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ABSTRACT: INTRODUCTION: The ulnar forearm flap has been performed by many authors for the reconstruction of finger injuries. This article describes the refinement of the perforator anatomy based on ulnar artery and presents our clinical experience using ulnar artery perforator free flap for finger resurfacing. METHODS: An anatomical study conducted in 10 cadaver forearms demonstrated the consistent origin of the ulnar perforator from the ulnar artery 40 mm proximal to the pisiform. The diameter of the artery was 0.9mm and the average length of the perforator from the skin to the origin of ulnar artery was 20mm. Based on this anatomic knowledge, 5 patients underwent ulnar artery perforator flap operations for finger resurfacing. RESULTS: All flaps survived without complication, and the patients were satisfied with the aesthetic and function outcome. DISCUSSION: The ulnar artery perforator flap is thin and pliable and provides nonhairy skin with color and texture matches. In addition, it is a simple and fast procedure with a reliable and constant blood supply. The ulnar artery perforator flap could be an alternative for the resurfacing of finger defects.
Annals of plastic surgery 03/2013; · 1.29 Impact Factor
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ABSTRACT: BACKGROUND: Nasal bone fracture is the most common traumatic disease among facial bone fractures. General treatment of this trauma is closed reduction, followed by intranasal packing. Vaseline or Furacin roll gauze, and Merocel are commonly used packing materials, but the pain produced while removing the packing is fearful for the patients. To compensate for this shortcoming, there has been an increased use of biodegradable synthetic polyurethane foam (SPF) recently. We performed a retrospective review to analyze the effectiveness of SPF after the closed reduction of nasal bone fracture. PATIENTS AND METHODS: A retrospective review was conducted in 109 patients who underwent closed reduction for pure nasal bone fracture. One group was packed with Furacin roll gauze and the other was packed with SPF. Postoperative pain, hemostatic effect, supporting ability on the fractured segment, and healing of the injured nasal mucosa were compared between the 2 groups. RESULTS: A total of 109 patients were reviewed, with 61 patients packed with Furacin roll gauze (group A) and 48 patients packed with SPF (group B). Between the 2 groups, only visual analogue scale of pain at postoperative fourth day was statistically low in group B (P = 0.045) with other parameters showing no statistical difference. DISCUSSION: Nasal packing after closed reduction of nasal bone fractures support the reduced fractured bony segment and also has the main role on hemostasis and healing of mucosal injury. Removal of the packing is painful and fearful to the patients. SPF as nasal packing material provides superior outcome in terms of pain and satisfaction and, at the same time, is not inferior to the conventional packing materials with regard to bleeding control, mucosal wound healing, toxicity, and stability of reduced fracture segment.
The Journal of craniofacial surgery 11/2012; · 0.81 Impact Factor
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ABSTRACT: Pott puffy tumor is defined as a forehead-localized swelling with overlying subperiosteal abscess and osteomyelitis of the frontal bone. It is an uncommon disease entity and more rarely reported with its frontocutaneous fistula. We report the unusual case of Pott puffy tumor appearing with a frontocutaneous fistula. We performed a frontal sinus surgery using a combined endonasal and percutaneous approach and frontal bone reconstruction with a resorbable mesh plate and bone cement. During a follow-up 1 year after the surgery, there was no recurrence, and we achieved excellent result from the aesthetic point of view.
The Journal of craniofacial surgery 03/2012; 23(2):e158-60. · 0.81 Impact Factor
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ABSTRACT: Fibroma of tendon sheath is a rare benign tumor that usually occurs in upper extremities. It is mostly asymptomatic and grows slowly within the tendons or tendon sheaths. Histopathologic findings show well-demarcated nodules consisting of haphazardly arranged fibroblast-like spindle cells, which are embedded in a dense, collagenous matrix. We present a patient with fibroma of the tendon sheath on the flexor hallucis longus tendon, which was in an unusual location and has never been reported. The lesion was completely excised and showed no evidence of recurrence after 2 years of follow-up.
The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 02/2012; 51(3):342-4.
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ABSTRACT: Complications of fingertip injury include pain, hyper- or dyssensitivity, cold intolerance, and fingertip atrophy. Especially in cases of soft-tissue defect or atrophy which result from crushing injury, fingertip pain often occurs when a finger touches the objects. To overcome this problem, several techniques including local flaps or free flaps were suggested. But these methods require intricate and multistaged procedures.Twelve patients who had fingertip pain with pulp atrophy were treated with pulp graft between March 2004 and March 2006. Under the local anesthesia, we made a fish-mouth incision at the most prominent portion of fingertip and elevated volar flaps. Composite tissue was harvested from the lateral aspect of great toe, and inserted between the previously elevated volar flaps. The harvested composite pulp tissue contained about 3- to 5-mm thick fat layer. Moisture dressing was performed. The visual analogue scale (VAS) was used to evaluate the degree of pain postoperatively. The follow-up period was in the range between the 12 and 24 months (average, 19 months). Pre- and postoperative differences in VAS scores were analyzed for statistical significance, using the Wilcoxon rank sum test. In addition, patients were asked about their level of satisfaction with the procedure. To evaluate the postoperative sensation of the graft, we performed the Semmes-Weinstein monofilament test, and static and dynamic 2-point discrimination test at 1 year postoperatively.The size of the graft was ranged from 276 mm (12 × 23 mm) to 750 mm (25 × 30 mm). At final follow-up review, 5 patients were very satisfied and 7 were satisfied. Atrophy of the fingertip was also improved. Fingertip pain reduced from 8.5 preoperative to 3.1 postoperative on VAS. These improvements were statistically significant. Semmes-Weinstein monofilament test was green (∼2.83) in 9 patients (75%) and blue (3.22-3.61) in 3 of 12 patients (25%). Static and dynamic 2-point discrimination test results came out as 6 and 5 mm, respectively.Composite graft applied to the fingertip is a simple technique, and gives few complications. This procedure can be performed under local anesthesia and gives a fairly high degree of satisfaction to patients. We believe this method is useful for treating fingertip pain with atrophy of pulp.
Annals of plastic surgery 07/2011; 67(1):25-9. · 1.29 Impact Factor
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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.
Annals of plastic surgery 05/2011; 68(6):579-82. · 1.29 Impact Factor
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ABSTRACT: 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.
Journal of Plastic Reconstructive & Aesthetic Surgery 05/2011; 64(12):1657-60. · 1.49 Impact Factor
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ABSTRACT: 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.
The Journal of craniofacial surgery 05/2011; 22(3):1149-51. · 0.81 Impact Factor
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ABSTRACT: An absorbable plating system is most commonly used to fix the bones in craniomaxillofacial surgery. Many studies focused on the advantages and clinical utility of absorbable plate and screws, but there are no reports on the complications related to these devices. From March 2004 to March 2009, 430 patients with facial bone fractures including infraorbital rim fractures underwent craniomaxillofacial surgery, in which rigid fixation was achieved with an absorbable plate and screws (Stryker, Freiburg, Germany). Five men with a delayed inflammatory reaction and infection at infraorbital rim fracture site were reviewed. Their mean age was 39 (range, 18-53 y), and all patients had maxillary sinusitis. The period from surgery to the onset of symptoms ranged from 3 to 10 weeks with a mean of 5 weeks. One patient was managed with oral antibiotics, but the other 4 patients required incisional drainage with the removal of the plate and screws because of abscess formation. The patients' symptom improved after removing the absorbable plate and screws and saline irrigation, and there was no recurrence of infection during the 12-month follow-up period. When fixing infraorbital fractures, particularly in patients with sinusitis, it is recommended to use short screws to prevent penetration of the maxillary sinus wall. In particular, one should pay attention and use shorter screws owing to the thinness of the medial infraorbital rim.
The Journal of craniofacial surgery 03/2011; 22(2):625-7. · 0.81 Impact Factor
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ABSTRACT: 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.
Burns: journal of the International Society for Burn Injuries 02/2011; 37(4):714-20. · 1.95 Impact Factor
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ABSTRACT: 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.
The Journal of craniofacial surgery 11/2010; 21(6):1990-1. · 0.81 Impact Factor
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ABSTRACT: 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.
The Journal of craniofacial surgery 11/2010; 21(6):1993-4. · 0.81 Impact Factor
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ABSTRACT: 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.
The Journal of craniofacial surgery 11/2010; 21(6):1976-8. · 0.81 Impact Factor
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ABSTRACT: 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.
The Journal of craniofacial surgery 09/2010; 21(5):1634-5. · 0.81 Impact Factor
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ABSTRACT: Histologically, nodular fasciitis is observed as similar to sarcoma in soft tissues, and it is referred to as pseudosarcomatous fasciitis. Its histologic findings can be summarized as spindle-shaped fibroblasts, intercellular space between fibroblasts, red blood cells released to the extravascular area, and deposition of mucus within the interstitium. The lesion looks similar to sarcoma histologically and shows the characteristic of rapid growth, which in result is readily misdiagnosed as malignancy. It occurs preferentially in the upper extremities, whereas rarely occurring in the head and neck region. When we encounter subcutaneous nodules of the head and neck region, it is important to keep nodular fasciitis in mind as a differential diagnosis to avoid unnecessary wide resection. In this article, we report a rare case of nodular fasciitis on the forehead and some reviews of the literature.
The Journal of craniofacial surgery 05/2010; 21(3):925-6. · 0.81 Impact Factor
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ABSTRACT: Human adipose-derived mesenchymal stem cells (MSCs) were differentiated into chondrogenic MSCs, and fibrin glue was used together to explore the feasibility of whether cartilages can be generated in vivo by injecting the differentiated cells. Mesenchymal stem cells extracted from human adipose were differentiated into chondrogenic MSCs, and such differentiated cells mixed with fibrin glue were injected subcutaneously into the back of the nude mouse. In addition to visual evaluation of the tissues formed after 4, 8, and 12 weeks, hematoxylin-eosin staining, Masson trichrome staining, measurement of glycosaminoglycan concentration using dimethylmethylene blue, agreecan through reverse transcriptase-polymerase chain reaction, type II collagen, and expression of SOX-9 were verified. Moreover, the results were compared with 2 groups of controls: 1 control group that received only injection of chondrogenic-differentiated MSC and the supporting control group that received only fibrin glue injection. For the experimental group, cartilage-like tissues were formed after 4, 8, and 12 weeks. Formation of cartilage tissues was not observed in any of 4, 8, and 12 weeks of the control group. The supporting control group had only a small structure formation after 4 weeks, but the formed structure was completely decomposed by the 8th and 12th weeks. The range of staining dramatically increased with time at 4, 8, and 12 weeks in Masson trichrome staining. The concentration of glycosaminoglycan also increased with time. The increased level was statistically significant with more than 3 times more after 8 weeks compared with 4 weeks and more than 2 times more after 12 weeks compared with 8 weeks. Also, in reverse transcriptase-polymerase chain reaction at 4, 8, and 12 weeks, all results expressed a cartilage-specific gene called aggrecan, type II collagen, and SOX-9. The study verified that the chondrogenic-differentiated MSCs derived from human adipose tissues with fibrin glue can proliferate and form new cartilage. Our findings suggest that formation of cartilages in vivo is possible.
The Journal of craniofacial surgery 03/2010; 21(2):468-72. · 0.81 Impact Factor
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ABSTRACT: Recently, a case of deep-lobe lipoma with enucleation was reported, but frozen-section biopsy for the confirmation of the malignancy was not done. It has been suggested that lipoma in the deeper tissues should be regarded as a well-differentiated liposarcoma and be treated with wide excision. Our experience is that of a 75-year-old woman who had a mass with fat density in the deep lobe of the right parotid gland, which extended through the parapharyngeal and the buccal spaces. Lumpectomy with frozen-section biopsy was performed, not only preserving branches of facial nerve but also ruling out the malignancy. Frozen-section biopsy showed a lipomatous lesion without malignancy, so further treatment such as total parotidectomy was not needed.
The Journal of craniofacial surgery 09/2009; 20(5):1601-2. · 0.81 Impact Factor
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The Journal of hand surgery, European volume. 07/2009; 34(3):400-1.
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ABSTRACT: 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.
The Journal of craniofacial surgery 06/2009; 20(3):951-2. · 0.81 Impact Factor
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ABSTRACT: 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.
The Journal of craniofacial surgery 05/2009; 20(3):822-4. · 0.81 Impact Factor
