Yong Chan Bae

Analysis of Frequency of Use of Different Scar Assessment Scales Based on the Scar Condition and Treatment Method

Analysis of scars in various conditions is essential, but no consensus had been reached on the scar assessment scale to select for a given condition. We reviewed papers to determine the scar assessment scale selected depending on the scar condition and treatment method. We searched PubMed for articles published since 2000 with the contents of the scar evaluation using a scar assessment scale with a Journal Citation Report impact factor >0.5. Among them, 96 articles that conducted a scar evaluation using a scar assessment scale were reviewed and analyzed. The scar assessment scales were identified and organized by various criteria. Among the types of scar assessment scales, the Patient and Observer Scar Assessment Scale (POSAS) was found to be the most frequently used scale. As for the assessment of newly developed operative scars, the POSAS was most used. Meanwhile, for categories depending on the treatment methods for preexisting scars, the Vancouver Scar Scale (VSS) was used in 6 studies following a laser treatment, the POSAS was used in 7 studies following surgical treatment, and the POSAS was used in 7 studies following a conservative treatment. Within the 12 categories of scar status, the VSS showed the highest frequency in 6 categories and the POSAS showed the highest frequency in the other 6 categories. According to our reviews, the POSAS and VSS are the most frequently used scar assessment scales. In the future, an optimal, universal scar scoring system is needed in order to better evaluate and treat pathologic scarring.

A Skin Fixation Method for Decreasing the Influence of Wound Contraction on Wound Healing in a Rat Model

Background The elasticity of the back skin of the rat reduced the tension around wounds during the wound healing process in that region, and thus activates wound contraction. The authors proposed two skin fixation methods using readily available materials to decrease the influence of wound contraction on wound healing and designed an experiment to determine their effects. Methods The authors made 36 skin wounds on the backs of 18 rats, and they divided them into three groups. Each group was treated with three different kinds of dressing materials, each with different skin fixing characteristics. Group A was a control group. Group B and group C were dressed by the first and the second skin fixation method. We measured the areas of the wounds post-surgically and calculated the wound area reduction rates. Results The two skin fixation methods both reduced the effect of wound contraction compared to the control group. Each of the two methods had different outcomes in reducing wound contraction. Conclusions The experiment demonstrated significant differences among the wound areas and the wound area reduction rates of the three groups as a result of differences in the degree of wound contraction. To obtain accurate results from wound healing experiments, appropriate skin fixation methods must be adopted.

Postoperative Speech Outcomes and Complications in Submucous Cleft Palate Patients

Background The postoperative speech outcomes of submucous cleft palate (SMCP) surgery are known to be poorer than those of other types of cleft palate. We attempted to objectively characterize the postoperative complications and speech outcomes of the surgical treatment of SMCP through a comparison with the outcomes of incomplete cleft palate (ICP). Methods This study included 53 SMCP patients and 285 ICP patients who underwent surgical repair from 1998 to 2015. The average age of the patients at the time of surgery was 3.9±1.9 years for the SMCP patients and 1.3±0.9 years for the ICP patients. A retrospective analysis was performed of the complications, the frequency of subsequent surgical correction for velopharyngeal dysfunction (VPD), and speech outcomes. Results In both the SMCP and ICP patients, no cases of respiratory difficulty, bleeding, or wound disruption were noted. Delayed wound healing and fistula occurred in 18.9% and 5.7% of the SMCP patients and in 14% and 3.2% of the ICP patients, respectively. However, no statistically significant difference in either delayed wound healing or fistula occurrence was observed between the two groups. The rate of surgical correction for VPD in the SMCP group was higher than in the ICP group. In the subset of 26 SMCP patients and 62 ICP patients who underwent speech evaluation, the median speech score value was 58.8 in the SMCP group and 66 in the ICP group, which was a statistically significant difference. Conclusions SMCP and ICP were found to have similar complication rates, but SMCP had significantly worse speech outcomes.

Effects of human adipose-derived stem cells and stromal vascular fraction on cryopreserved fat transfer.

BACKGROUND The use of cryopreserved adipose tissue for soft tissue augmentation is common, but unpredictability of fat graft viability remains a limitation. Adipose-derived stem cell (ADSC) and stromal vascular fraction (SVF) have been introduced to enhance viability and improve the survival of transplanted fat tissue. OBJECTIVE To investigate whether supplementation with ADSC or SVF improved the survival of cryopreserved fat grafts. METHODS The cryopreserved fat grafts were treated with ADSC, SVF, or normal saline in 30 six-week-old male nude mice to test whether ADSC and SVF could improve the survival of the transplanted fat tissue. The authors examined the weight, volume, and histological features of each group (n = 10) at 8 weeks after transplantation to evaluate the survival of the fat tissue. RESULTS There was no difference between the control and SVF groups with respect to weight, volume, and histological findings. However, the ADSC group showed a significant increase in weight and volume compared with the control and SVF groups. Histological examination showed that the ADSC supplementation improved the quality of the transplanted fat grafts. CONCLUSION Taken together, these results suggest a potential clinical utility of ADSC but no advantage of SVF in facilitating cryopreserved fat transfer.

Impact of Disturbed Wound Healing after Surgery on the Prognosis of Marjolin’s Ulcer

Background Marjolins ulcer is known to present a high proportion of recurrence and poor prognosis compared to other kinds of skin cancer. Based on our experience, Marjolins ulcer patients who have received reconstructive surgery present a higher proportion of recurrence when there was disturbed wound healing after surgery. The impact of disturbed wound healing after surgery on the prognosis was examined in this study. Methods A retrospective study was carried out on 26 patients who were diagnosed with Marjolins ulcer and received surgery in this hospital from 1996 to 2011. Histologic grading, lymph node metastasis at diagnosis, and the wound healing process were evaluated and chi-squared analysis applied in order to determine the correlation with recurrence. Results The proportion of recurrence increases in patients with a low histologic grade or lymph node metastasis at diagnosis. The proportion of recurrence is even higher when the problem occurs during the wound healing process after surgery. Conclusions Disturbed wound healing after surgery could be used as a sign to quickly identify the recurrence of carcinoma. Therefore, in the event a problem occurs in the wound healing process after surgery, one should keep in mind that this could be a sign of the possibility of recurrence and proceed with careful observation and active diagnosis through additional physical examinations, general X-ray tests, computed tomographys, magnetic resonance imagings, and so on, to obtain an early diagnosis of recurrence.

Lower lip reconstruction after wide excision of a malignancy with barrel-shaped excision or the webster modification of the bernard operation.

Background Because there are numerous methods for reconstruction of the lower lip, it is not easy to choose the optimal method. In choosing the surgical method for lower lip reconstruction, we obtained acceptable outcomes based on our treatment strategy, which included either a barrel-shaped excision or the Webster modification of the Bernard operation. We report on the surgical outcomes based on our treatment strategy. Methods This study included 26 patients who underwent lower lip reconstructive surgery from September 1996 to September 2010. The operation was done using either a barrel-shaped excision or the Webster modification, considering the location of the defect, the size of the defect, and the amount of residual tissue on the lateral side of the vermilion after excision. Results In our series, 3 patients underwent a single barrel-shaped excision, and nine patients underwent a double barrel-shaped excision. In addition, the unilateral Webster modification was performed on in 6 patients, and there were eight cases of bilateral Webster modification. All of the patients except one were satisfied with the postoperative shape of the lip. In one case both recurrence and dehiscence occurred. One patient had a good postoperative lip shape, but had difficulty wearing a denture, and also underwent commissuroplasty. Furthermore, there were two patients who complained of drooling, and 4 with paresthesia. Conclusions A soft tissue defect resulting from wide excision of a lower lip malignancy can be successfully reconstructed using only one of two surgical methods: the barrel-shaped excision or the Webster modification of the Bernard operation.

Outcomes of Surgical Treatment of Vascular Anomalies on the Vermilion

Background The vermilion plays an important role in both the aesthetic and functional aspects of facial anatomy. Due to its structural features, the complete excision of vascular anomalies on the vermilion is challenging, making it difficult to determine the appropriate treatment strategy. Thus, the authors analyzed the results of surgical treatment of vascular anomalies on the vermilion. Methods The medical records of 38 patients with vascular anomalies on the vermilion who underwent surgery from 1995 to 2013 were analyzed. Nine of the cases had an involuted hemangioma, and 29 cases had a vascular malformation; of the vascular malformations, 13, 11, one, and four cases involved were capillary malformations (CMs), venous malformations (VMs), lymphatic malformations (LMs), and arteriovenous malformations (AVMs), respectively. We investigated the surgical methods used to treat these patients, the quantity of surgical procedures, complications and instances of recurrence, and self-assessed satisfaction scores. Results A total of 50 operations were carried out: 28 horizontal partial excisions, eight vertical partial excisions, and 14 operations using other surgical methods. All cases of AVM underwent complete excision. Six cases experienced minor complications and one case of recurrence was observed. The overall average satisfaction score was 4.1 out of 5, while the satisfaction scores associated with each lesion type were 4.2 for hemangiomas, 3.9 for CMs, 4.2 for VMs, 5.0 for LMs, and 4.0 for AVMs. Conclusions It is difficult to completely excise vascular anomalies that involve the vermilion. This study suggests that partial excision focused on correcting the overall contour of the lips is effective and leads to satisfactory results.

The Usefulness of Surgical Treatment in Slow-Flow Vascular Malformation Patients.

Background Many difficulties exist in establishing a treatment plan for slow-flow vascular malformation (SFVM). In particular, little research has been conducted on the surgical treatment of SFVMs. Thus, we investigated what proportion of SFVM patients were candidates for surgical treatment in clinical practice and how useful surgical treatment was in those patients. Methods This study included 109 SFVM patients who received care at the authors’ clinic from 2007 to 2015. We classified the patients as operable or non-operable, and analyzed whether the operability and the extent of the excision varied according to the subtype and location of the SFVM. Additionally, we investigated complications and self-assessed satisfaction scores. Results Of the 109 SFVM patients, 59 (54%) were operable, while 50 (46%) were nonoperable. Total excision could be performed in 44% of the operable SFVM patients. Lymphatic malformations were frequently non-operable, while capillary malformations were relatively operable (P=0.042). Total excision of venous malformations could generally be performed, while lymphatic malformations and combined vascular malformations generally could only undergo partial excision (P=0.048). Complications occurred in 11% of the SFVM patients who underwent surgery; these were minor complications, except for 1 case. The average overall satisfaction score was 4.19 out of 5. Conclusions Based on many years of experience, we found that approximately half (54%) of SFVM patients were able to undergo surgery, and around half (44%) of those patients were able to fully recover after a total excision. Among the patients who underwent surgical treatment, high satisfaction was found overall and relatively few complications were reported.

Usefulness of Microfat Grafting in Patients With Repaired Cleft Lip

AbstractIn many patients, the volume of the upper lip is deficient after cleft lip repair operation. However, there is no well-established procedure to correct this volume deficiency. In the present study, the authors attempted to increase the overall three-dimensional volume of the upper lip in repaired cleft lip patients with upper lip volume deficiency through autogenous microfat grafting. Thirty patients with upper lip volume deficiency after cleft lip repair underwent fat grafting in the upper lip from November 2007 to March 2015. Among these patients, postoperative outcome was evaluated in 15 patients using 2 methods for the evaluation. One method involved measuring the change in the shape of lips using pre- and postoperative photographs, and the other involved investigating the levels of satisfaction with the surgical results by distributing a scoring questionnaire to patients, doctors, and the general public. The ratio of upper lip protrusion relative to the lower lip increased by 46.71% on average after operation, and the sum of the vermilion heights increased by 31.68% on average. In the survey of satisfaction levels, patients, plastic surgeons, and the general public gave mean scores of 3.80, 3.91, and 4.03, respectively. When volume deficiency of the upper lip is present in repaired cleft lip patients, correction using autogenous microfat grafting is believed to be effective.

Characteristics and Treatment of Cutaneous Melanoma of the Foot

Background In East Asia, the foot is the most common site of cutaneous melanoma. The purpose of this study was to investigate the differences between cutaneous melanoma of the foot and melanomas of other sites. Methods We studied 52 patients who underwent surgical treatment for cutaneous melanoma of the foot from September 2000 to January 2015. Through a retrospective review of their medical records, we collected data relating to their sex, age, histopathological subtype, Clark level, tumor thickness, lymph node involvement, stage, and survival rate, and we compared these parameters to those of 61 patients treated for melanoma of other sites. Moreover, we analyzed the surgical procedures, complications, and mortality rates associated with cutaneous melanoma on various parts of the foot. Results Melanoma of the foot differed from other melanomas only in the histopathological subtype. Other clinical features, including survival rate, did not differ significantly between the two groups heel was the most common site of melanoma of the foot (22 cases, 42.3%). The method of reconstruction varied depending on the region involved. Conclusions A comparison of melanoma of the foot to other melanomas showed that melanoma of the foot was associated with a significantly different distribution of histological subtypes. Consistent with previous findings, we found that the acral lentiginous subtype was the most common among melanomas of the foot. Furthermore, in contrast with previous studies, we did not find a worse prognosis or lower survival rate for melanoma of the foot in comparison with other melanomas.