Reconstruction of a temporal scalp defect without ipsilateral donor vessel possibilities using a local transposition flap and a latissimus dorsi free flap anastomosed to the contralateral side: a case report

Scalp defects necessitate diverse approaches for successful reconstruction, taking into account factors such as defect size, surrounding tissue, and recipient vessel quality. This case report presents a challenging scenario involving a temporal scalp defect where ipsilateral recipient vessels were unavailable. The defect was effectively reconstructed utilizing a transposition flap and a latissimus dorsi free flap, which was anastomosed to the contralateral recipient vessels. Our report underscores the successful reconstruction of a scalp defect in the absence of ipsilateral recipient vessels, emphasizing the importance of employing appropriate surgical interventions without necessitating vessel grafts.

Application of tenotomy on Korean native cattle (Hanwoo) with spastic paresis symptoms in the field

Bovine spastic paresis (BSP) is a neuromuscular disorder characterized by hypertension and stiffness of hindlimb. Two Korean native cattle (Hanwoo) calves developed BSP or BSP-like symptoms, and a tenotomy of superficial tendon of medial head and deep tendon of lateral head of gastrocnemius muscle was performed for treatment. A cast was applied postoperatively to prevent muscle rupture and was removed three weeks later. The prognosis was evaluated at 3 weeks, 6 and 18 months postoperatively. Neither calf showed any other postoperative sequelae. This is the first case study to report the diagnosis, treatment, and prognosis of BSP in Hanwoo.

Preliminary results of alternative treatment for postmastectomy pain syndrome: stromal vascular fraction-enriched fat grafting

Postmastectomy pain syndrome (PMPS) is defined as chronic pain lasting more than 3 months after surgery. PMPS reduces the quality of life for patients and affects their daily life. Although the pathogenesis of PMPS has not been clearly elucidated, it is strongly suggestive of neuropathic pain caused by damage to the intercostobrachial nerve. While previous studies have used stromal vascular fraction (SVF)-enriched fat grafts in patients with neuralgia, few studies have used it for PMPS. Therefore, the present study evaluated the use of SVF-enriched fat, which includes adipose-derived stem cells with good differentiation capacity, in patients with PMPS to improve quality of life and reduce neuropathic pain. In three patients, the fat was mixed with concentrated SVF using a centrifuge and injected into the primary pain sites. After surgery, in all three cases, the subjective pain scale score decreased significantly over time.

Breast implant-associated anaplastic large cell lymphoma: a case report with a history of spontaneously resolved late seroma

We report a case of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), which had a history of spontaneous resorption of late seroma before diagnosis. A 47-year-old woman with a history of augmentation mammoplasty with round textured implants in January 2013 presented with a swelling on her right breast 6 years later, which was diagnosed as late seroma with suspected intracapsular rupture using ultrasonography (USG). Although aspiration was not done at the time of the initial USG, the seroma resolved spontaneously within weeks. A further workup proceeded with USG-guided aspiration followed by magnetic resonance imaging. Cytology of the aspirated fluid showed atypical cells. Cell block cytology and immunohistochemical staining confirmed the diagnosis of BIA-ALCL. En bloc resection with total capsulectomy and explantation was performed as curative surgery. Pathologic stage pT2N0M0 was confirmed and the patient was followed up without further treatment. Although the classic presentation of BIA-ALCL is known as late persistent seroma, an atypical manifestation such as spontaneous resorption may occur, as in the current case. A high level of suspicion and a thorough investigation with appropriate modalities will make it possible to detect this rare and potentially devastating disease.

Outcomes of saline implant-based immediate breast reconstruction: 15-year follow-up results

Background@#Although rarely used at present in South Korea, saline implants accounted for most of the implants used from 1992 to 2007. However, few studies have reported on the long-term outcomes of saline implants, especially in breast reconstruction. We analyzed the long-term outcomes of patients who underwent direct-to-saline implant reconstruction. @*Methods@#This retrospective study included patients who underwent saline implant-based immediate breast reconstruction between 2003 and 2007. The patients’ demographic information, medical history, operative/implant details, and oncologic data were collected. Early and late complications, reoperations, and final outcomes of the implant (maintenance, explantation, exchange, and autologous conversion) were analyzed to determine the long-term results and to identify factors affecting the outcomes. @*Results@#Early complications (within 90 days) were noted in 19.5% of patients and late complications (after 90 days) occurred in 29.3% of patients. The most common early complications were skin necrosis and delayed healing, whereas the most common late complications were rippling or visibility and capsular contracture. Of the implants, 22% were replaced (12%) or converted to autologous tissue (10%). The factors that influenced the final outcomes were patient age, nipple-areola-sparing procedure, breast size, implant fill volume, and implant manufacturer. @*Conclusions@#Patients who previously received saline implants still visit the clinic for consultations. This long-term follow-up study with few dropouts reflects the real needs of reconstruction patients. Our results provide useful information for consulting with patients who already have saline implants or those who request for as much information about available implant options as possible.

Psychological characteristics of adult neurofibromatosis type 1 patients seeking elective surgery

Background@#Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder involving the nervous system characterized by the development of neurofibromas throughout the body. Patients with NF1 are also known to have cognitive, behavioral, social, and emotional problems. Using the Symptom Checklist-90-Revision (SCL-90-R) questionnaire, we aimed to assess the psychological characteristics of NF1 patients seeking surgery at a tertiary hospital. @*Methods@#Adult NF1 patients visiting a plastic surgery outpatient clinic between March 2018 and March 2020 were enrolled in this study. The presence and intensity of psychopathological symptoms were assessed using 10 domains, including the General Severity Index (GSI). Standard T-scores were used to compare the results to population-based norms. The impact of demographic factors was also analyzed. @*Results@#In total, 65 patients were included in the study. The mean GSI of all patients was 43.7, and the mean score of the other nine domains was 45.3. No scores deviated from the population-based normal ranges. Nonetheless, women had significantly higher mean T-scores than men in a few domains, including the GSI, obsessive-compulsive disorder, depression, and anxiety. Most of the other characteristics, such as age, education, marital status, family history, and tumor site did not have significant effects. @*Conclusions@#Adult NF1 patients who visit plastic surgery clinics for elective surgery have psychopathological characteristics that do not differ from the general population according to the SCL-90-R. The results of this study can be considered in consultations with these patients.

An alternative method to create a breast mound after tissue expander insertion: The modified Goldilocks technique

With the recent increase in reported cases of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), fears of breast implants have increased. In particular, some patients now desire expander removal without implant insertion. In the case described herein, a 41-year-old female patient who had undergone a skin-sparing mastectomy with expander insertion due to breast cancer requested expander removal due to fear of BIA-ALCL during expansion. The authors modified the Goldilocks technique to prevent a chest wall deformity due to expansion. The expanded skin was sufficiently thick, as it was engrafted with acellular dermal matrix, and some of it was de-epithelized and rolled in. The patient’s chest wall depression was completely corrected and an acceptable breast mound was created. To summarize, this technique was used to correct a chest wall deformity and to form a breast mound in a patient who underwent expander removal without implant insertion.

Single vertical incision thoracoabdominal flap for chest wall reconstruction following mastectomy of locally advanced breast cancer

PURPOSE: Skin grafts have been widely used in managing extensive chest wall defects after mastectomy for advanced breast cancer. However, their durability and tolerability to radiotherapy is still controversial. A thoracoabdominal (TA) flap with a few technical refinements can safely transfer a larger flap while minimizing complications. METHODS: From January 2007 to February 2018, a retrospective review was performed to compare 2 groups after wide breast excision: skin graft group (group 1) and lateral-based, single vertical incision rotation-advancement TA flap (group 2). Patients' demographics, operative details, complications, hospital stay, postoperative outpatient visits, cost, and start of adjuvant therapy were analyzed between the 2 groups. RESULTS: During the study period, 34 patients received skin graft and 41 patients received TA flap. group 2 had a shorter hospital stay (6.41 ± 2.64 days vs. 12.62 ± 4.60 days, P 1 year was observed in 4 patients in only group 1 (43.90% vs. 38.24%, P = 0.613). CONCLUSION: TA flap has a simple design that minimizes concerns involving the donor site. Moreover, it does not require complicated procedures and allows for re-elevation whenever necessary. Finally, it guarantees faster wound recovery than skin graft with fewer complications.

Response to Letter: Upper eyelid platinum weight placement for the treatment of paralytic lagophthalmos: A new plane between the inner septum and the levator aponeurosis

No abstract available.

Treatment of Abdominal Wall Endometriosis Using a Mini-Abdominoplasty Design

Abdominal wall endometriosis is a condition in which functioning endometrial tissue is present outside the uterine cavity, and the standard treatment is extensive surgical excision. A 46-year-old woman presented with an irregular lower abdominal mass measuring 8.5×4.5 cm. The patient had a history of a cesarean delivery 15 years previously. For treatment, a mini-abdominoplasty was designed to avoid possible wound complications and to optimize the cosmetic outcomes. The lesion was excised with an adequate margin because of the possibility of recurrence. The resected structures were the lower mid-abdominal skin, subcutaneous fat, anterior and posterior rectus sheath, and rectus abdominis muscle. The incisional wound was closed layer by layer, including abdominal fascia repair with acellular dermal matrix. At a 3-month postoperative outpatient follow-up visit, the patient was highly satisfied with the cosmetic results and reported no complications. Optimal oncological, functional, and cosmetic surgical outcomes can be achieved by complete excision followed by mini-abdominoplasty.

Upper eyelid platinum weight placement for the treatment of paralytic lagophthalmos: A new plane between the inner septum and the levator aponeurosis

BACKGROUND: The most common surgical treatment for paralytic lagophthalmos is the placement of a weight implant in the upper eyelid; however, this technique confers the risks of implant visibility, implant extrusion, and entropion. In this study, we present a new technique of placing platinum weight implants between the levator aponeurosis and inner septum to decrease such complications. METHODS: A total of 37 patients with paralytic lagophthalmos were treated between March 2014 and January 2017 with platinum weight placement (mean follow-up, 520.1 days). After dissecting through the orbicularis oculi muscle, the tarsal plate and levator aponeurosis were exposed. The platinum weights (1.0–1.4 g) were fixed to the upper margin of the tarsal plate and placed underneath the orbital septum. RESULTS: Five patients could partially close their eye after surgery. The average distance between the upper eyelid and the lower eyelid when the eyes were closed was 1.12 mm. The rest of the patients were able to close their eye completely. Three patients patient developed allergic conjunctivitis after platinum weight insertion, which was managed with medication. None of the patients complained of discomfort in the upper eyelid after surgery. Visibility or extrusion of the implant were observed in three patients. CONCLUSIONS: Postseptal weight placement is a safe and reproducible method in both primary and secondary upper eyelid surgery for patients with paralytic lagophthalmos. It is a feasible method for preventing implant visibility, implant exposure, and entropion. Moreover, platinum is a better implant material than gold because of its smaller size and greater thinness.