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Mycobacterium avium complex (MAC) infection mainly causes pulmonary disease. However, in 20% to 30% of cases, it also induces various extrapulmonary diseases. Disseminated MAC infection occasionally occurs in immunocompromised patients but very rarely in immunocompetent patients. An 80-year-old immunocompetent woman presented with multiple chronic wounds on the scalp that had not improved despite prolonged treatment. A scalp abscess caused by disseminated MAC infection 4 years ago had gone through repeated cycles of improvement and aggravation despite continued use of anti-mycobacterial agents and active wound care. Enhanced brain computed tomography and magnetic resonance imaging revealed multiple skull defects and abscesses invading the dura mater. Under general anesthesia, the infected scalp skin and bone were sufficiently removed, and the bone and soft tissue defects were repaired with cranioplasty using a titanium mesh plate and local flap. As exemplified in this case, multiple chronic wounds unresponsive to treatment need to be screened for MAC infection. As chronic MAC infection in the scalp can cause skull destruction and brain infection, it needs to be treated aggressively at an early stage to prevent serious morbidity and mortality. Effective MAC infection management involves adequate medication, regular follow-up imaging, and active surgical procedure.

Primary cutaneous marginal zone B-cell lymphoma (PCMZL) is an uncommon type of malignant lymphoma that mainly occurs in the trunk and upper extremity, with less frequent incidence observed on the head. Herein, we report the early diagnosis and treatment of a rare case of facial PCMZL in an Asian patient. A 51-year-old man presented with masses on the forehead and nose tip, which he had incidentally discovered 2 months previously. The masses appeared as a papule on the forehead and a patch on the nose. There were no signs of infection or bleeding, and the patient reported no other symptoms. After complete surgical excision, PCMZL was diagnosed based on the permanent biopsy. The histopathological findings revealed lymphoid aggregations with multifocal granulomas. Further treatment and follow-up were conducted at the hematology and oncology department. Despite its rarity in Asian populations, cutaneous lymphoma should be included in the differential diagnosis of facial masses. Early diagnosis and treatment based on a physical examination, imaging study, and excisional biopsy are important for a favorable prognosis.

Cryptococcus neoformans usually causes an opportunistic infection in immunosuppressed patients. Immunocompetent patients may also develop the infection in the central nervous system or the lungs, but soft tissue infection is uncommon, and the development of a cryptococcal abscess in the pubic region is particularly rare. A 47-year-old male construction worker with headaches and fever visited the hospital due to a soft tissue mass in the pubic region with pus-like discharge. It was detected 6 months previously, and had gradually increased in size, tenderness, and erythema. The granulomatous lesion of the pubic area was excised en bloc, and primary closure was performed. Antifungal agents were used for the systemic infection. Histological examination identified the specimen as a fungal infection suspected to be cryptococcosis. During the 3-month follow-up period, there was no recurrence, infections in other areas, or major wound complications. This case is an example of a cryptococcal abscess with dissemination in the pubic region of an immunocompetent patient. There is no established cure for subcutaneous cryptococcal abscesses, but surgical excision, which can simultaneously achieve accurate diagnosis and treatment, is considered to be an effective treatment method.

Posttraumatic pseudoaneurysm of the face is caused by blunt, penetrating, or surgical trauma. Although its incidence is low, pseudoaneurysm rupture can cause a life-threatening, massive hemorrhage. A 48-year-old man visited our emergency center due to a fall-down accident. Three-dimensional computed tomography (CT) showed a comminuted zygomaticomaxillary complex fracture of the left face. After open reduction and internal fixation, the surgical wound healed without any complications. However, the patient was readmitted 10 days after surgery due to pus-like discharge from the wound. Contrast-enhanced CT to find the abscess unexpectedly revealed a pseudoaneurysm in the left retromaxillary area. Massive oral bleeding occurred on the night of re-hospitalization and emergency surgery was done. The bleeding site was identified as a pseudo-aneurysmal rupture of the posterior superior alveolar artery in the retromaxillary area. Hemostasis was achieved by packing Vaseline gauze in the maxillary sinus using an endoscope. Delayed rupture and massive bleeding of posttraumatic retromaxillary pseudoaneurysm after a zygomaticomaxillary fracture is a low-probability, but high-impact event. Therefore, additional contrast-enhanced CT should be considered to evaluate the possibility of a posttraumatic pseudoaneurysm in cases of severe comminuted zygomaticomaxillary fracture.

Mucinous cystadenoma, one of the subtypes of cystadenomas, is a rare benign salivary gland tumor. Most of the cases reported tumors presenting as asymptomatic, slow growing, single masses, primarily occurring in the parotid glands, buccal mucosa, and hard palate. This report describes a case of multiple mucinous cystadenomas that presented as subcutaneous swellings in both cheeks, which were mistaken for a benign subcutaneous tumor. A complete surgical excision was performed through an intraoral incision. There were no recurrences or complications. A diagnosis of mucinous cystadenoma was made by histopathological examination. Mucinous cystadenomas are differentiated from other salivary gland tumors based on the pathological findings. A malignant transformation is also possible. Preoperative imaging cannot identify mucinous cystadenomas because of their small size and atypical features, and needle biopsy has its limitations in such salivary gland tumors. Therefore, accurate diagnosis and treatment through surgical excision become important.

Background Nasal bone fractures occur frequently because the nasal bone is located at the forefront of the face. The goal of this study was to examine the cause, change in severity, change in incidence, and demographics of nasal bone fracture according to today's lifestyle. Methods A total of 2,092 patients diagnosed as having nasal bone fractures at our department between 2002 and 2017 were included in this study. We retrospectively examined patients' medical records to extract information regarding age, sex, cause of injury, combined facial bone fractures, and related injuries such as skull base fracture, spinal cord injury, brain hemorrhage, and other bone fractures. Fracture severity was classified by nasal bone fracture type. Results No statistically significant difference was found in annual number of patients treated for nasal bone fracture. The proportion of patients who underwent closed reduction was significantly decreased over time for those with nasal bone fractures caused by traffic accidents. However, it was not significantly changed for those with nasal bone fractures due to other causes. The number of patients with combined facial bone fractures increased over time. Incidences of severe nasal bone fracture also increased over time. Conclusion The study suggested that there is a decrease in the frequency and increase in the severity of nasal bone fracture due to traffic accident. Many protective devices prevent nasal bone fractures caused by a small amount of external force; however, these devices are not effective against higher amounts of external force. This study highlights the importance of preoperative thorough evaluation to manage patients with nasal bone fractures due to traffic accident.

Tumoral calcinosis is a condition characterized by deposition of calcium salts in the skin and sub- cutaneous tissue, commonly found around the joints. However, tumoral calcinosis of the auricle is extremely rare. We present the case of a 13-year-old boy with tumoral calcinosis of the helix of the ear auricle. A 13-year-old boy presented with a 10-year history of an enlarging mass on the left auricle. The mass was hard, non-tender, and non-compressible. The patient had no history of trauma. Complete surgical excision and pathological examination of the specimen was performed. The final diagnosis of the excised mass was tumoral calcinosis. After 9 months of follow-up, there were no signs of recurrence of the tumor and the patient was satisfied with the surgical results. Tumoral calcinosis of the auricle is extremely rare and may be misdiagnosed as other tumors. Pathological examination is essential for definitive diagnosis and complete surgical excision should be considered as the treatment of choice.

Sarcoidosis is a systemic inflammatory disease characterized by non-caseating granulomas of unknown origin. Of the fewer than 6% of sarcoidosis cases that occur in subcutaneous tissue, most occur on the face or forearm, but rarely in the toe. A 33-year-old man was admitted to our institute with a 2-cm mass on his chin and a 0.5-cm mass on his right fourth toe. Based on preoperative ultrasonography, epidermal cysts were suspected, and histopathological tests were performed after removing the masses. Histopathologically, the chin and toe tissue samples showed chronic granulomatous inflammation, without necrosis, indicative of sarcoidosis. Chest computed tomography revealed a large number of small nodules in both the interlobar fissures and the peribronchial area, and a large number of small lymph nodes in both the hilar and interlobar node areas. On the basis of the histopathologic and imaging findings, the patient was diagnosed with sarcoidosis. This very rare case of sarcoidosis, occurring in both chin and toe, suggests that thorough evaluation is needed to find other mass when we find sarcoidosis in facial area.

BACKGROUND In scalp allotransplantation, the scalp from a brain-dead donor, including hair, is transferred to a recipient with scalp defects. Opinions differ on the appropriateness of scalp allotransplantation. In order to maintain graft function and cosmetic outcomes, scalp transplantation recipients would need to receive lifelong immunosuppression treatments. The risks of this immunosuppression have to be balanced against the fact that receiving a scalp allotransplant does not extend lifespan or restore a physical function. Therefore, the present study aimed to investigate risk acceptance and expectations regarding scalp allotransplantation in different populations. METHODS A questionnaire survey study was conducted. A total of 300 subjects participated; survey was conducted amongst the general public (n=100), kidney transplantation recipients (n=50), a group of patient who required scalp reconstruction due to tumor or trauma (n=50), and physicians (n=100). The survey was modified by using the Korean version of the Louisville instrument for transplantation questionnaire. RESULTS Risk acceptance and expectations for scalp transplantation varied widely across the groups. Kidney transplantation recipients revealed the highest risk acceptance and expectations, whereas the physicians were most resistant to the risks of scalp transplantation. CONCLUSION Our study demonstrates that, in specific groups, scalp allotransplantation and the need for immunosuppression carries an acceptable risk despite the lack of lifeextending benefits. Our results suggest that scalp allotransplantation can be an acceptable alternative to existing scalp reconstruction surgeries in patients with pre-existing need for immunosuppression.

Meningiomas originate in the central nervous system and are the most common intracranial benign tumor. However, although rarely, they can develop extracranially. Primary extracranial meningiomas are frequently misdiagnosed, resulting in inappropriate clinical management. The most common sites of extracranial meningiomas include the skull, scalp, orbit, nose, paranasal sinuses, middle ear, neck, and skin. A 77-year-old woman presented with a mass on her left eyebrow. Computed tomography revealed an enhancing soft tissue mass in the left frontal area. The differential diagnoses included benign and malignant tumors. The patient underwent surgical excision by a direct approach, with dissection through the galea plane. Histological examination showed tumor cells arranged in sheets or whorls, with occasional psammoma bodies. The margins were free of tumor. The mass measured 2.1 × 1.1 × 2 cm, and was diagnosed as an extracranial meningioma. The patient had no recurrence 1 year later. Extracranial meningiomas are rare; nonetheless, ectopic meningioma should be considered in the differential diagnosis of any mass lesion in the eyebrow region.

Rationale: Hemangiomas of the glans penis are very rare. Treatment options include surgical excision, laser therapy, intralesional sclerotherapy, electrofulguration, and cryotherapy. However, there have been no definitive treatment guidelines established to date. Patient concerns: A 19-year-old man presented with a mass on the glans penis, incidentally found during a circumcision performed at a local urology clinic 3 months before visiting our department. Diagnoses: Histopathological examination identified the specimen as a cavernous hemangioma. Interventions: The mass was completely excised and the resulting wound was closed layer by layer. Outcomes: The patient was discharged without complications, such as wound dehiscence or infection. Follow-up 14 months after surgery showed that the wound was well healed without recurrence and the patient was satisfied with the aesthetic result. Lessons: Although there are many options to treat hemangiomas occurring on the glans penis, surgical excision can be considered when they are small in size.

Rationale: The hand is the most common site for foreign body injuries. Pencil lead penetration mainly occurs in school-age children. We report a case of proximal migration of a retained pencil lead in the hand, emphasizing the importance of adequate imaging and prompt removal of the foreign body. Patient concerns: We report the case of an 8-year-old boy who visited our outpatient clinic for a retained foreign body in the right palm. Removal was planned under general anesthesia. Black staining from the pencil lead was observed around the tendon sheath in the operative field, but the foreign body itself was not apparent. Diagnosis: Intraoperative radiography located the foreign body at the wrist, 5 cm away from the original site. Proximal migration of the retained foreign body was suspected. Intervention: Incision was extended toward the wrist and the foreign body was discovered in the flexor sheath at the wrist. Conclusion: Foreign bodies may migrate to adjacent tissues, but rarely wander far. Computed tomography is the most useful tool in diagnosing a pencil lead foreign body. Lessons: Adequate imaging and prompt removal of the foreign body is important. When a retained foreign body is removed after a delay, the physician must always consider the possibility of foreign body migration.

Osteomas are benign, slow-growing tumors that most frequently occur in the craniomaxillofacial region. These tumors are mostly asymptomatic and are generally found incidentally. A giant osteoma is generally considered to be greater than 30 mm in diameter or 110 g in weight. A 35-year-old female presented to us with complaints of a firm mass that showed continuous growth on the forehead following trauma. A hairline incision was made to expose the osteoma. Biopsy of the tumor confirmed a osteoma. There were no complications after surgery. Postoperative computed tomography revealed that the tumor was completely removed. Because a peripheral giant osteoma of the frontal bone with a history of trauma is a rare finding, thorough history-taking, physical examination, and preoperative imaging tests are needed for patients with a history of trauma to rule out a giant osteoma.

Rationale Although lipomas are the most common benign form of soft tissue tumor in the body, giant lipomas of the hand, defined as >5 cm in diameter, are extremely rare. Patient concerns A 49-year-old man presented with a soft and fixed lump in the left hypothenar area. The mass was not tender, but it was associated with symptoms of tingling sensation and paresthesia in the left ring and little fingers that had lasted for 4 years. Diagnoses Preoperative image studies revealed an encapsulated and multilobulated mass, which measured 8 cm × 5 cm × 2 cm. Basic histologic examination identified the specimen as a lipoma and further immunohistochemical studies ruled out the possibility of malignancy. Interventions To enable a complete excision of the mass, the palmar digital branch of the ulnar nerve for the little finger passing through the mass was temporarily transected. After complete excision of the mass, the branch was coapted again under microscopy. Outcomes Complete sensory recovery was achieved 6 months after surgery, without any sign of recurrence. Lessons Although giant lipomas in the hand can extend to vital components such as neurovascular structures, muscles, and tendons, meticulous en bloc resection can provide excellent results without any complications.

Introduction: Peripheral osteoma, which arises from the periosteum, commonly develops in the head and neck region and is found frequently in the mandible, maxilla, and paranasal sinuses. However, osteoma of the face, especially from the nasal bone, is quite rare. Patient concerns: A 34-year-old female visited our outpatient department with a small mass on the nose. She had n laser treatment of nevus at the same spot 14 years before, and it had enlarged slowly since 10 years before. Diagosis: Computed tomography scan revealed a 0.7 × 0.5 cm sized radio-opaque tumor of the nasal bone. Interventions: Under general anesthesia, surgical excision was performed through a transcolumellar and infracartilaginous incision. The excised tumor was a 0.7 × 0.5 cm sized hard mass. Outcomes: Biopsy confirmed it as a peripheral osteoma. After tumor removal, structural stability of nasal framework including bone and cartilage was maintained, and symmetry of the nasal dorsum was acquired. Conclusion: Chronic osteoma can compress the abutting structures. In the case of the nose, either structural instability or asymmetry can occur. By applying open rhinoplasty techniques, postoperative scars could be hidden and additional correction of the affected structure could be carried out if necessary. As a result, the surgeon can achieve the functional and esthetic outcomes simultaneously.

Rationale:Mucosa-associated lymphoid tissue (MALT) lymphoma, also known as extranodal marginal zone B-cell lymphoma, usually occurs in the gastric mucosa, lung, lacrimal glands, and salivary glands. MALT lymphoma arising from the accessory parotid gland is extremely rare and can therefore be

Schwannomas are benign, slow-growing tumors that arise from the Schwann cells of peripheral nerve sheaths and are also known as neurilemmomas or neurinomas. These tumors are covered with a well-demarcated capsule and commonly measure 2-4 cm in diameter. They frequently occur in the head and neck or in the extremities. The lesions themselves do not cause an inflammatory reaction, and patients usually present when these lesions compress the associated peripheral nerve and cause sensory or motor issues secondary to neuropathy. Schwannomas do not have a predilection for sex or ethnicity, but tend to develop between the second and fifth decades of life. Surgical resection is curative, and the possibility of recurrence or malignant transformation is considered extremely low [1,2]. Schwannomas of the intercostal nerve are extremely rare with few cases of large or symptomatic lesions reported in the literature. No intercostal schwannomas have been reported as an incidental finding. Here, we report a small intercostal schwannoma found during a chest wall reconstruction. A 58-year-old male patient with a sternal mass underwent excisional biopsy of a sternal lesion. The mass was found to be a chondrosarcoma on histopathology, and the patient subsequently underwent a secondary operation for wide resection and reconstruction of the chest wall defect. In the operating room, the sternal mass was resected en bloc with a wide surgical margin. In order to restore the resulting chest wall defect, a composite island flap was elevated, including the left tenth rib and the latissimus dorsi muscle. During this process, a 1-cm×1-cm mass was incidentally found along the subcostal groove of the tenth rib (Fig. 1). This well demarcated mass was excised. The remainder of the operation was uneventful. The results of the histologic examination of this lesion were consistent with a schwannoma (Fig. 2). Upon inquiry, the patient did report occasional bouts of pain in the area, which was described as sharp stabbing pain that worsened with coughing and exercise. However, the preoperative chest computed tomography images did not indicate the presence of the intercostal schwannoma. He did not report any paresthesia or hypoesthesia in the area innervated by the tenth intercostal nerve. The patient was discharged 14 days after the operation without any complications. The patient did not report any subsequent episodes of the pain. Fig. 1 (A, B) Intraoperative photographs. A 1-cm×1-cm mass was incidentally found under the left tenth rib. Fig. 2 Histopathologic images of the specimen. (A) The low-power view shows a biphasic pattern with a cellular Antoni A area (black arrow) and a hypocellular Antoni B area (white arrow) (H&E, ×40). (B) The high-power view shows tumor cells forming ... The most common presentation of schwannomas is a palpable mass, the percussion of which result in a painful paresthesia along the involved peripheral nerve [3]. In the case described here, the patient recalled a sharp shooting pain along the tenth intercostal nerve distribution of the left chest wall that worsened with coughing and exercise. While uncommon, schwannomas of the intercostal nerve can grow to compress the nerve against the subcostal groove, causing intercostal neuralgia, including pain, tenderness, paresthesia, and hypoesthesia. Chronic intercostal neuralgia is relatively common among adults, and is caused by herpes zoster infection, diabetic polyneuropathy, vertebral facet joint hypertrophy or arthritis, and malposition of the costovertebral joint (slipping rib syndrome) [3]. Intercostal neuralgia can also be caused by tumors and/or inflammation in the mediastinal, paravertebral, and costal areas [4]. The intercostal schwannoma and neuralgia in our case did not cause significant disability to the patient, which was most likely due to the fact that the lesion was smaller than most intercostal schwannomas (1 cm×1 cm compared to the usual size of 2-4 cm). The intercostal nerves are a part of the somatic nervous system, and originate from the anterior root of the thoracic spinal nerve (T1-T12). Each intercostal nerve is responsible for the sensation of the skin and parietal pleura and the motor activation of the intercostal muscle at its respective level. Since the tenth intercostal nerve is not responsible for significant sensory or motor function, we were able to completely excise the schwannoma in our patient without any morbidities or complications. This patient was a very rare case of intercostal schwannoma. The small tumor was responsible for intercostal neuralgia. Such small intercostal schwannomas are difficult to detect clinically because the intercostal nerve is located deep in the chest wall and may not be apparent in radiologic studies. However, larger lesions may involve the surrounding tissue and cause symptoms such as pleural effusion, dyspnea, and Horner's syndrome [5]. Therefore, incidentally found intercostal schwannomas, although generally benign and asymptomatic, should be excised to prevent the development of symptoms or complications from further growth.

Background The medial canthus is an important area in determining the impression of a person's facial appearance. It is composed of various structures, including canthal tendons, lacrimal canaliculi, conjunctiva, the tarsal plate, and skin tissues. Due to its complexity, medial canthal defect reconstruction has been a challenging procedure to perform. The contralateral paramedian forehead flap is usually used for large defects; however, the bulkiness of the glabella and splitting at the distal end of the flap are factors that can reduce the rate of flap survival. We reconstructed medial canthal defects using ipsilateral paramedian forehead flaps, minimizing glabellar bulkiness. Methods This study included 10 patients who underwent medial canthal reconstruction using ipsilateral paramedian forehead flaps between 2010 and 2012. To avoid an acute curve of the pedicle, which can cause venous congestion, we attempted to make the arc of the pedicle rounder. Additionally, the pedicle was skeletonized from the nasal root to the glabella to reduce the bulkiness. Results All patients had basal cell carcinoma, and 3 of them had recurrent basal cell carcinoma. All of the flaps were successful without total or partial flap loss. Two patients developed venous congestion of the flap, which was healed using medicinal leeches. Four patients developed epiphora, and 2 patients developed telecanthus. Conclusions Large defects of the medial canthus can be successfully reconstructed using ipsilateral paramedian forehead flaps. In addition, any accompanying venous congestion can be healed using medicinal leeches.

Summary Background The medial sural perforator island flap may be suitable for the reconstruction of postburn knee flexion contractures. However, postburn knee flexion contractures are usually associated with burns of the calf, which is the donor site of the medial sural perforator flap. Thus, there are concerns regarding the safety of raising medial sural perforator flaps from burned calves. Methods Between 2005 and 2010, 12 patients (11 males and 1 female) with postburn knee flexion contractures associated with second-degree burns of the calf (that healed by secondary intention) underwent reconstruction using a medial sural perforator island flap (based on the medial sural perforator) or medial sural perforator plus island flap (based on the medial sural perforator and other vessels that are pedicles of the sural flaps). Results All 12 flaps, which ranged in size from 7 to 15 cm in width and from 9 to 23 cm in length, survived completely. Of the 12 flaps, three were medial sural perforator island flaps and nine were medial sural perforator plus island flaps. Of the nine medial sural perforator plus island flaps, two included the lesser saphenous vein, five included the lesser saphenous vein and its accompanying artery, and two included the lesser saphenous vein, the distal sural nerve and their accompanying arteries. Healing of all donor sites was uncomplicated. All patients were completely satisfied with their results. Conclusions Although this series is not large, the authors are convinced that some reliable medial sural perforators are usually present under second-degree burned calf skin that healed by secondary intention, and that the medial sural perforator island flap or the medial sural perforator plus island flap can be safely used even though the skin may not be as pliable as normal skin.

A 45-year-old male presented with amputation of posterior heel soft tissue after an accident involving broken glass panes. The defect measured 4 × 6.5 cm, and the composite amputated tissue consisted of skin and subcutaneous layers. Intraoperative exploration of the amputated tissue revealed 2 perforator arteries (diameter ≤0.4 mm) in the central portion of the subcutaneous tissue and 4 superficial veins (diameter ≈0.6 mm) in the wound margin. These vessels were anastomosed end-to-end to the corresponding vessels from the wound bed using 11-0 nylon sutures. The replanted tissue survived completely. The patient retained excellent aesthetic and functional outcomes at the 13-month follow-up visit. The present case serves to demonstrate the feasibility of microsurgical replantation for the posterior heel. Although such isolated amputations are far less common than digital amputations, our experience suggests that microsurgical replantation is indicated beyond the current spectrum of clinical repertoire.

Background A schwannoma is a benign, slow-growing peripheral nerve sheath tumor that originates from Schwann cells. Orbital schwannomas are rare, accounting for only 1% of all orbital neoplasms. In this study, we retrospectively review orbital schwannomas and characterize clinical, radiologic, and histologic features of this rare entity. Methods A retrospective review was performed to identify patients with histologically confirmed orbital schwannoma, among a list of 437 patients who had visited our hospital with soft tissue masses within the orbit as the primary presentation between 2010 and 2014. Patient charts and medical records were reviewed for demographic information, relevant medical and family history, physical examination findings relating to ocular and extraocular sensorimotor function, operative details, postoperative complications, pathologic report, and recurrence. Results Five patients (5/437, 1.1%) were identified as having histologically confirmed orbital schwannoma and underwent complete excision. Both computed tomography (CT) and magnetic resonance imaging (MRI) studies were not consistent in predicting histologic diagnosis. There were no complications, and none of the patients experienced significant scar formation. In two cases, patients exhibited a mild postoperative numbness of the forehead, but the patients demonstrated full recovery of sensation within 3 months after the operation. None of the five patients have experienced recurrence. Conclusion Orbital schwannomas are relatively rare tumors. Preoperative diagnosis is difficult because of its variable presentation and location. Appropriate early assessment of orbital tumors by CT or MRI and prompt management is warranted to prevent the development of severe complications. Therefore, orbital schwannomas should be considered in the differential diagnosis of slow-growing orbital masses.

Eyebrow reconstruction is a challenge because eyebrow hair is unique. Although various surgical methods have been used to reconstruct eyebrow defects, to the best of our knowledge, the use of eyebrow free flaps for eyebrow reconstruction has not been reported. We describe the successful reconstruction of a large eyebrow defect using a supraorbital artery perforator free flap and show that microvascular eyebrow transplantation is another tool for reconstructing large eyebrow defects. Accordingly, we recommend that microvascular eyebrow transplantation be considered a useful option for the reconstruction of large eyebrow defects.

Many methods have been used to reattach amputated fingertips. Of these methods, microsurgery has been accepted as the procedure of choice because the defining characteristic of a microsurgically replanted finger is that its surival in the recipient bed is predicated on functioning intravascular circulation. Although considerable progress has been made in the techniques for microvascular replantation of amputated fingers, the replantation of an amputated fingertip is difficult because digital arteries branch into small arteries. This is in addition to digital veins that run from both sides of the nail bed to the median dorsal sides, which are difficult to separate from the immobile soft tissue. Furthermore, even with the most technically skilled microsurgeon, replantation failure often occurs, especially in severe injury cases. Therefore, the technique is not the only protection against failure, and a new strategy of fingertip reattachment is needed. From March of 1997 to December of 1999, 12 fingers of 11 patients with zone 1 or zone 2 fingertip amputations that were reattached microsurgically but were compromised were deepithelialized, reattached, and then inserted into the abdominal pocket. All had been complete amputations with crushing injuries. Approximately 3 weeks later, the fingers were depocketed and covered with a skin graft. Of the 12 fingers, 7 survived completely and 3 had partial necrosis on less than one-third the volume of the amputated part. The complete survival rate was approximately 58 percent. The results of the above 10 fingers were satisfactory from both functional and cosmetic aspects. The authors believe that this high success rate was achieved because the deepithelialized finger pulp was placed in direct contact with the deep abdominal fascia, which was equipped with plentiful vascularity, not subcutaneous fat. In addition, the pocketing was performed promptly before necrosis of the compromised fingertip occurred. From the results of this study, it is clear that this new method is useful and can raise the survival rate of an amputated fingertip.

Cryptotia is a congenital auricular anomaly found more commonly in Orientals than whites. The characteristics of cryptotia are the invagination of the upper part of the auricle under the temporal skin and the deformity of the auricular cartilage. The goals of the repair of cryptotia are to release the upper ear from the side of the head to restore the retroauricular groove, to correct the malposition, and to correct the cartilaginous deformity. To lengthen the skin between the superior portion of the auricle and the scalp, the authors used both the modified Z-plasty and the temporal advancement flap. We partially detached the abnormal insertion of the superior auricular muscle at the upper part of the helix to make it weak. After complete exposure of the posterior aspect of the upper auricular cartilage, the constricted intrinsic transverse and oblique muscles were cut, and everting horizontal mattress sutures were inserted on the antihelix to expand the constricted body and crus of the antihelix. Thereafter, an ultrathin Medpor sheet (0.85-mm thickness) was fixed with 6-0 nylon sutures to the posterior aspect of the corrected antihelical cartilage for lengthening and splinting the relatively shortened upper pole of the deformed cartilage. This operative method is thought to be useful in maintaining the lengthened auricular height and shape, and in preventing the relapse of ear cartilage deformities.

Background: Although the reconstruction of palmar defects of the thumb with exposed vital structures is difficult because of a lack of locally available tissue, several local flaps are available for the reconstruction of these defects. The majority of these flaps are raised from the dorsal or dorsolateral aspect of the thumb and index finger or from the forearm. Methods: Between 1998 and 2008, 23 patients underwent reconstruction of palmar defects of the thumb at Chonnam National University Medical School, using the radial midpalmar (perforator-based) island flap (distal thenar perforator-based island flap), a perforator-based island flap harvested from the radial aspect of the midpalm and based on perforators from the terminal branch of the superficial palmar arch and the princeps pollicis artery. Results: All flaps survived completely. Flap sizes ranged from 2 to 4 cm in width and from 2.5 to 6 cm in length. Donor sites were closed primarily in 10 patients and covered with skin grafts in 13 patients. Healing of all donor sites was uncomplicated, and donor-site morbidity was minimal with acceptable scarring. Long-term follow-up ranging from 6 to 37 months (mean, 16 months) revealed excellent flap sensibility. Conclusions: The radial midpalmar (perforator-based) island flap offers acceptable functional and cosmetic outcomes with respect to elasticity, durability, skin color and texture, and sensation for the reconstruction of extensive palmar defects of the thumb. The authors recommend that this flap be considered a treatment of choice for the reconstruction of these defects.

Transcutaneous or endoscopic approaches are commonly used to reduce closed anterior table frontal sinus fractures. However, transcutaneous approaches cause serious skin sequelae, and endoscopic approaches have a steep learning curve. To resolve these problems, between 2001 and 2008, a transcutaneous transfrontal approach through a small peri-eyebrow skin incision was used in 17 male patients. Postoperative computed tomography scans showed adequate reduction of displaced bone fragments in all cases. No complications related to this procedure, such as uncontrollable sinus bleeding, infection and posterior table and brain injuries, were observed. Follow-ups ranged from 4 to 27 months, with an average of 14 months. Contour deformities were effectively restored and cosmetic results at incision sites were acceptable in all patients. The transcutaneous transfrontal approach through a small peri-eyebrow incision is a safe procedure that can be performed with minimal morbidity and offers good access and excellent aesthetic results. Based on the results obtained, the authors suggest that this method be considered the treatment of choice for the reduction of closed anterior table frontal sinus fractures.

The pigment synthesizing melanoma, so-called animal type melanoma, is a rare variant of melanoma that is characterized by prominent melanin production and an unpredictable prognosis. Congenital onset of this melanoma is exceedingly rare. A 2-month-old Korean girl had a black nodule and a satellite black macule on the scalp which were noticed at birth. She received a surgical resection 3 months later because of rapidly growing lesions and the histopathologic features of a pigment synthesizing melanoma. Two months later, she returned with cervical area swelling, and the excised multiple lymph nodes showed metastatic malignant melanoma. The exact origin and pathogenesis of congenital pigment synthesizing melanoma is different from the more common forms of melanoma and remains poorly understood.

Background The cheek rotation flap has sufficient blood flow and large flap size and it is also flexible and easy to manipulate. It has been used for reconstruction of defects on cheek, lower eyelid, or medial and lateral canthus. For the large defects on central nose, paramedian forehead flap has been used, but patients were reluctant despite the remaining same skin tone on damaged area because of remaining scars on forehead. However, the cheek flap is cosmetically superior as it uses the adjacent large flap. Thus, the study aims to demonstrate its versatility with clinical practices. Methods This is retrospective case study on 38 patients who removed facial masses and reconstructed by the cheek rotation flap from 2008 to 2015. It consists of defects on cheek (16), lower eyelid (12), nose (3), medial canthus (3), lateral canthus (2), and preauricle (2). Buccal mucosa was used for the reconstruction of eyelid conjunctiva, and skin graft was processed for nasal mucosa reconstruction. Results The average defect size was 6.4 cm2, and the average flap size was 47.3 cm2. Every flap recovered without complications such as abnormal slant, entropion or ectropion in lower eyelid, but revision surgery required in three cases of nasal side wall reconstruction due to the occurrence of dog ear on nasolabial sulcus. Conclusion The cheek rotation flap can be applicable instead of paramedian forehead flap for the large nasal sidewall defect reconstruction as well as former medial and lateral canthal defect reconstruction.

Inverted nipple, which is defined as a nipple located on a plane lower than the areola, presents both functional and cosmetic problems. It is a source of repeated irritation and inflammation, and interferes with nursing. In addition, its abnormal appearance may cause psychological distress. Inverted nipples are congenital or acquired, and are classified as the umbilicated and invaginated types or divided into 3 groups (grades 1, 2, and 3). With consideration of its underlying pathophysiologic components and severity, various surgical procedures have been proposed. For correcting the inverted nipple, the authors introduce an alternative, simple method using 2 triangular areolar dermal flaps. Compared with other methods using triangular areolar dermal flaps, each triangle is approximately 1 mm shorter than the diameter of the nipple, and the deepithelialized areolar dermal flaps are lodged at the slit in the bundle of the lactiferous ducts in the grade 2 inverted nipple. From August 2000 to December 2001, 11 patients (16 nipples) were treated. Five patients had bilateral inverted nipples. Patient age at operation ranged from 18 to 31 years (mean age, 27 years). All nipples were congenital and they had no previous operation. Thirteen nipples were grade 2 and 3 were grade 3 according to the classification of inverted nipple by Han and Hong. The mean follow-up period was 8.7 months (range, 3-12 months). Follow-up examinations revealed no evidence of recurrence of inversion. There was no complication associated with surgery, such as infection, hematoma, permanent sensory disturbance, or nipple necrosis. The resulting scars were minimal. All patients were satisfied with their results. The authors conclude that their procedure is reliable, preserves the lactiferous ducts in grade 2 inverted nipple, requires no special postoperative care, and leaves minimal scars and no recurrence of inversion. This technique can be applied to any type of inverted nipple as a primary surgical procedure.

A diverse variety of methods for reconstructing eyebrow defects has been described previously, and each procedure has inherent advantages and disadvantages. The authors present a case of reconstruction of a partial eyebrow defect using two eyebrow island flaps, which are modifications of the subcutaneous pedicle flap.