Young-Min Yim

Reconstruction of scalp defect after Moyamoya disease surgery using an occipital pedicle V-Y advancement flap.

Scalp necrosis is an infrequent complication of Moyamoya disease surgery, which is more prevalent in the parietotemporal area. Because scalp vascularity is severely compromised after Moyamoya disease surgery, reconstruction of defects with local scalp tissue is challenging. To cover defects, a flap is needed that is highly vascularized and has great mobility and territory to avoid existing scars. After tracing ipsilateral occipital artery, an advancement flap that was based on occipital artery and vein was designed to fit the defect. The flap was elevated in the subperiosteal layer and advanced without tension to cover the defect. Occipital pedicle V-Y advancement flaps were used in 7 patients who had scalp necrosis of the parietotemporal area and a mean defect size of 8.7 cm2. There were no complications such as flap necrosis, infection, or recurrence of defect in all patients during 9-month follow-up. Occipital pedicle V-Y advancement flap is a useful alternative flap for scalp defects after surgical treatments that compromise scalp vascularity, such as Moyamoya disease surgery.

Symmetric Lipofibromatous Hamartoma Affecting Digital Nerves

Lipofibromatous hamartoma of the nerve is a benign tumor, which affects the major nerves and their branches in the human body. It is often found in the median nerve of the hand and is commonly associated with macrodactyly, but it is rarely found in the digital nerves at the peripheral level. This tumor is often found in young adults and may go through a self-limiting course. However, operation is indicated when the tumor size is large or when the associated nerve compressive symptoms are present. We have experienced a rare case of lipofibromatous hamartoma that symmetrically involved the volar digital nerves of both index fingers on the ulnar side. With the aid of a microscope, we dissected and removed the tumor as much as possible without sacrificing the nerve. No sensory change occurred in both fingers and no sign of recurrence was observed upon follow-up.

Fibrolipoma of the tip of the nose.

Fibrolipoma is a rare benign tumor that usually presents as an asymptomatic, slowly growing mass with a firm or soft consistency clinically. Histopathologic findings show the proliferation of normal mature fat and fibrous tissue. We report a first case of the fibrolipoma of the nasal tip in a 24-year-old man. The lesion was totally excised and showed no evidence of recurrence after 6 months of follow-up.

Multiple huge epidermal inclusion cysts mistaken as neurofibromatosis.

Epidermal inclusion cyst is one of the common benign soft tissue tumors, and it can be easily confirmed and treated by surgical excision. We experienced a patient who had multiple masses on the face and scalp region, and the masses had been misdiagnosed as neurofibromatosis because of accompanying mental retardation. We would like to introduce a case of clinical diagnosis error caused by the lack of radiologic evaluation and pathologic confirmation. A 27-year-old male patient visited with multiple masses, with a length of approximately 1 to 10 cm on the face and scalp region. These mass have developed since childhood without known etiology, and there has been no histologic examination or surgical excision done in the past. The patients history of seizure disorder and mental retardation led the primary clinician to diagnose it as neurofibromatosis in the initial stage, and therefore, the clinician gave an advice on the possibility of frequent recurrence to the patient. As the masses increased in size, the patient came to our hospital after all. We found that the masses were soft and mobile through the physical examination, and magnetic resonance imaging showed evidence of epidermal inclusion cyst, which is distinguished from neurofibromatosis. Based on physical examination and magnetic resonance imaging, we performed total excision and biopsies. On the histologic examination, it was diagnosed as an epidermal inclusion cyst showing keratotic material internally, and the cyst wall was composed of lamellate keratin. The follow-up period was 12 months, and a recurrence has not occurred. The wound was healed without any specific complication, and both the patient and the guardian were satisfied with the physical enhancement. We have observed a misdiagnosed case that was misconceived by the situation, accompanying mental retardation. Due to this misconception, any surgical treatment was not performed at all, and the symptoms eventually worsened as multiple huge epidermal inclusion cysts. We present this case with a brief review of literature.

Pleomorphic adenoma in the auricle.

Pleomorphic adenoma (PA) is a rare tumor of the skin that may arise from either the apocrine or the eccrine glands. Only 4 cases of PA in the auricle have been reported. We experienced the case of a 40-year-old woman who had a slowly growing, nontender auricle mass for 3 years. Under a clinical diagnosis of an epidermal inclusion cyst, we performed a total excision of the tumor with the skin and with direct closure. No recurrence was found during the 18 months of postoperative follow-up. Histologic examination confirmed a diagnosis of PA. Hematoxylin-eosin stain showed tubules that were lined with 2 layers of epithelial cells. The stroma was composed of the myxoid and chondroid matrices. Immunohistochemical staining was positive for cytokeratin, epithelial membrane antigen, and gross cystic disease fluid protein, whereas it was negative for S-100 and carcinoembryonic antigen. These findings suggested that this tumor originated from the apocrine glands. Only a few cases of PA in the auricle have been reported in the literature, 2 of which occurred in the helical rim. Recurrence is rare if there is complete resection of the tumor along with the surrounding capsule. We report herein a rare case of PA that developed in the auricle.

Pulse oximeter probe-induced electrical burn

The idea of a letter to the editor in response to a published article is essentially to evoke an immediate response of the authors and the readers. Although there is no uniform policy on the duration or the time limit for these response letters (letter to the editor), most of the journals entertain responses to the articles published in the journal during a stipulated time frame that usually varies from 2 weeks to 6 months. Probably because many times unduly delayed response may not bring the desired result. Two recently published articles by Rao and Menezes in the category ‘letter to the editor’ in the journal ‘BURNS’ as a response to articles published as old as 3–5 years [1,2], hence appeared surprising. Although the duration or the time limit for such response letters (letter to the editor) to be entertained by a journal office is debatable. The journal of ‘BURNS’ strategy of accepting the response letters, even if late, is appreciable as such delayed response letters are also likely to evoke some response [3–5]. It speaks highly about the liberal, encouraging and ‘better late than never’ policy of the journal in this regard.

V-Y-Z Plasty for correcting cryptotia

ryptotia is a congenital defect in which the upper pole of the ar cartilage is buried beneath the scalp of the temporoparital area and the superior auriculocephalic sulcus is absent. here is a coexisting deformity of the cartilage with a severely urved superior crus of the antihelix. The most commonly sed technique for repair is the local flap combined with corection of the cartilage. For local flaps, the Z-plasty, V-Y rocedure, rotational flap, transposition flap, or subcutaneous edicled flap can be used.1–5 Because of deficient superior and posterior skin coverge, recurrence could often be a problem, so it is important o provide enough skin. When we use the V-Y procedures, we can provide enough tissue, but there is a possibility of a dog ear and retroauricular sulcus deficiency. We have therefore done V-Y procedures together with a Z-plasty in conjunction (V-Y-Z plasty) to correct cryptotia and so have overcome these defects (Fig. 1). By modifying Kubo’s method we have created a triangular flap on the temporal scalp and skin over the auricle. The anterior edge of the triangular flap ends on the anterior skin part of the concealed superior helix. The posterior edge of the flap has remained in the mastoid area 2 to 3 cm posterior to the posterior auricular sulcus and ends in the middle of the auricle. The Z-plasty was designed as the peripheral rim taking into account the

Successful replantation of an amputated earlobe by microvascular anastomosis.

In the microsurgical area, replantation of ear amputation by microvascular anastomosis is considered to be the best method in terms of texture, color, and shape. Only a few cases of successful ear replantation with microvascular anastomosis have been reported because the size of the vessels is very small, and identifying appropriate vessels for anastomosis is difficult. Furthermore, most cases were total or subtotal (upper two thirds of the ear) amputations, and they were successfully reconstructed by replantation.To the best of our knowledge, this is the first case of a patient with ear lobe avulsion who underwent successful replantation by single arterial anastomosis. We report our case with a brief review of the literature.