Comparison of outcomes of two methods of axillary osmidrosis surgery: Subdermal excision versus liposuction combined with diode laser ablation

Background@#Patients with axillary osmidrosis suffer from a foul odor due to the bacterial decomposition of apocrine gland secretions. This condition is stressful, especially for teenaged students and young working people in Korea, who seek a reliable method for reducing odor that allows them to quickly return to school or work after surgery. Thus, surgeons must seek ways to effectively remove sweat glands with minimal complications. The conventional subdermal excision method has been widely used for the removal of sweat glands, but it can have many complications. The purpose of this study is to determine whether liposuction combined with diode laser ablation is effective for sweat gland removal compared with the subdermal excision method. @*Methods@#From 2011 to 2017, we compared two surgical methods for osmidrosis: subdermal excision and liposuction combined with diode laser ablation. An objective analysis of sweat (apocrine) gland count, determined by histopathological examinations of preoperative and postoperative punch biopsy specimens, was combined with a subjective assessment of patients’ symptoms (malodor grade) preoperatively and postoperatively. @*Results@#A larger percentage of sweat glands were removed by subdermal excision than by liposuction with diode laser ablation. However, no statistically significant difference was found between the two methods with regard to the percentage of apocrine glands removed. Liposuction with diode laser ablation had fewer perioperative complications and higher patient postoperative satisfaction than subdermal excision. @*Conclusions@#Liposuction with diode laser ablation is a useful method for axillary osmidrosis surgery in teenaged students and young working people in Korea.

The periareolar excision technique for improved scars in breast burns

Regardless of size or severity, post-burn breast scars can be traumatic for patients. There are various approaches to post-burn scar management, but herein we present the results of a novel approach in which we tried to remove the scars in an early stage of treatment. Breast burn patients, whose wound area included the nipple-areolar complex, were treated using a periareolar incision design similar to that of periareolar reduction mammoplasty. The remnant scar was located only along the periareolar complex. As a result, more cosmetically satisfactory results were achieved compared to skin grafting or local flap procedures.

Frontonasal dysplasia: A case report

Frontonasal dysplasia is an uncommon congenital anomaly with diverse clinical phenotypes and highly variable clinical characteristics, including hypertelorism, a broad nasal root, median facial cleft, a missing or underdeveloped nasal tip, and a widow's peak hairline. Frontonasal dysplasia is mostly inherited and caused by the ALX genes (ALX1, ALX3, and ALX4). We report a rare case of a frontonasal dysplasia patient with mild hypertelorism, a broad nasal root, an underdeveloped nasal tip, an accessory nasal tag, and a widow's peak. We used soft tissue re-draping to achieve aesthetic improvements.

Peroneal Artery Perforator Free Flap on the Palm and Removal of Back Foreign Body in High Voltage Electrical Burn Patient: A Case Report

Early Debridement and Cultured Allogenic Keratinocyte Dressing Prevent Hypertrophic Scarring in Infants with Deep Dermal Burns

BACKGROUND: Deep dermal burns are frequently treated with excision and skin grafting. Otherwise, wound healing may take up to 4 to 6 weeks, with serious scarring. Especially in pediatric patients, post-burn scarring could result in psychologic trauma and functional disability. We aimed to investigate the efficacy of early debridement and dressing using cultured allogenic keratinocytes in infants with deep dermal burns to prevent hypertrophic scarring. METHODS: From April 2016 to April 2018, 18 infants were treated for deep dermal burns. Except for 5 infants who underwent skin grafting or excision, 13 infants were included in this study. We performed early debridement in these patients using Versajet™ and serial dressings using Kaloderm®. RESULTS: The average operative date was 8.3 days after the accident. The mean healing time was 18.3 days after the accident. The patients did not experience any contraction, but 3 patients had hyperpigmentation, 2 patients had mild hypertrophic scarring, and 1 patient had mixed pigmentation (hyperpigmentation and hypopigmentation). CONCLUSIONS: Our prophylactic scar therapy, using early debridement with Versajet™ and dressings with Kaloderm®, may be beneficial for infants with dermal burns. This method was able to shorten the healing time, resulting in better scar outcomes. Our follow-up findings revealed that the scars had an aesthetically pleasing appearance and patients were able to perform normal activities without restrictions.

Are More Low-Risk Prostate Cancers Detected by Repeated Biopsy? A Retrospective Pilot Study

PURPOSE: We hypothesized that there might be a higher incidence of low-risk prostate cancer (PCa) in men diagnosed at a repeated biopsy. Thus, we investigated differences in clinicopathological results of PCa after primary and repeated biopsy. MATERIALS AND METHODS: We retrospectively reviewed patients diagnosed with PCa at a primary or repeated biopsy from January 2004 to April 2011. Patients were stratified into primary biopsy and repeated biopsy groups. We analyzed prostate-specific antigen, clinical stage, Gleason score (GS), positive core ratio, and low-risk group by using D'Amico classification. We also investigated GS upgrading and upstaging after radical prostatectomy (RP). RESULTS: Among 448 primary and 37 repeated biopsy PCa patients, 82 (group 1) and 25 (group 2) underwent RP. The percentage of low-risk patients did not differ significantly between the groups. The positive biopsy core ratio was significantly lower in group 2 (p=0.009). The percentages of GS upgrading and upstaging were 42.7% and 47.6% in group 1, respectively (p=0.568), and 48.0% and 52.0% in group 2, respectively (p=0.901). In the analysis of low-risk patients, GS upgrading and upstaging were not significantly different between the groups (p=0.615 and p=0.959, respectively). CONCLUSIONS: A lower positive core ratio may imply a small volume of PCa and possibly insignificant PCa in the repeated biopsy group. However, no significant differences were observed for the ratio of low-risk cancers, GS upgrading, or upstaging between the groups. Therefore, PCa diagnosed at a repeated biopsy is not an additional indication for active surveillance.

Small (<4 cm), Unclassified Renal Cell Carcinoma Presenting with Initial Bone Metastasis: A Case of a Metastatic Lesion Missed at the Initial Diagnosis

A 49-year-old man presented with an incidentally detected right renal mass on a health examination. The abdominal computed tomography and magnetic resonance imaging showed a 3-cm right renal mass suspected of being a hypovascular tumor, such as papillary renal cell carcinoma, and an osteoblastic metastatic lesion on the right iliac bone. However, we missed a bone lesion at the time of diagnosis. A laparoscopic radical nephrectomy was performed and the final pathology confirmed unclassified renal cell carcinoma. The follow-up imaging studies showed several neck lymph nodes and multiple bone metastases at the lumbar spine, right iliac bone, and left femur. Thirteen cycles of temsirolimus were administered to the patient, but follow-up positron emission tomography showed newly developed liver and left adrenal metastasis and increased bone metastasis. It is important to note that T1a renal cell carcinoma can present with distant metastasis and thus demands scrupulous examination even though the tumor size may be small.