Eun Young Rha

Morel-lavallee lesion in children.

Morel-Lavallee lesion (MLL) is a closed degloving injury resulting from blunt shearing or tangential forces. In this condition, hemolymph is collected in the closed space between the separated subcutaneous tissue and the underlying fascia. The clinical manifestation of MLL varies from soft fluctuant swelling to skin necrosis or wound sepsis. Due to its inconsistent clinical manifestations and delayed onset, it is rarely described. We present a case of a 28-month-old child who developed delayed MLL arising from pelvic fracture after a motor vehicle accident. In addition, we provide a review of MLL and describe rare cases of it in children.

Accuracy of the method for estimating breast volume on three-dimensional simulated magnetic resonance imaging scans in breast reconstruction.

Background: The authors have developed a simple and intuitive method for measuring breast volume based on three-dimensional simulated images of magnetic resonance imaging scans to accurately estimate breast volume before breast reconstruction. Methods: The authors performed a retrospective review of the medical records of 18 patients (20 breasts) who had undergone breast reconstruction at Yeouido St. Mary’s Hospital from March of 2009 to July of 2012. All of the patients underwent preoperative assessment of breast volume with two methods: a plaster cast maneuver and a three-dimensional simulated magnetic resonance imaging scan. To determine the accuracy of each method, the authors compared the mastectomy volume with the plaster cast maneuver and with three-dimensional simulated magnetic resonance imaging. Results: In the authors’ series, the mean values of the plaster cast maneuver, three-dimensional simulated magnetic resonance imaging, and mastectomy volume were 433.85 ± 176.65 ml, 529 ± 193.33 ml, and 495.25 ± 192.45 ml, respectively. In addition, the mean error between the plaster cast maneuver and mastectomy volume was 137.4 ± 97.66 ml and that between three-dimensional simulated magnetic resonance imaging and mastectomy volume was 54.63 ± 46.30 ml. From a linear regression curve, the correlation coefficient (r2) of the plaster cast maneuver was 0.629 (p = 0.003) and that of three-dimensional simulated magnetic resonance imaging was 0.945 (p < 0.001). Conclusions: The authors’ method for preoperatively measuring breast volume on three-dimensional simulated magnetic resonance imaging scans was both efficient and accurate. It would therefore be useful for achieving better aesthetic outcomes of breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.

One-stage nipple and breast reconstruction following areola-sparing mastectomy.

Background Skin-sparing mastectomy with immediate breast reconstruction is increasingly becoming a proven surgical option for early-stage breast cancer patients. Areola-sparing mastectomy (ASM) has also recently become a popular procedure. The purpose of this article is to investigate the reconstructive and aesthetic issues experienced with one-stage nipple and breast reconstruction using ASM. Methods Among the patients who underwent mastectomy between March 2008 and March 2010, 5 women with a low probability of nipple-areolar complex malignant involvement underwent ASM and immediate breast reconstruction with simultaneous nipple reconstruction using the modified C-V flap. The cosmetic outcomes of this series were reviewed by plastic surgeons and patient self-assessment and satisfaction were assessed via telephone interview. Results During the average 11-month follow-up period, there were no cases of cancer recurrence, the aesthetic outcomes were graded as excellent to very good, and all of the patients were satisfied. Two patients developed a gutter-like depression around the reconstructed nipple, and one patient developed skin erosion in a small area of the areola, which healed with conservative dressing. The other complications, such as necrosis of the skin flap or areola, seroma, hematoma, or fat necrosis did not occur. Conclusions Since one-stage nipple and breast reconstruction following ASM is an oncologically safe, cost-effective, and aesthetically satisfactory procedure, it is a good surgical option for early breast cancer patients.

Volume Measurement of Various Tissues Using the Image J Software.

Various methods have been introduced to assess the tissue volume because volumetric evaluation is recognized as one of the most important steps in reconstructive surgery. Advanced volume measurement methods proposed recently use three-dimensional images. They are convenient but have drawbacks such as requiring expensive equipment and volume-analysis software. The authors devised a volume measurement method using the Image J software, which is in the public domain and does not require specific devices or software packages. The orbital and breast volumes were measured by our method using Image J data from facial computed tomography (CT) and breast magnetic resonance imaging (MRI). The authors obtained the final volume results, which were similar to the known volume values. The authors propose here a cost-effective, simple, and easily accessible volume measurement method using the Image J software.

Posttraumatic delayed cranio-orbital cerebrospinal fluid leakage: Case report

A 56-year-old man sustained subarachnoid haemorrhage, skull base fracture and multiple facial fractures in a traffic accident. Two weeks later, the patient developed a subperiosteal fluid collection into the orbit of the right side presenting with a progressive proptosis and an increased intraocular pressure. We performed drainage of the fluid on the superior part of the right orbit, followed by a surgical reduction of the facial fractures. The patient had no exophthalmos any longer, whose intraocular pressure was normalised. In conclusion, our case indicates that careful monitoring of clinical signs and a follow-up radiography would be mandatory for patients with craniocerebral trauma despite a lack of the definite symptoms. Clinicians should consider the possibility that the cerebrospinal fluid (CSF) leakage into the orbit might occur in these patients.

Palliative 5‐fluorouracil and cisplatin chemotherapy in recurrent metastatic sebaceous carcinoma: Case report and literature review

Sebaceous carcinoma is a rare malignant tumor of the skin. Although this tumor is not completely understood due to its rarity and the paucity of published reports, it is known to be an aggressive tumor with a high incidence in Asia. Sebaceous carcinomas occur preferentially in the periocular region and require attention not to miss the associated Muir–Torre syndrome. In the case of localized disease, a wide local excision with clear margin followed by adjuvant radiation therapy is usually considered the standard treatment strategy but there is no agreed treatment strategy or standard chemotherapeutic regimen for recurrent metastatic sebaceous carcinoma. We report here two cases of recurrent metastatic sebaceous carcinoma patients who responded to 5‐fluorouracil and cisplatin combination chemotherapy, and review the literature. We suggest that 5‐fluorouracil‐cisplatin can be considered a feasible and effective treatment modality for recurrent sebaceous carcinoma.

Emerging Fixation Technique to Prevent Pectus Bar Displacement: Needlescope-Assisted 3-Point Fixation

BACKGROUND Bar flipping displacement is one of the most common complications after the Nuss procedure for pectus excavatum. We evaluated the results of a modified Nuss procedure with needlescope-assisted bar fixation. METHODS The records of 41 patients with pectus excavatum who underwent single pectus bar insertion with the Nuss procedure between July 2011 and August 2014 were retrospectively reviewed. The patients were divided into two groups: those who did not undergo 3-point fixation (group A) and those who did undergo 3-point fixation (group B). RESULTS There were 36 male patients and 5 female patients with a mean age of 10.7 ± 8.3 years (range: 3-36 years). The postoperative Haller index (HI) (2.61 ± 0.42) was significantly lower than the preoperative HI (3.91 ± 1.07; p < 0.01). The angle of the initial bar position was 5.59 ± 7.37 degrees in group A and 8.52 ± 9.61 degrees in group B, with no significant difference between the groups (p > 0.05). The rate of reoperation to correct bar displacement was lower in group B (3.3%) than in group A (9.1%). CONCLUSION Needlescope-assisted 3-point fixation of the bar was performed without an additional skin incision and showed a low rate of reoperation to correct displacement of the pectus bar.

Bioabsorbable plates and screws fixation in mandible fractures: clinical retrospective research during a 10-year period.

AbstractWe present the basic guidelines for the safe fixation of a mandible fracture using a bioabsorbable system with less strength than the metallic system based on our 10 years of experience.We conducted a retrospective review of 75 patients who had undergone fixation using a bioabsorbable system for a mandible fracture. We analyzed the method of fixation and the size and thickness of the plates and screws that were selected depending on the mandible’s fracture site.Minor complications including intraoral wound disruptions and infections occurred in 12 (16%) patients, and 2 (2.7%) patients among 10 patients who presented with infections had nonunion; therefore, they underwent replacement of the absorbable system with the titanium system. Bone resorption that was caused by the absorbable plate occurred in 12 (16%) patients.The bioabsorbable system also may be able to replace the metallic system in the fixation of comminuted mandible fractures if further research on the development of the system is supported.

Squamous Cell Carcinoma on the Upper Lip of a Patient with Discoid Lupus Erythematosus

Discoid lupus erythematosus (DLE) is a chronic autoimmune mucocutaneous disease with an unknown etiology. Typically, central atrophy, small white keratinized plaques with elevated borders, and telangiectasia are seen in patients with DLE. Lesions are found on the oral cavity in 20% of patients with DLE, and upper lip involvement occurs in less than 3% of the oral cavity lesions [1,2]. Squamous cell carcinoma (SCC) developing in a lesion of DLE is very rare, and is extremely rare on the upper lip [2]. A 49-year-old male patient with a recurrent oral ulcer had been diagnosed with DLE 9 years earlier. Multiple recurrent crusted ulcerative plaques had developed along the upper lip vermillion 7 years earlier. A protruding mass lesion had occurred at the right upper lip 1 year before presentation to our institution, and a wedge resection of the lesion was performed promptly. The lesion was confirmed to be verruca vulgaris. On serial follow-up, the fast growing mass that was confirmed as SCC in the left upper lip had a concurrently expending crusted lesion, which was confirmed to be keratoacanthoma in the right upper lip. The affected area of the carcinoma was about 4.0×2.2 cm, horizontally occupying about 70% of the upper lip, and vertically occupying 80% (Fig. 1). Several enlarged lymph nodes of both submental areas were found using preoperative magnetic resonance imaging. A full thickness defect of 5.5×2.5 cm had developed after a wide excision, and bilateral functional cervical lymph node dissection was performed by the head and neck surgery team (Fig. 2). Fig. 1 Photograph of a 49-year-old male discoid lupus erythematosus patient. A 4.0×2.2 cm squamous cell carcinoma on the left upper lip (red arrow) and keratoacanthoma on the right upper lip (blue arrow). Fig. 2 Photograph of the lip defect after wide excision of the squamous cell carcinoma. A near-total upper lip defect developed, and the flap was designed on the left side first. A bilateral nasolabial orbicularis oris myocutaneous flap was designed and elevated adjacent to both sides of the upper lip defect, along the course of the angular vessel and the remaining orbicularis oris muscle. The near-total upper lip defect was covered successfully by rotation and advancement of the island flap. The remaining mucosal defect was covered with a full-thickness skin graft from triangularly shaped skin, which was located on the lateral side of the alar base (Fig. 3). Fig. 3 Photograph after elevation of the bilateral flaps. The bilateral flap was elevated with a suture placed on the orbicularis oris muscle. A full-thickness skin graft (black arrow-head) from triangularly shaped skin, which was located on the lateral side ... There were no significant postoperative complications. Oral competence was excellent and sensation was preserved. There was no microstomia, and the patient was satisfied with the results (Fig. 4). Fig. 4 Photograph at postoperative 2 weeks. Oral competence was excellent, and there was no symptom of microstomia. SCC is a rare complication of long-standing DLE. The overall incidence of SCC in DLE has been reported to be 3.3% [1]. The lower lip has been the most commonly affected area in DLE and DLE-related malignant transformation, while the upper lip has been affected in 2.3% of DLE-related SCC [1,2]. It has been reported that ultraviolet irradiation, chronic infection, scars, and long-term immunosuppressive status are possible predisposing factors for the development of SCC in DLE [1-4]. The diagnosis of SCC can be clinically suggestive, but it is essential for SCC to be histologically confirmed. Asanafi and Werth [4] suggested that a diagnosis should only be made after repeated biopsies and careful reevaluation of the course of a specific lesion in relationship to the lupus skin lesions in a patient because differentiating between hypertrophic DLE and SCC can be difficult both clinically and histologically. Our patient was also histologically diagnosed with verruca vulgaris before diagnosis of SCC. DLE-related SCCs have been observed to be more aggressive than conventional SCCs [1]. The recurrence, metastasis, and mortality rates were 10% to 20% higher than that of non-DLE-related SCCs [3]. Therefore, aggressive therapy is warranted, and a near-total upper lip defect is an inevitable consequence. The reconstructive method for the upper lip should be chosen in consideration of the orbicularis sphincter function and aesthetic outcomes. Considering these factors, the nasolabial orbicularis oris myocutaneous island flap [5] was a suitable choice for our patient. The known advantages of this flap are an easy design with a wide range of coverage ability, a good color, texture match, and thickness of the skin, maintenance of symmetry, and balance of the lip and commissures [5]. The scars in our patient were inconspicuous due to their locations over the borders of the natural esthetic subunits and also because of the migrated new mustache that developed. We report a rare case of SCC arising from DLE, involving the upper lip. A bilateral nasolabial orbicularis oris myocutaneous island flap is a readily available flap for total upper lip reconstruction.

Topical Application of a Silicone Gel Sheet with Verapamil Microparticles in a Rabbit Model of Hypertrophic Scar.

Background: The authors developed a novel treatment based on the topical application of a silicone gel sheet containing verapamil microparticles. The ability of these silicone gel sheets to inhibit hypertrophic scar in a rabbit ear wound model was examined. Methods: Ten New Zealand White rabbits with a total of 80 wounds in both ears were used in this study. The rabbits were divided into five groups (control; silicone gel sheet; and silicone gel sheet plus 0.25, 2.5, and 25 mg of verapamil per gram). Histopathologic findings were quantified. Results: The mean scar elevation index, fibroblast counts, and capillary counts differed significantly among the five groups (p < 0.05). The median scar elevation index was significantly lower in the silicone gel sheet plus 2.5 mg of verapamil per gram group than in the silicone gel sheet group (1.2 versus 2.2). The median number of fibroblasts was significantly lower in the silicone gel sheet plus 0.25 mg of verapamil per gram group than in the silicone gel sheet group (172.5 versus 243). In the median number of capillary lumina, there was no significant difference between the silicone gel sheet group and the silicone gel sheet plus 0.25, 2.5, and 25 mg of verapamil per gram groups (28.5, 18, 20, and 18, respectively). Conclusion: Topical application of a silicone gel sheet with verapamil microparticles may be a novel, effective treatment method for hypertrophic scar, but its safety and efficacy in humans must be tested in clinical trials.