Paik-Kwon Lee

Gluteal fold V-Y advancement flap for vulvar and vaginal reconstruction: a new flap.

Background: Soft-tissue reconstruction following vulvar cancer resection is a difficult challenge because of the functional, locational, and cosmetic importance of this region. Although numerous flaps have been designed for vulvar reconstruction, each has its disadvantages. Methods: The authors introduce the gluteal fold fasciocutaneous V-Y advancement flap for vulvovaginoperineal reconstruction after vulva cancer resection. This flap is supplied by underlying fascial plexus derived from perforators of the internal pudendal artery and musculocutaneous perforators of underlying muscle. The sensory supply of this flap comes from the posterior cutaneous nerve of the thigh and the pudendal nerve. An axis of V-shaped triangular flap is aligned to the gluteal fold. A total of 17 flaps were performed in nine patients. Results: All flaps survived completely, with no complications except for small perineal wound disruption in three patients. Conclusions: This flap is thin, reliable, sensate, easy to perform, and has matched local skin quality and concealed donor-site scar on the gluteal fold. In addition, it can cover large vulvovaginal defects because it can be advanced farther as a result of the character of the gluteal fold area. In our experience, the gluteal fold fasciocutaneous V-Y advancement flap has proven very useful for vulvar reconstruction, especially at the point of donor-site scar, flap thickness, and degree of flap advancement.

Capsular Flaps for the Management of Malpositioned Implants After Augmentation Mammoplasty

Among the reasons for reoperation after augmentation mammaplasty is the malpositioned implant, especially a lowered inframammary fold or symmastia, which is difficult to repair. The peri-implant capsule, a physiologic response to a foreign body, is naturally formed and suitable for use as a flap because of its high vascularity. In addition, it is sufficiently tough for suspension of the implant. The authors introduce the idea that the capsular flap is very useful for the correction of symmastia or a lowered inframammary fold. In such situations, the capsular flaps are used to prevent migration of the implant after raising of the inframammary fold or defining of the midline with capsulorrhaphy. This technique successfully corrected the malpositioned implants in this study, and all the patients were satisfied. There was no recurrence of a lowered inframammary fold or symmastia. These findings suggest that the capsular flap should be considered a safe and effective option for the management of malpositioned implants.

Simple Epicanthoplasty with Minimal Scar

BackgroundAsian eyelids are characterized by the presence of an epicanthal fold and the absence of a supratarsal fold. Because many Asians desire wide, open, large eyes, elimination of the medial epicanthal fold along with double-eyelid operation frequently are performed for cosmetic improvement. Medial epicanthoplasty enhances the aesthetic result by lengthening the palpebral fissure horizontally, thus producing larger-looking, open eyes. This study describes the author’s method for correcting the medial epicanthal fold.MethodsSimple epicanthoplasty with minimal scar, the author’s method, was performed to correct the epicanthal folds of 52 patients from December 2001 to August 2005 at the Catholic University of Korea Kangnam St. Mary’s Hospital.ResultsThis technique yielded excellent results in terms of inconspicuous scar and long-lasting open medial canthal area during a 3-year follow-up period. Of the 52 patients, 2 showed a depressed scar on the lower eyelid, which was corrected satisfactorily.ConclusionMany procedures have been introduced to correct the epicanthal fold, but scarring or undercorrection remains as a dilemma for surgeons to overcome. Simple epicanthoplasty with minimal scar is a simple, easy-to-follow, and effective method that can be applied to various cases of medial epicanthal fold.

Unusally Huge Metastatic Cutaneous Renal Cell Carcinoma to the Right Buttock: Case Report and Review of the Literature

Jung-Ho Lee, MD, Paik-Kwon Lee, MD, PHD, Sang-Tae Ahn, MD, PHD, Deuk-Young Oh, MD, Jong-Won Rhie, MD, PHD, and Ki-Taik Han, MD, PHD, have indicated no significant interest with commercial supporters.