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Hook Sun,김민영,Jin Woo Kim 대한미용성형외과학회 2023 Archives of Aesthetic Plastic Surgery Vol.29 No.1
Skin avulsions are severe traumatic injuries, in which sections of skin and subcutaneous tissue are torn off from the body, and the surgical management and salvage of these injuries are quite challenging due to their high morbidity and mortality. The entire or partial loss of an avulsed flap is prone to occur. If this happens, scars can be particularly conspicuous, and additional surgery, such as skin grafts or local flaps or even composite grafts, might be required. A 24-year-old male patient presented to the emergency room with a severe traumatic avulsion injury on his nose. We used a combination of three therapies to minimize the loss of the distal portion of the avulsed flap: polydeoxyribonucleotide injection, continuous non-rebreather mask oxygen therapy, and chemical leeching. We achieved complete flap salvage of the avulsed wound, and the patient showed full satisfaction in both aesthetic and functional aspects. Although this report is confined to a single case of severe avulsed injury, we suggest this triple-combination therapy as a good combined modality for maximizing the salvage of an avulsed flap on the basis of this case and a literature review.
김민영,김진우,Hook Sun,Ji Young Yun,정의한 대한미용성형외과학회 2022 Archives of Aesthetic Plastic Surgery Vol.28 No.4
Known to be chemically inert, Aquafilling filler has been widely used in local aesthetic clinics in South Korea for breast augmentation. However, Aquafilling is only approved as a dermal filler and is not approved as an injectable filler for breast augmentation by the U.S. Food and Drug Administration or the Ministry of Food and Drug Safety. Several reports of complications following large-volume Aquafilling injections in the breast have been published. In this study, an HIV (human immunodeficiency virus)-infected transgender patient presented to the emergency room with a purulent infection of the breast and systemic fever. The patient had a history of large-volume Aquafilling injection in both breasts 3 years earlier to obtain a feminized appearance of the breasts. After using intravenous antibiotics and performing several surgical debridements over 4 weeks, the overall inflammatory response subsided. The skin defect site was covered successfully using an Integra Wound Matrix Dressing and there were no recurrent complications over 2 years of follow-up visits. Before injecting Aquafilling to augment patients’ breasts, a thorough consultation is mandatory, and doctors must notify patients that the risk of complications may be relatively high. Furthermore, any fillers including Aquafilling must not be used for unapproved purposes.
김동일,선욱,오갑성,김순걸,백세민,오재욱 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.6
The development of microsurgical free-tissue transfer in the early 1970 ushered in a new era in reconstructive surgery. Many new flaps have since been described. However, available free flaps with defined arterial inflow and venous outflow are limited and may not suit the particular needs of a defect. Thus efforts have been made to expand the reconstructive surgeon's armamentarium by devising flaps perfused by unconventional means. In the decade, then, there have been experimental and clinical attempts in using the venous flap. The arterialized venous flap represents another variation in conventional flap perfusion. A vein in the flap receives blood inflow by means of anastomosis to an artery in the flap recipient site. Flap drainage is provided by a secondary flap vein that is connected to a recipient site vein. The survival of an arterialized venous flap was first demonstrated by Nakayama et al. in 1981 in an abdominal skin flap of the rat. We reconstructed the soft tissue defect of the dorsum of the right foot with the groin arterialized venous flap because of the accidental injury to arterial pedicle during dissecting the flap. The defect was 5×7 cm in size. The dorsalis pedis artery was anastomosed to the vena comitants of superficial circumflex iliac artery. The superficial vein of the flap was anastomosed to the saphenous vein. The flap became gradually dark red with swelling. Hyperbaric oxygen therapy and salvage procedure was performed. The circulation of the flap become stabilized 2 weeks postoperatively. The flap survived satisfactorilt. So, we suggest that arterialization of the venous system is a viable means of reestablishing nutrient flow to the groin free flap.
Kim, Keun Tae,Sun, Hook,Chung, Eui Han Korean Cleft Palate-Craniofacial Association 2019 Archives of Craniofacial Surgery Vol.20 No.2
Background: Epidermal cysts are benign, slow growing cysts that often develop on the head, neck, chest, and back of adults. The most common method of surgical excision involves the use of a scalpel and often leaves a scar proportional to the size of the cyst. Therefore, minimally invasive techniques are required. Among these techniques, the $CO_2$ laser-based technique is minimally invasive and has lower complication rate, shorter recovery times, and lesser scarring. This paper aimed to compare the results and postoperative complications associated with a $CO_2$ laser-based excision against conventional surgical excision for epidermal cysts. Methods: We surveyed 120 patients, aged 16 to 65 years, with epidermal cysts on the face measuring 0.5 to 2.2 cm in diameter. Twelve months later, we compared the scar length, recurrence rate, patient satisfaction, and complications between patients treated with $CO_2$ laser excision versus surgical excision. Results: The mean scar length (12 months postoperative) after $CO_2$ laser excision was $0.30{\pm}0.15cm$, and that following surgical excision was $1.23{\pm}0.43cm$ (p= 0.001). The procedure time (time from incision after local anesthesia to the end of repair) was $16.15{\pm}5.96minutes$ for $CO_2$ laser excision versus $22.38{\pm}6.05minutes$ for surgical excision (p= 0.001). The recurrence rates in the surgical excision group and $CO_2$ laser excision group were 3.3% and 8.3%, respectively; this difference was not statistically significant (p= 0.648). Conclusion: The cosmetic outcome of $CO_2$ laser excision is excellent. For epidermal cysts measuring 2.2 cm or smaller, $CO_2$ laser excision is recommended, especially when aesthetic outcome is considered important.
Late Complication of a Silicone Implant Thirty Years after Orbital Fracture Reconstruction
이치안,강석주,윤지영,Hook Sun 대한두개안면성형외과학회 2017 Archives of Craniofacial Surgery Vol.18 No.2
Alloplastic materials used for orbital fracture reconstruction can induce complications, such as infection, migration, extrusion, intraorbital hemorrhage, and residual diplopia. Silicone is one of the alloplastic materials that has been widely used for decades. The author reports a rare case of spontaneous extrusion of a silicone implant that was used for orbital fracture reconstruction 30 years earlier. A 50-year-old man was admitted to the emergency room for an exposed substance in the lower eyelid area of the left eye, which began as a palpable hard nodule a week earlier. The exposed material was considered to be implant used for previous surgery. Under general anesthesia, the implant and parts of the fibrous capsule tissue were removed. Several factors hinder the diagnosis of implant extrusions that occur a long period after the surgery. So, surgeons must be aware that complications with implants can still arise several decades following orbital fracture reconstruction, even without specific causes.