Primary cutaneous CD4+ small/medium T-cell lymphoma: a case report

Kim, Jeenam,Jeong, Minkyoung,Jun, Dongkeun,Lee, Myungchul,Shin, Donghyeok,Kim, Wookyoun,Choi, Hyungo Korean Cleft Palate-Craniofacial Association 2021 Archives of Craniofacial Surgery Vol.22 No.4

Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder is a rare disease characterized by a single mass on the face or upper part of the trunk. It usually presents an asymptomatic and favorable progression, and its histopathologic findings include small and medium-sized lymphoid cells. The authors report a case of primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder on the forehead. A 51-year-old man presented with a protruding mass on his forehead that the patient had noted 1 month previously. Surgical excision and a permanent biopsy were performed under local anesthesia. Based on the biopsy results, the mass was diagnosed as a primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder. There was no evidence of recurrence at a 15-month follow-up visit.

Subungual Osteochondromas of the Toe: Two Case Reports for Diagnosis and Treatment

Lee Myung Chul,Seo Chan Eol,Kim Wook Youn,Kim Wan Seop,Kim Jeenam,Shin Donghyeok,Choi Hyungon 대한성형외과학회 2023 Archives of Plastic Surgery Vol.50 No.1

Benign cartilaginous tumors, known as chondrogenic tumors, show cartilage components in the microscopic diagnosis. We present two clinical cases with cartilaginous tumors of the toes showing distinctive clinical manifestations. Two juvenile patients visited our outpatient clinic due to tumors with toenail deformities. A 10-year-old girl presented with a palpable mass with a nail deformity on the left third toe. The initial pathology report was soft tissue chondroma until complete resection. Another 15-year-old male patient visited the dermatology department with a toenail deformity and underwent a punch biopsy. The pathology report was fibrosis with myxoid degeneration. Excisional biopsies were performed for both patients. In the operative field, we observed exophytic tumors connected to the distal phalangeal bones. The final pathology reports were subungual osteochondroma on both patients. The specimen exhibited mature bone trabeculae with a focal cartilaginous cap. Benign cartilaginous tumors have a slow, progressive course and do not show significant symptoms. However, tumors in subungual areas are accompanied by toenail deformities and they can cause pain. Their clinical characteristics lead to a delayed diagnosis. Surgeons can be confused between soft tissue and chondrogenic tumors. When they conduct physical examinations, these categories should be considered in the differential diagnosis.

Autogenous fat grafting for mild-to-moderate postoperative temporal hollowing after decompressive craniectomy: One-year follow-up

Choi, Jaemin,Choi, Hyungon,Shin, Donghyeok,Kim, Jeenam,Lee, Myungchul,Kim, Soonheum,Jo, Dongin,Kim, Cheolkeun Korean Society of Plastic and Reconstructive Surge 2018 Archives of Plastic Surgery Vol.45 No.1

Background Temporal hollowing is inevitable after decompressive craniectomy. This complication affects self-perception and quality of life, and various techniques and materials have therefore been used to restore patients' confidence. Autologous fat grafting in postoperative scar tissue has been considered challenging because of the hostile tissue environment. However, in this study, we demonstrate that autologous fat grafting can be a simple and safe treatment of choice, even for postoperative depressed temporal scar tissue. Methods Autologous fat grafting was performed in 13 patients from 2011 to 2016. Fat was harvested according to Coleman's strategy, using a tumescent technique. Patient-reported outcomes were collected preoperatively and at 1-month and 1-year follow-ups. Photographs were taken at each visit. Results The thighs were the donor site in all cases for the first procedure. The median final volume of harvested fat was 29.4 mL (interquartile range [IQR], 24.0-32.8 mL). The median final volume of fat transferred into the temporal area was 4.9 mL on the right side (IQR, 2.5-7.1 mL) and 4.6 mL on the left side (IQR, 3.7-5.9 mL). There were no major complications. The patient-reported outcomes showed significantly improved self-perceptions at 1 month and at 1 year. Conclusions Despite concerns about the survival of grafted fat in scar tissue, we advise autologous fat grafting for patients with temporal hollowing resulting from a previous craniectomy.

Relationship between mandible fractures and third molars

Lee, Yunhae,Kim, Jeenam,Lee, Myungchul,Shin, Donghyeok,Choi, Hyungon Korean Cleft Palate-Craniofacial Association 2019 Archives of Craniofacial Surgery Vol.20 No.6

Background: This study was conducted to determine the relationship between third molar (M3) and mandibular fracture. Methods: Patients with unilateral mandibular angle or condyle fractures between 2008 and 2018 were evaluated retrospectively. Medical records were reviewed regarding the location of fractures, and panoramic radiographs were reviewed to discern the presence and position of ipsilateral mandibular third molars (M3). We measured the bony area of the mandibular angle (area A) and the bony area occupied by the M3 (area B) to calculate the true mandibular angle bony area ratio (area A-B/area A×100). Results: The study consisted of 129 patients, of which 60 (46.5%) had angle fractures and 69 (53.5%) had condyle fractures. The risk of angle fracture was higher in the presence of M3 (odds ratio [OR], 2.2; p< 0.05) and the risk of condyle fracture was lower in the presence of M3 (OR, 0.45; p< 0.05), than in the absence of M3. The risk of angle fracture was higher in the presence of an impacted M3 (OR, 0.3; p< 0.001) and the risk of condyle fracture was lower in the presence of an impacted M3 (OR, 3.32; p< 0.001), than in the presence of a fully erupted M3. True mandibular angle bony area ratio was significantly lower in the angle fractures than in the condyle fractures (p= 0.003). Conclusion: Angle fractures had significantly lower true mandibular angle bony area ratios than condyle fractures. True mandibular angle bony area ratio, a simple and inexpensive method, could be an option to predict the mandibular fracture patterns.

Treatment of a Chronic Open Wound Related to Sacrococcygeal Pilonidal Cyst and Squamous Cell Carcinoma: A Case Report

Seo Chan Eol,Kim Jeenam,Choi Hyungon,Shin Dong Hyeok,Lee Myung Chul 대한창상학회 2023 Journal of Wound Management and Research Vol.19 No.1

Pilonidal sinus disease is a cystic lesion or draining sinus tract involving the sacrococcygeal area. A long-standing sinus tract can lead to squamous cell carcinoma in the tract and overlying skin. We present the case of a 56-year-old female patient who had undergone pilonidal cyst excision whose postoperative pathologic report indicated squamous cell carcinoma. The sinus tract did not heal for 3 months, and the patient was then transferred to our clinic. Our team conducted a thorough resection of the cystic lesion and the overlying skin, followed by the relocation of two flaps to restore the skin and soft tissue defect. The patient recovered after a 1-month wound healing period. Postoperative fluid collection or discharge did not occur, and the patient achieved the ability to perform daily activities such as walking and eating meals in the sitting position. Adequate resection of cystic lesions is necessary when treating pilonidal sinus disease. A benign cyst can turn into a malignant lesion, and additional wide excision followed by tissue restoration is a therapeutic option for curative treatment.

Juvenile psammomatoid ossifying fibroma of the maxilla

Kwon, Yongseok,Shin, Donghyeok,Kim, Jeenam,Lee, Myungchul,Choi, Hyungon Korean Cleft Palate-Craniofacial Association 2020 Archives of Craniofacial Surgery Vol.21 No.3

Juvenile psammomatoid ossifying fibroma (JPOF) is a rare, benign, fibro-osseous variant of ossifying fibroma. It exhibits short-term rapid growth and has a high recurrence rate. Herein we describe a case of JPOF of the maxilla that was treated via complete excision utilizing an intraoral approach with immediate reconstruction using an iliac bone graft, in conjunction with a comprehensive review of the literature. A 20-year-old man presented with a mass on his right cheek that he reported had been growing over the last 10 months. In that cheek he had noticed fullness and experienced pressure, tenderness, and fluffiness, with no other ophthalmic or dental symptoms. After clinical, radiological, and histological examinations, the diagnosis was confirmed as JPOF. Surgical excision was performed, followed by immediate reconstruction with an autologous iliac cortical and cancellous bone graft harvested from the right iliac crest under general anesthesia. Good cicatrization of the intraoral surgical wounds and right iliac crest were evident. He was monitored for 6 months after the surgery and exhibited appropriate midfacial contour. There were no signs of recurrence or complications.

Transposition Flap for Cutaneous Lesion Coverage in Dermatomyositis

Bae Jaehyun,Jun Dongkeun,Kim Jeenam,Choi Hyungon,Shin Dong Hyeok,Lee Myungchul 대한창상학회 2020 Journal of Wound Management and Research Vol.16 No.3

Dermatomyositis (DM) is an autoimmune inflammatory myopathy with some cutaneous manifestations. We present the case of a patient with a bone-depth skin ulceration on the elbow that was well healed with a transposition flap using a dorsal interosseous artery perforator. A 56-year-old man reported difficulties when climbing stairs and diffuse pain of unclear origin throughout his body that started 2 months previously. The patient was diagnosed with DM, and the department of plastic and reconstructive surgery was consulted for the management of an ulcerative skin lesion on the left elbow. The dorsal interosseous artery was first detected by vascular Doppler ultrasonography, and a transposition flap was designed including the pedicle. The flap was transposed to cover the bone exposure over the olecranon. At 4 weeks postoperatively, complete healing of the wound was observed without complications, and the patient had full range of motion of the elbow without pain. Despite major developments in the medical treatment of DM, ulcerative cutaneous lesions remain difficult to treat. Our experience suggests that the use of a transposition flap including the dorsal interosseous artery is suitable for the treatment of ulcerative lesions around the elbow in DM patients.

Ulcerative Skin Metastasis Lesion in Non-Small Cell Lung Cancer

Bae Jaehyun,Jun Dongkeun,Kim Jeenam,Choi Hyungon,Shin Dong Hyeok,Park Jin Hee,Kim Wan-Seop,Lee Myungchul 대한창상학회 2020 Journal of Wound Management and Research Vol.16 No.2

Venous ulcers, ischemic wounds and skin lesions from autoimmune diseases are some examples of unhealing wounds. Practitioners treating such wounds should consider the possibility of skin metastasis of neoplasms, especially in patients with cancer. Treatment of cutaneous metastasis in cancer must include both surgical resection and chemotherapy. Here we present a patient who had lung cancer with skin metastasis. Though incidence of metastasis from lung cancer is known to be as low as 1% to 12%, its prognosis is poor. Also, the clinical features of these skin lesions tend to vary, often resulting in them being misdiagnosed as benign lesions. The diagnosis of malignancy for this particular case was delayed. After the metastatic lesion was diagnosed as such, surgical resection was performed and the defect caused by wide excision was covered by a superior gluteal artery perforator flap. Though the patient was administered an anticancer drug, the wound healed well after the operation.

Reconstruction of Upper Extremity Using Pedicled Latissimus Dorsi Myocutaneous Island Flap and Skin Graft after Necrotizing Fasciitis: A Case Report

Youngsu Na,Shin Dong Hyeok,Choi Hyungon,Kim Jeenam,Lee Myung Chul 대한창상학회 2023 Journal of Wound Management and Research Vol.19 No.1

Necrotizing fasciitis of the upper extremities is a severe, life-threatening condition, potentially resulting in amputation or death in the absence of prompt and aggressive surgical treatment. Reconstruction is eventually required after adequate surgical debridement, and patients are often referred to a plastic surgeon for this purpose. Herein, we present the case of a patient with extensive soft tissue defects on the upper extremity after fasciotomy for necrotizing fasciitis. We successfully performed a pedicled latissimus dorsi myocutaneous island flap, full-thickness skin graft, and split-thickness skin graft for this patient. After 2 months, the patient did not have any wound problems and could carry out adequate upper extremity motion.

Scalp reconstruction using the reverse temporalis muscle flap: a case report

Na, Youngsu,Shin, Donghyeok,Choi, Hyungon,Kim, Jeenam,Lee, Myungchul Korean Cleft Palate-Craniofacial Association 2022 Archives of Craniofacial Surgery Vol.23 No.3

The scalp is the thickest skin in the body and protects the intracranial structures. The coverage of a large scalp defect is a difficult surgical procedure, the full details of which must be considered prior to the procedure, such as defect size and depth, and various factors related to the patient's general condition. Although a free flap is the recommended surgical procedure to cover large scalp defects, it is a high-risk operation that is not appropriate for all patients. As such, other surgical options must be explored. We present the case of a patient with an ulcer on the scalp after wide excision and split-thickness skin graft for squamous cell cancer. We successfully performed a reverse temporalis muscle flap for this patient.