: The epidemiology of burns in Korea has been sporadically reported in the treatis based on data from one burn center or hospital. The nationwide epidemiological study for burns in the Korea is scarce. It is necessary to establish the national medical plan for providing the specialized burn care for burn victims, burn prevention and burn safety for publics. METHODS: This study is done based on the burn patients data receiving medical treatment, from the Korea National Health Insurance Service during 2010~2014. We reviewed the following issues; the average annual burn incidence, and tendency of burn occurrence in every year, sex distribution of burn patients, the yearly numbers of pediatric burn patients, incidence of specific-age pediatric burn patients, incidence of burns by specific-age group, and prevalent sites of burns. RESULTS: 1) The average annual burn patient is 545,462 in 2010~2014. The average annual incidence of burn patients per 100,000 population is 1,091. The total annual numbers of burn patient is gradually increasing in tendency. 2) Male and female sex ratio is 39 (the mean 214,832 male burn patients per year): 61 (the mean 330,630 female burn patients per year). 3) The average pediatric burn patient (1~15 age) is 123,934 and it consists of 22.7% of the average annual burn patients during 2010~2014. 4) The most prevalent age of pediatric burns revealed at the age of 1 (21.7%). The incidence of burn patients of 1~2 age occupy 38.4% of the total pediatric burn patients. 5) The four age group-specific burn incidence are classified as pediatric group (0~15 age) 22.7% (123,934 patients), adolescence-middle age group (16~39 age) 32.3% (176,288 patients), middle-old age group (40~74 age) 41.9% (228,427 patients), super old age group (over 75) 3.1% (16,813 patients). 6) The mean yearly burn sites was 567,200. Among them, the most prevalent site of burn was hand (32.8%), and followed by upper extremities (13.5%), lower extremities (13.4%), face (10.5%), foot (10.1%), trunk (6.6%). the unspecified area and etc (13%), respiratory tract (0.1%). CONCLUSION: Based on the data from the Korea National Health Insurance Service, the average annual burn incidence is mean 545,462 burn patients during 2010~2014 in Korea, and revealed increasing in tendency. This epidemiological data can be attribute to providing the specialized burn care to domestic burn victims, and to establish the plans for burn prediction and prevention, and burn safety.

Lower Lid Orbicularis Oculi Myocutaneous Transposition Flap for Orbital Radiation Induced Scars

PURPOSE: Reconstruction for post-radiation scar on periorbital area including upper eyelid takes consider of eyelid function and cosmetic results. It is a challenging procedure to reconstruct the severe radiation induced scars deformities on face around the orbital area in terms of its complicated anatomy and restoration of cosmetic social function. The authors report a reconstruction case of radiation induced severe facial deformities with scars including upper lid and periorbital area using evidence based plastic surgical techniques such as newly designed lower lid orbicularis oculi myocutaneous transposition flap, lateral canthopexy, skin graft, composite graft, fat graft, acellular dermal matrix graft, Z-plasty focusing on cosmetic and functional result. METHODS: A 18 year-old female patient had right upper facial deformities caused by radiation induced wide scars around the right periorbital, upper lid and temporal area after treatment for hemangioma at age of 1. She also showed right facial palsy on forehead, and hypoplasia of left ala nasi. The patient suffered from skin atrophy, wide scar formation, scar contractures on right periorbital area, severe lagophthalmos on right eye, right frontal facial palsy, and small hypoplastic left ala nasi. At the first operation, release of scars and full thickness skin graft, reposition of asymmetric right eyebrow caused by facial palsy using Z-plasty, correction of temporal depression using acellular dermal matrix (AlloDerm(R)) graft, and auricular composite graft for left ala nasi reconstruction were performed. And after 4 months follow-up, the second operations were performed including lower orbicularis oculi muscle transposition flap for upper lid lagophthalmos, lateral canthopexy, and fat graft. RESULTS: Lower lid orbicularis oculi muscle transposition flap and all grafts were successfully survived. After 3 weeks follow-up, she showed good looking facial appearance and facial symmetry, and there were no complications. CONCLUSION: For post-radiation facial scar reconstruction, it showed a better cosmetic outcome using flap transfer rather than skin graft. The newly designed lower eyelid orbicularis oculi muscle transposition flap, canthopexy, fat graft give a good result for reconstruction of radiation induced scars of upper eyelid and periorbital deformities.

Analysis of the Development of the Nasal Septum and Measurement of the Harvestable Septal Cartilage in Koreans Using Three-Dimensional Facial Bone Computed Tomography Scanning

BACKGROUND: The septal cartilage is the most useful donor site for autologous cartilage graft material in rhinoplasty. For successful nasal surgery, it is necessary to understand the developmental process of the nasal septum and to predict the amount of harvestable septal cartilage before surgery. METHODS: One hundred twenty-three Korean patients who underwent three-dimensional (3D) facial bone computed tomography (CT) were selected for evaluation of the midsagittal view of the nasal septum. Multiple parameters such as the area of each component of the nasal septum and the amount of harvestable septal cartilage were measured using Digimizer software. RESULTS: The area of the total nasal septum showed rapid growth until the teenage years, but thereafter no significant change throughout the lifetime. However, the development of the septal cartilage showed a gradual decline due to ossification changes with aging after puberty in spite of a lack of change in the total septal area. The area of harvestable septal cartilage in young adults was 549.84+/-151.26 mm2 and decreased thereafter with age. CONCLUSIONS: A 3D facial bone CT scan can provide valuable information on the septal cartilage graft before rhinoplasty. Considering the developmental process of the septal cartilage identified in this study, septal surgery should not be performed until puberty due to the risk of nasal growth impairment. Furthermore, in elderly patients who show a decreased cartilage area due to ossification changes, septal cartilage harvesting should be performed carefully due to the risk of saddle nose deformity.