Won-Il Sohn

Use of split thickness plantar skin grafts in the treatment of hyperpigmented skin-grafted fingers and palms in previously burned patients

Palmar and finger burns are often seen in children, and are usually as a result of contact burns. Some patients with deep hand burns are treated with full-thickness or split-thickness skin grafts. Skin graft is commonly used for hand reconstruction. However, the grafted skin would be more pigmented than the adjacent skin and different from skin texture. 19 patients who showed hyperpigmentation after skin graft of finger and palm were treated. They all were injured by hand burns. We performed mechanical dermabrasion of the hyperpigmentation scar and application of a split thickness skin harvested from medial aspect of plantar of foot. Patients were asked about their level of satisfaction with the procedure and scar appearance was assessed using a five-point Likert scale. Also scar appearances were assessed using a Vancouver Scar Scale (VSS). The grafts were completely taken in all 19 patients. The color of the graft became similar to adjacent tissue. 15 patients were very satisfied, and four patients were relatively satisfied. The average score of the patients postoperative appearance improvement was 4.5 (improved to significantly improved postoperative appearance). Average VSS score was improved from 9.53 to 2.53. There was no hypertrophic scar on plantar donor site. The technique of the split-thickness plantar skin graft after mechanical dermabrasion is simple and provided good results in both color and texture for the patients who showed hyperpigmentation after grafting.

Intramuscular lipoma of the sternocleidomastoid muscle.

Intramuscular lipoma is a rare benign mesenchymal tumor that infiltrates the skeletal muscle. These lipomas are usually found on the extremity, but rarely occur in the head and neck. To our knowledge, only 4 cases of intramuscular lipoma in the sternocleidomastoid muscle have been reported in the literature. The recurrence rate of intramuscular lipoma is high, and it shows the pattern of infiltration to tissues, and thus different from general lipomas, its resection should include adjacent normal muscular tissues. In addition, although rare, concerning intramuscular lipoma that developed in the head and neck area, because important structures are present densely in a small space, it is important to establish a preoperative plan by determining the size and location of the tumor through preoperative clinical and radiologic tests. We had a case of intramuscular lipoma in sternocleidomastoid muscle and resected the mass completely including a portion of attached muscles. The postoperative course was uneventful, and no evidence of recurrence occurred after 6 months of follow-up.

Giant epidermal inclusion facial cyst.

Epidermal inclusion cyst is one of the most common subcutaneous tumors, and its size normally varies from 1 to 5 cm in diameter. Only few giant epidermal inclusion cysts have been reported in the literature, and giant epidermal cyst of the face has never been reported. An 83-year-old woman visited our hospital for a huge mass on the right side of her face extending to the temporal area, creating deformity of her right ear. The mass was 15 × 15 × 8 cm(3) with soft, cystic nature. It has developed since 20 years ago with no known etiology. Computed tomography scan was obtained for preoperative evaluation, which showed a 15 × 15 × 7-cm(3) huge, lobulated, and septated mass with no underlying bone or brain involvement. We performed complete excision sand biopsy. On histologic examination, the final diagnosis of epidermal inclusion cyst was made. Keratotic material was within the cyst, and the cystic wall was composed of lamellate keratin. Follow-up period was 10 months, and no signs of recurrence were seen. The patient was satisfied with the improvement of her facial appearance. We have observed a case of giant epidermal inclusion cyst of the face, which has never been reported, and present this case with a brief review of literature.

Angiomyoma in the buccal space.

Angiomyoma is a rare benign tumor originated from vascular smooth muscle cells, in other words, the tunica media, and the characteristic is the detection of numerous blood vessels together with spindle-shape smooth muscle cells. In most cases, it occurs in the subcutaneous tissue of the limbs, especially in the lower limbs, but it is very rare that it occurs in the head and neck area. In the head and neck area, it is developed most frequently in the larynx and the turbinates, and in addition, the development in the oral cavity (lip, hard palate, tonsil), nose, ear, cheek, parotid gland, and submandibular region has been reported. To the best of our knowledge, this is the first case report of angiomyoma that developed in the buccal space and some reviews of the literature.

Lymph node compression of the lesser occipital nerve: A cause of migraine

Recent investigation has focussed on the concept of peripherally triggered migraine headaches caused by compression, irritation or entrapment of the sensory nerves in the head and neck. We report a case of a 52-year-old male suffering from an occipitoparietal migraine that presented with a mass in the right occipital area. The mass was found in the deep layer of subcutaneous tissue just over the semispinalis muscle, sitting on top of the lesser occipital nerve, which was preserved through delicate dissection using loupe magnification. Histopathological findings of the mass reported benign, reactive hyperplasia of the lymph node. After removal of the mass, the patient reported complete resolution of headaches. Sensation of the scalp was not altered. This is the first report of a case of hyperplastic lymph node causing migraine through physical compression of a peripheral nerve.

Submuscular fibrolipoma of the forehead.

Fibrolipoma is a rare variant of lipoma with a mixture of fibrous connective tissue. Clinically, it presents as an asymptomatic, slowly growing mass with a smooth, firm, or soft consistency. Although fibrolipoma can occur in any part of the body, in the head region it mainly occurs in the oral cavity and sometimes in the lip, parotid gland, nose, and cheek. We present the first case of a 65-year-old man with a submuscular fibrolipoma of the forehead that showed no evidence of recurrence after excision.

Extraskeletal chondroma in the auricle.

Extraskeletal chondroma is a rare benign tumor that develops in soft tissues, and histologically, it is a lobulated nodule surrounded by a fibrous capsule, and the inside consists of mature cartilage cells and diffuse hyalinized matrix. It occurs preferentially in the hand and foot area of adults, and the development in the head and neck area is very rare. We had a very rare case of extraskeletal chondroma that developed in the auricle and report the case together with a review of the literature.

Reconstruction of fingertip defects with great toe pulp grafts.

Abstract Various methods have been used to treat fingertip defects that are caused when distal parts are amputated. In this study, we used the pulp graft harvested from the lateral aspect of the great toe. Between September 2004 and August 2006, the great toe pulp graft were performed on 16 patients. The ages of patients ranged from 4 to 58 years. The average follow-up duration was 28 months. Complete graft take was observed in 13 of 16 patients. Partial necrosis was observed in 2 patients, and total necrosis in 1 patient. The pulp graft was painless and the color and texture of the graft were similar to the adjacent skin. Semmes-Weinstein monofilament and 2-point discrimination tests showed good recovery of fingertip sense. The scar of the fingertip was assessed by Vancouver Scar Scale and Cold intolerance by Visual Analog Scale and the results were satisfactory and also improved with time. The recipient site wasclosed with little scar. There were no gait disturbances. To conclude, the great toe pulp graft can provide soft-tissue and sensory recovery in fingertip defects.

Reverse on-top plasty in mutilating hand injuries.

AbstractFor crushing injury of the hand that involves 4-digit amputations sparing the thumb, lengthening of amputated stump and covering the defect are important for hand function. From March 2007 to September 2011, the authors performed “reverse on-top plasty” in 5 patients. The fifth metacarpal bone was disarticulated, turned over 180 degrees, and embedded in reverse direction so that the metacarpal base becomes the tip of new finger. Soft tissue defects were covered using anterolateral thigh free flap or reverse radial forearm flap.The mean follow-up period was 21.2 months, and major complications such as bony resorption did not occur. Static 2-point discrimination showed fair recovery of fingertip sense. Key pinch power was 76.4% of the uninjured hand. In conclusion, reverse on-top plasty is good in gaining more sufficient finger length and durability using cartilaginous portion of the fifth metacarpal bone than the previously used on-top plasty.

Forehead abscess caused by Klebsiella oxytoca with undiagnosed type 2 diabetes.

Klebsiella is an opportunistic pathogen that is known to cause septicemia, pneumonia, urinary tract infections, hepatobiliary tract infections, and soft tissue infections in patients who have severe underlying diseases or are under immunosuppression. Most Klebsiella species found are Klebsiella pneumoniae, and Klebsiella oxytoca is rarely cultured in humans. We report a case of a 48-year-old man presenting with a soft fluctuating mass on his forehead. The lesion was an abscess, and percutaneous drainage yielded pus from which K. oxytoca was isolated. Parenteral levofloxacin was administrated leading to resolution of infection signs. Because of the rarity of the pathogen, evaluation for underlying illnesses was done, and the patient was diagnosed with type 2 diabetes mellitus. This is the first report of a patient with previously undiagnosed diabetes who was found with an extraorbital abscess caused by K. oxytoca, which we present with a review of diagnosis, pathogenesis, and treatment.