The quality of the recipient vessel is critical for good outcomes after microsurgical breast reconstruction, and damage to the recipient vessels should be minimized. Radiation therapy (RTx) and chemotherapy (CTx) are widely used as adjuvant treatments for breast cancer. They may result in changes in recipient vessels for microsurgical breast reconstruction. Therefore, in this study, we evaluated the changes in recipient vessels for breast reconstruction after adjuvant treatment for breast cancers. Overall, 167 patients with unilateral breast cancer who underwent surgical resection between 2017 and 2021 were selected. Notably, 33 of these patients received only mastectomy without adjuvant treatment (Group A), 44 received only adjuvant RTx (Group B), 43 received only adjuvant CTx (Group C), 47 patients received both adjuvant CTx and RTx (Group D). Using preoperative and postoperative computed tomography (CT) angiography, the vessel diameters of the thoracodorsal artery (TDA) and the internal mammary artery (IMA) on the affected and unaffected sides were measured, and differences in vessel diameters between the two sides and characteristics of each group were analyzed. The diameter of affected vessels (TDA and IMA) significantly decreased in groups B and D compared with the changes in vessel diameters on the unaffected side (p < 0.001). However, there was no significant difference in the diameter of vessels in groups A and C (Group A: p = 0.644, Group B: p = 0.367). Therefore, the diameter of recipient vessels for microsurgical breast reconstruction significantly decreased when RTx was performed postoperatively. Thus, plastic surgeons conducting delayed breast reconstruction must thoroughly understand the changes in recipient vessels associated with adjuvant treatment. Consequently, the preoperative consideration of these possibilities enables plastic surgeons to provide patients with accurate information about the risks associated with surgery, ensuring that informed decisions are made.

Lower extremity reconstruction is challenging because of its intricate anatomy and dynamic biomechanics. Although microsurgical free tissue transfer offers pivotal solutions to limited local tissue availability, vascular pedicle exposure after free tissue transfer is common. We evaluated a novel method of managing pedicle exposure after free tissue transfer using a reprocessed micronized dermal substitute. Ten patients who underwent lower-extremity reconstruction using free tissue transfer and micronized dermal substitute between January and December 2023 were retrospectively reviewed. When native tissue could not be closed over the pedicle, reprocessed micronized artificial dermal matrix (rmADM) was cut and stacked to protect and stabilize it. Epithelialization was achieved by secondary skin grafting or healing by secondary intention. Flap dimensions, recipient artery and vein, ADM size, time required for granulation tissue maturation and complete epithelialization, and flap outcomes were analyzed. The mean age was 55.80 ± 20.70 years, and six patients (60%) were diabetic. The mean rmADM coverage area was 8.70 ± 8.41 cm2, and the average time required for complete epithelialization was 50.89 ± 14.21 days. Except for one total necrosis due to bypass graft failure, nine limbs were successfully salvaged. Application of rmADM offers numerous advantages, including vascular collapse prevention, moisture maintenance, granulation tissue growth promotion, and pedicle stabilization.

The epidemiology of facial fractures is continuously evolving due to various influencing factors, including social, economic, and technological advancements. Thus, an updated analysis of facial bone fractures is necessary. This study aimed to provide an updated epidemiological analysis of facial bone fractures and assess severity using multiple factors. We retrospectively reviewed patients who underwent facial bone fracture surgery at 3 teaching hospitals in South Korea between January 2015 and December 2020. Data collected included patient demographics (sex and age), trauma mechanism, alcohol intoxication status, and fracture types. Trauma mechanisms were categorized into 7 groups: assault, fall, sports, occupational injury, motor vehicle crash, bicycle, and personal mobility. Severity was assessed using the modified facial injury severity scale. A total of 5953 patients (4437 males and 1516 females) were included, with ages ranging from 1 to 92 years (mean age: 36.37±18.61 y). A steady decline in the number of patients was observed from 2015 to 2020. Falls were the most common cause of facial fractures (2300 cases, 39%), and nasal bone fractures were the most frequent type (3683 cases, 46%). The number of elderly patients (> 60 y) and injuries caused by personal mobility devices increased steadily. Male sex and alcohol intoxication were associated with higher severity scores. Motor vehicle crashes had the highest severity scores (2.246). While the incidence of facial bone fractures has decreased in recent years, the proportion of elderly patients and injuries caused by personal mobility devices is increasing, posing a significant burden on the health care system.

Background: Split-thickness skin graft (STSG) is a fundamental and versatile technique used in reconstructive surgery. Despite numerous studies addressing the management of STSG donor sites, there is still little consensus on the optimal dressing method. This study aimed to analyze the effectiveness of a novel method that combines a fenestrated polyurethane film with negative-pressure wound therapy (NPWT) over conventional moist dressings.Methods: Between January 2021 and December 2022, 23 patients who received STSG were retrospectively reviewed. In group A, a polyurethane film punctured with a 20-gauge needle was applied to the skin graft donor site. A NPWT system (CuraSys) was subsequently applied over the film. The conventional NPWT was replaced with a portable NPWT (PICO system) on the day of discharge. On the 14th postoperative day, the NPWT and film were removed. In group B, patients were administered a traditional moist dressing until epithelization. Postoperative pain, reepithelization rate, and dressing cost per cm² were compared.Results: Group A exhibited a lower mean pain score on all the measured days. Furthermore, group A demonstrated a significantly shorter time required for complete reepithelization (18.07±8.43 days vs. 28.20±5.25 days, P=0.003) and a lower dressing cost per square centimeter (6,517±6,162 KRW [4.82±4.56 USD] vs. 23,036±27,157 KRW [17.05±20.11 USD], P=0.006).Conclusion: The combination of fenestrated polyurethane film and NPWT resulted in reduced pain caused by dressing, a faster reepithelization rate, and lower dressing cost than that of conventional moist dressing.

BACKGROUND:Volume changes in reconstructed flaps, particularly regarding symmetry, are an important consideration to improve long-term esthetic results in patients who undergo breast reconstruction. Asian patients with thin abdominal tissues tend to require bipedicled flaps, which provide a greater volume of abdominal tissue. We investigated volume changes in free abdominal flaps and the factors that may affect flap volume, particularly the number of pedicles. METHODS:The study included all consecutive patients who underwent immediate unilateral breast reconstruction using free abdominal flaps between January 2016 and December 2018. The initial flap volume was calculated intraoperatively, and the postoperative flap volume was calculated using computed tomography or magnetic resonance imaging based on the Cavalieri principle. RESULTS:The study included 131 of 249 patients. Compared with the initial inset volume, the mean flap volumes at 1 and 2 years postoperatively decreased to 80.11% and 73.80%, respectively. The multivariable analysis of factors that affect flap volume showed a significant association with the flap inset ratio, radiation (P = .019,.040, respectively). Stratification based on the number of pedicles showed that the flap inset ratio was significantly negatively correlated with the postoperative flap volume change in unipedicled (P < .05) but not in bipedicled flaps. CONCLUSIONS:The flap volume decreased over time, and its change had a negative correlation with the flap inset ratio in the unipedicled group. Therefore, prediction of postoperative volume changes in various clinical situations is important before breast reconstruction.

Medial epicanthoplasty is a crucial component in Asian cosmetic eyelid surgery. Conventional surgical methods have mandated wide undermining for the purpose of sufficient release. However, excessive undermining may result in hypertrophic scar or webbing deformities. To minimize undesirable results, the authors are proposing a novel approach. From March 2010 to December 2017, a triangular resection epicanthoplasty was performed in 421 Asian patients. The authors’ procedure consists of triangular skin resection, the release of orbicularis oculi muscle and upper half medial epicanthal tendon, and dog ear correction. No complication regarding scarring or webbing was reported. The revision was performed in 18 cases where the patients wanted additional correction. The triangular resection epicanthoplasty offers both optimal results and minimal scar with relative simplicity.

Abstract: Dermatochalasis is a consequence of aging and results in various problems, such as tired look, dry eye syndrome, or reduced vision. Although the demand for upper blepharoplasty is growing in the senescing world, the demand from male patients has been generally overlooked. Male patients prefer natural creases and fast recoveries, with minimal swelling. The authors introduce a novel method that will satisfy the demands of most male patients. This technique includes muscle-sparing skin incisions and fixation of folds through 6 slit incisions. This study retrospectively reviewed 40 Asian male patients who had been subject to this procedure. The patients were evaluated for fold attenuation, scar perception, and patient satisfaction; favorable outcomes with minimal complications were observed.

Kwon, Byung Yeun MD; Kim, Daheui MD; Kim, Young Jin MD, PhD; Jun, Daiwon MD; Lee, Jung Ho MD, PhD Author Information

Background The practice of medicine by uncertified personnel is a common concern in public healthcare. Although the introduction of the Korean National Health Insurance Service has significantly reduced the number of these cases, the problem persists in the field of aesthetics. Herein, we report an outbreak of devastating facial stigmata in patients treated with illegal cosmetic procedures. Methods During 1 week in November 2021, five patients presented to Bucheon St. Mary’s Hospital for the management of identical patterns of severe facial scarring. Each patient had been treated for “skin rejuvenation” by a single unlicensed practitioner. Months of needling therapy by the practitioner, aimed at resolving the problem, only aggravated the scarring. The victims visited our hospital after the practitioner ceased to answer their calls. The patients had similar presentations with multiple prominent scars on both cheeks. Ectropion of the right lower eyelid due to scar contracture was observed in one patient. Results Five monthly treatments with intralesional triamcinolone injection and laser therapy were performed. Despite thorough management, the patients were left with improved but distinctive stigmata on their faces. Conclusions Cases of illegal aesthetic procedures are difficult to prosecute because the patients have implicitly agreed to the procedure. Therefore, active legislative measures should be adopted to prevent further victimization. Public education on the dangers of illegal aesthetic practices is also necessary.

The emphasis on tip plasty in Asian rhinoplasty has led to heightened concerns about complications regarding nasal tip skin. Although uncommon, these complications can cause tremendous frustration to surgeons when encountered. Conventional methods such as skin graft or healing by secondary intention cause an unpleasant scar. Instead, an extended dermofat graft in revision rhinoplasty enables both replacement of the dorsal implant and adequate coverage of the nasal tip without modifying the previous tip plasty. A patient who experienced nasal tip skin thinning after augmentation rhinoplasty was treated successfully with an extended dermofat graft. The authors believe that this is a solid method for managing patients with nasal tip skin complications.

Frontal sinus fractures are common traumatic injuries of the head and neck, accounting for 8% of facial fractures. When a severe frontal sinus fracture and a naso-ethmoid-orbital fracture occur together, a postoperative contour deformity is highly likely. A pericranial flap is a reliable and versatile tool for craniofacial reconstruction. The authors fabricated an anteriorly-based pericranial flap in multiple layers to camouflage the fracture site and augment the brow ridge for volumization. Open reduction and pericranial flap coverage using this method (dubbed the “Persian carpet” method) were successfully performed in a 26-year-old male patient with a comminuted frontal bone fracture and a naso-ethmoid-orbital fracture.

ABSTRACTOrbital varix is uncommon disease entity, accounting for less than 1% of orbital tumor. Authors report a case of tumor mimicking lower eyelid varix of inferior palpebral vein induced by forced closure of the patient's eyelids. A 21-year-old female visited our institution with a complaint of eyelid mass that only appeared on frowning. A 0.5 × 1.0 cm2 sized soft, nontender and nonpulsating mass was observed at her left lower eyelid when she frowned. Preoperative ultrasound imaging revealed a hypoechoic cystic lesion above orbicularis oculi muscle. A surgical resection through transconjunctival approach was performed. Congestion of perforating inferior palpebral vein caused by contraction of orbicularis oculi muscle was observed intraoperatively. Histopathology has confirmed dilated venous structures. The symptom was immediately resolved after surgery. No sign of recurrence was detected after two years of follow-up.

Although skin- or nipple-sparing mastectomy has been popular in the treatment of breast cancer, the radical excision of breast tissue is unavoidable in certain circumstances. However, the ability of an acellular dermal matrix (ADM) to expand remains questionable, and this situation may further hinder tissue expansion. From October 2017 to January 2020, patients who underwent immediate breast reconstruction with tissue expander placement using ADM whose initial fill volume was less than 50 mL were retrospectively reviewed. The primary outcomes were the number of visits and number of days required to complete the expansion, and the secondary outcomes were the amount of postoperative expansions, expander fill ratio and expander volume. Between the prepectoral group (n = 26) and subpectoral group (n = 39), the mean number of days (81.46 days versus 88.64 days, p = 0.365) and mean number of visits (5.08 versus 5.69, p = 0.91) required to complete expansion exhibited no significant differences. Additionally, there were no significant differences in the mean amount of postoperative expansion (314.23 mL versus 315.38 mL, p = 0.950), the mean final volume (353.08 mL versus 339.62 mL, p = 0.481) or the mean final volume ratio (0.89 versus 0.86, p = 0.35) between the two groups. Therefore, we suggest that prepectoral tissue expander placement after conventional mastectomy can be a valid option.

Virginal mammary hypertrophy (VMH), also known as juvenile mammary hypertrophy, is characterized by excessive enlargement of the breasts. Especially in adolescent patients, this condition can cause a negative body image to develop and result in significant psychological stress. Furthermore, social problems can arise from difficulties in finding appropriately-fitting attire and having trouble exercising. Although the mechanism of VMH has not been fully elucidated, several associated drugs have been identified. In this report, we present a 15-year-old female patient with Wilson disease who developed macromastia after administration of penicillamine for 8 months. Despite cessation of penicillamine for 3 months, the condition remained stable; thus, reduction mammoplasty was performed. After surgery, the patient was able to return to activities of daily living. Although rare, physicians should be aware of the fact that penicillamine can cause VHM. Therefore, patients with Wilson disease should be checked regularly for changes in breast volume in order to minimize possible complications.

In spite of thorough presurgical planning, emergency situations requiring longer pedicle length may arise during anterolateral thigh (ALT) free flap surgeries. While performing vessel graft for pedicle lengthening, discrepancy may occur because of a certain genetic predisposition or vascular variation at the anastomosis site of the graft vessel and the flap pedicle. A 76‐year‐old male patient with neurofibromatosis type I had a 15 x 10 cm defect, which was caused by radical excision of a malignant peripheral nerve sheath tumor on his back. A 15 x 10 cm sized free ALT flap was obtained. The distance between the recipient vessels and the defect area was 20 cm. The diameters of vessels in the harvested flap were as follows: proximal end of the descending branch of the lateral circumflex femoral artery (LCFA)—artery/vein: 3.0/2.5 mm, distal end of the descending branch of the LCFA—artery/vein: 1.0/1.0 mm, and perforator in the ALT flap—artery/vein: 0.8/1.0 mm. The conventional method requires transfer of the distal portion of the LCFA (below the bifurcation) which mandates us to perform anastomoses with a vessel diameter discrepancy of 2 mm. As an alternative, a bifurcating perforator‐including flap was transposed to the most distal part of the descending branch of the LCFA. An ALT flap with a pedicle having a total length of 20 cm was constructed. The flap survived without any complications. This technique may provide an option for resolving size discrepancy between the graft vessel and the ALT pedicle.

For skin defects caused by full-thickness burns, trauma, or tumor tissue excision, skin grafting is one of the most convenient and useful treatment methods. In this situation, graft fixation is important in skin grafting. This study was performed to compare the effectiveness of skin graft fixation between high-concentration fibrin sealant and sutures. There have been numerous studies using fibrin sealant for graft fixation, but they utilized slow-clotting fibrin sealant containing less than 10 IU/mL thrombin.

Various skin tumours such as squamous cell carcinoma and extramammary Paget's disease can occur in the vulval area, and reconstruction of the vulval area can be a very challenging task.A retrospective analysis of vulvar reconstruction using the new method 'internal pudendal perforator artery-based gull wing flap' was performed from April 2012 to December 2013. A perforator vessel from the internal pudendal artery was detected with a portable Doppler and marked, and this was the pivot point around which the flap was rotated. The flap was rotated by more than 150 degrees-180 degrees internally, and the labium and the external wall of the vagina were reconstructed with sufficient volume.Anatomical and aesthetic reconstruction of the labium and the vagina was performed without serious complications. Functional and aesthetic vulvar reconstruction can be achieved by using a flap that provides sufficient volume of the labium. Our new technique, the 'internal pudendal perforator artery-based gull wing flap', is good and it can be used to reconstruct a functional and aesthetically acceptable vulvovagina for large defect wound after tumour excision.

Purpose. Early postoperative fractional laser treatment has been used to reduce scarring in many institutions, but the most effective energy parameters have not yet been established. This study sought to determine effective parameters in the treatment of facial laceration scars.Methods. From September 2012 to September 2013, 57 patients were enrolled according to the study. To compare the low and high fluence parameters of 1,550 nm fractional erbium-glass laser treatment, we virtually divided the scar of each individual patient in half, and each half was treated with a high and low fluence setting, respectively. A total of four treatment sessions were performed at one-month intervals and clinical photographs were taken at every visit.Results. Results were assessed using the Vancouver Scar Scale (VSS) and global assessment of the two portions of each individual scar. Final evaluation revealed that the portions treated with high fluence parameter showed greater difference compared to pretreatment VSS scores and global assessment values, indicating favorable cosmetic results.Conclusion. We compared the effects of high fluence and low fluence 1,550 nm fractional erbium-glass laser treatment for facial scarring in the early postoperative period and revealed that the high fluence parameter was more effective for scar management.