Search

Background: During the coronavirus disease 2019 (COVID-19) pandemic, the everyday use of face masks massively increased to prevent the spread of infection. Many people complain of ear pain and erosion when wearing a mask for extended periods of time. If prolonged mask usage is uncomfortable for ordinary people, a question arises—how much more inconvenient must mask wearing be for patients with a full-thickness skin graft (FTSG) donor site in the retroauricular region? Herein, we evaluated complications related to face mask use in 27 patients with a retroauricular FTSG donor site, with the goal of clarifying whether the retroauricular region is still an appropriate FTSG donor site in the context of the COVID-19 pandemic.Methods: Complications in 27 patients treated by FTSGs harvested from the retroauricular region from 2019 to 2021 were investigated. A questionnaire comparing the normal and the operated sides was administered. Pain, itching, soreness, deformity, and symmetry were further investigated.Results: Pain and itching were the only observed complications. The operated side was slightly more painful than the normal side in four patients (14.8%), and four patients (14.8%) reported itching on the operated side. However, all patients who experienced complications stated that the pain or itching did not interfere with mask wearing. Most symptomatic patients were older than 60 years of age (23.8%, p=0.185) and wore masks for longer periods of time (28.5%, p=0.326).Conclusion: Few retroauricular donor site-related complications occurred, and none of these complications caused inconvenience in daily life. Therefore, in the COVID-19 pandemic, the use of the retroauricular region as an FTSG donor site remains appropriate.

In prepectoral direct-to-implant breast reconstruction using the acellular dermal matrix (ADM)-assisted technique, breast volume asymmetry can occur. We hypothesized that ADM size influences implant size selection in prepectoral breast reconstruction with implant coverage using an ADM. We investigated factors influencing implant size selection and provide guidelines for surgeons.A retrospective chart review was performed to identify all patients who underwent prepectoral direct-to-implant breast reconstruction between January 2017 and October 2020. We assessed patient characteristics, preoperative expected implant volume, ADM size, volume of implant used in surgery, and symmetry scale of aesthetic item scale (AIS) 6 months after surgery. We compared the symmetry score of AIS between a group in which the preoperative expected silicone implant size (ES) was used and a group in which a silicone implant of a smaller size than planned (SS) was used.Patient characteristics, including age, body mass index (BMI), and excised breast volume, were similar between the groups (P .05). ADM size had a significant effect on implant size selection (odds ratio = 1.760, P .01). The symmetry score of AIS was higher in the SS group.ADM size must be considered when selecting implant size in prepectoral direct-to-implant breast reconstruction using the ADM-assisted technique.

Calcinosis cutis is a very rare disease characterized by insoluble calcium salt deposits in the skin. There are five types of calcinosis, dystrophic type being the most common among them. Dystrophic calcinosis is generally caused by local tissue damage. We present the dystrophic calcinosis cutis case of a patient with no underlying diseases but a burn injury which occurred 10 years ago. She visited the hospital for an ulcerative wound on the same area. She also had sustained a dog bite injury on the same site 9 months ago, which was treated at an oriental clinic with no improvement. Physical examination by palpation revealed a hard mass under the skin. As the mass was of a large size, the possibility of a foreign body was considered. Surgical resection and biopsy of the mass diagnosed it as dystrophic calcinosis cutis. Although clinical features of this case were unlike previous calcinosis cutis cases, performing a biopsy proved helpful towards its diagnosis.

Various implant wrapping methods with acellular dermal matrix (ADM) have been introduced, but most focus on random trimming and suturing aimed to maximize implant coverage. Here we present our clinical experience using a “tear-drop appearance” wrapping method to achieve natural contours through upper pole volume replacement. We retrospectively reviewed the data of 56 consecutive cases of prepectoral prosthetic-based breast reconstruction (PPBR) using this wrapping method following nipple-sparing mastectomy between March 2020 and June 2021. The “tear-drop appearance” wrapping design creates an anatomical tear-drop–shaped pocket to encourage lower pole fullness and create a natural contour through upper pole volume replacement by ADM. Patients’ baseline characteristics, operative data, and complications were analyzed. Aesthetic outcomes were measured using the BREAST-Q and Aesthetic Item Scale (AIS). A successful reconstruction was achieved without major complications and using a single ADM sheet. Four types and three sizes of ADMs were used. The mean resected breast tissue weight was 274.3 g, while the mean implant volume was 230.0 cc. The average BREAST-Q and AIS scores were 4.6 ± 0.8 and 4.5 ± 0.7, respectively. Owing to its simplicity, reproducibility, and effectivity, this method is an excellent implant coverage option that achieves a natural contour in PPBR.

Odontogenic cutaneous fistula of dental origin at the alar-facial groove is rarely reported. As many patients present with only skin lesions without dental problems, it is often confused with a cyst, abscess or pyogenic granuloma. We report the case of a 52-year-old man who presented with a relapsing cutaneous ulcer in the left alar-facial groove area. Ultrasonography findings suggested a ruptured epidermal cyst, and an excisional biopsy was performed. At 10 days after the surgery, wound dehiscence and pus discharge were observed. Computed tomography revealed a sinus tract, and a diagnosis of odontogenic cutaneous fistula was made. After consultation with the dental department, endodontic treatment was performed. During reoperation, a remnant fistula from the left alar-facial groove area to the left upper central incisor was observed, for which fistulectomy was performed. The patient remained disease-free postoperatively. With early accurate diagnosis, patients with odontogenic cutaneous fistula can be protected from unnecessary surgical intervention and ineffective antibiotic therapy.

Crohn’s disease is difficult to diagnose owing to its varied symptoms, among which fistulae are a late-stage symptom that appears mainly in the form of a perianal fistula. A patient who was previously healthy without clinical history visited our hospital with an ulcer of unknown cause at the right flank and gluteal region. Using computed tomography (CT) and colonoscopy, we diagnosed the ulcer as an enterocutaneous fistula caused by Crohn’s disease and successfully treated it with general surgery. In young, lean men with skin lesions of unknown cause, a CT or colonoscopy test may be useful for diagnosing underlying gastrointestinal problems.

The round block technique (RBT) is an oncoplastic surgery method that uses volume displacement techniques after partial mastectomy. However, cosmetic problems occur after tissue rearrangement in patients with small breasts or those in whom a large amount of breast tissue is excised. Therefore, we used an acellular dermal matrix (ADM) when the volume was insufficient after tissue rearrangement. Patients who underwent breast reconstruction using the ADM with the RBT after breast-conserving surgery (BCS) were included. The ADM graft was performed in two layers. First, it was placed on the glandular flap, and the patient was then seated to ascertain the degree of deformity. If the volume was insufficient, a graft was also performed under the skin flap. Overall, 107 oncoplastic surgeries were performed. Tumors were most commonly located in the upper outer quadrant of the breast, and the mean resected breast tissue was 27.1 g. Seroma was the most common complication, but it improved with several aspirations. There were no major complications or cosmetic problems requiring reoperation. Therefore, if the ADM was used for defects that could not be reconstructed with the RBT alone, safe and cosmetically good results could be obtained.

As vessel diameter decreases, reperfusion after anastomosis becomes more difficult. When a blood vessel is sutured, its inner diameter becomes narrower owing to the thickness of the suture material and the number of sutures. To minimize this, we attempted replantation using a 2-point suture technique. We reviewed cases of arterial anastomosis in vessels with a diameter of less than 0.3 mm during replantation performed over a four-year period. In all cases, close observation was followed by absolute bed rest. If reperfusion was not achieved, a tie-over dressing was applied, and hyperbaric oxygen therapy was administered in the form of a composite graft. Of the 21 replantation cases, 19 were considered successful. Furthermore, the 2-point suture technique was performed in 12 cases, of which 11 survived. When three or four sutures were performed in nine patients, eight of these cases survived. Composite graft conversion was found in three cases in which the 2-point suture technique was used, and two of these cases survived. The survival rate was high in cases where 2-point sutures were used, and there were few cases of conversion to a composite graft. Reducing the number of sutures aids in optimizing reperfusion.

Background Direct-to-implant breast reconstruction following nipple-sparing mastectomy is becoming increasingly common. The weight of the breast specimen informs implant selection. However, specimens of the same weight may have different volume. Therefore, identifying the factors affecting the density of breast specimens may facilitate the selection of implants with an appropriate volume. Methods From December 2015 to May 2018, 108 patients underwent direct-to-implant reconstruction following nipple-sparing mastectomy. The weight of the breast specimens was measured using an electronic scale in the operating room. Furthermore, the volume of specimens was measured using the water displacement technique. Multiple regression analysis was performed on factors that can affect breast density, such as menopause, neoadjuvant chemotherapy (CTx), age, body mass index, and diabetes mellitus. Results The average density of breast specimens in patients older than 50 years (n=36) was 0.96±0.04 g/mL, which was significantly lower than the 1.01±0.08 g/mL observed in patients younger than 50 years (n=72) (P=0.007). The mean density of breast specimens in patients who underwent neoadjuvant CTx (n=25) was 0.96±0.06 g/mL, which was significantly lower than the value of 1.00±0.08 g/mL in those who did not (n=83). Conclusions It is advisable to select an implant slightly larger than the mastectomy specimen weight in patients older than 50 years or in those who have undergone neoadjuvant CTx.

Hepatic solitary fibrous tumors (SFTs) are mostly benign and rare because of information regarding the clinical symptoms, treatment, and prognosis of their malignant forms is currently lacking. A literature review concerning malignant SFTs revealed that there were a few cases where patients experienced abdominal right upper quadrant (RUQ) pain as their first clinical symptom, and metastases were found after being diagnosed with hepatic SFT. Here, we report a patient who was previously healthy without any clinical symptoms such as RUQ pain or weight loss, but had the appearance of a metastatic mass as the first clinical presentation before a primary hepatic SFT was detected (J Liver Cancer 2019;19:143-148)

Summary:. Costochondritis after breast reconstruction and radiation therapy is rarely reported. Moreover, it is difficult to diagnose using computed tomography and magnetic resonance imaging; as such, wound debridement and reconstruction must be performed in several stages. A 51-year-old woman was diagnosed with invasive cancer of the right breast, and she underwent nipple sparing mastectomy and direct-to-implant breast reconstruction in November 2007. Thirteen years later, in September 2020, she experienced pain and swelling on her right breast. Incisional drainage and implant removal were performed in another clinic; however, the infection was not controlled. An implant-induced infection was suspected, and debridement was performed to a level where fresh tissue appeared in the upper layer of the intercostal muscle. Antibiotics and open dressing were used for 10 days; however, yellowish debris was noted, and third to fifth ribs and costal cartilages turned dark brown. Radiation-induced costochondritis was diagnosed based on clinical findings from the intraoperative field, wound course, and cartilage biopsy. Radical chest wall resection and reconstruction was performed using Teflon (Dupont/Chemours, Wilmington, Del.) and latissimus dorsi musculocutaneous flap. The patient was discharged 2 weeks after surgery without any complications. Costochondritis should be clinically diagnosed while performing the first debridement in staged operation. Radical chest wall resection is essential with chest wall reconstruction using Teflon and a latissimus dorsi musculocutaneous flap.

Background:. Upper blepharoplasty in elderly patients has characteristics that differ from those of younger patients. Blepharoptosis in elderly patients causes not only aesthetic problems but also functional problems such as entropion, visual disturbance, and sore eyes. We hypothesized that factors influencing patient satisfaction with upper blepharoplasty in elderly patients include aesthetic outcomes, functional outcomes, and personal factors. Methods:. This study included 57 patients aged >65 years who underwent upper blepharoplasty between April 2018 and March 2019. All surgeries were performed through the “Upper Blepharoplasty Service Project” of the public health center in Geoje City. To evaluate the individual characteristics of the patients, a preoperative questionnaire (including sociodemographic characteristics, main symptoms of discomfort in the upper eyelid, and degree of expectation of surgical results) was administered to the patients. After 6 months, a satisfaction survey was conducted accordingly. Results:. The main symptoms of discomfort were sagging of the skin of the upper eyelid. The mean score for patient satisfaction was 3.84 ± 0.40, and satisfaction with the results of surgery relative to the cost was 4.53 ± 0.63, which was the highest score. Significant verification of the regression coefficients showed that functional improvement and cognitive degree of postsurgery precautions had a significant effect on patient satisfaction, whereas aesthetic outcomes and expectations of surgical results were not correlated with patient satisfaction. Conclusion:. The findings indicated that elderly patients tended to be satisfied with functional improvement that resolved their symptoms of discomfort and personal factors such as cost and cognitive degree of precautions after upper blepharoplasty.

Background Minimizing scarring has long been a challenge in plastic surgery. Factors affecting scar formation are well known, but the effect of some patient-specific factors such as dermal thickness remains unverified. Management of factors predictive of scarring can improve postoperative patient satisfaction and scar treatment. Methods For 3 years, we used ultrasonography to measure dermal thickness in female patients who had undergone thyroidectomy for cancer at our hospital. We confirmed the influence of dermal thickness on hypertrophic scar formation and the Patient and Observer Scar Assessment Scale scar score 6 months after surgery. Results There was a positive correlation between dermal thickness and scar score (pl0.05), and dermal thickness appears to be a cause of hypertrophic scar formation (pl0.05). Conclusion Thick dermis was found to cause poor scar formation and hypertrophic scarring. Prediction of factors that can influence scar formation can be used to educate patients before surgery and can help in scar management and improvement in patient satisfaction.

Typical transcranial approaches are insufficient for adequate visualization and resection of skull base tumors. Different approaches with multiple modifications have been attempted. Here, we describe a new approach for a lesion that is central and hard to treat by conventional craniotomy and successful reconstruction with calvarial bone graft and titanium mesh plate. A 69-year-old female patient presented with recurrent meningioma. The tumor had invaded the frontal lobe, right supraorbital rim, and ethmoidal bone. We performed a modified anterior craniofacial approach that fully exposed the tumor and invaded bone. In consideration of the patient's age and cosmetic result, the tumor and invaded bone was resected and the defect area was reconstructed with titanium mesh and calvarial bone graft. At 6 months postoperative the patient had no complications and was satisfied with the esthetic result. We report this case to demonstrate the successful approach and reconstruction using this technique.

Background Several oncoplastic approaches have been implemented in recent years to enhance cosmetic results and to reduce complications. The round block technique is a volume displacement technique for breast reconstruction after breast-conserving surgery (BCS). However, its indications are currently limited according to tumor location, and its cosmetic results and complications have not been clearly established. We hypothesized that the round block technique could produce favorable cosmetic results without major complications regardless of tumor location or nipple-tumor distance, below a certain resected tumor volume and tumor-breast volume ratio. Methods All breast reconstructions using the round block technique after BCS were included in this analysis. Patients’ data were reviewed retrospectively to investigate complications during follow-up, and clinical photos were used to evaluate cosmetic results. The relationships of tumor location, nipple-tumor distance, tumor volume, and the tumor-breast volume ratio with cosmetic results were investigated. Results In total, 108 breasts were reconstructed. The mean resected tumor volume was 30.2±15.0 mL. The cosmetic score was 4.5±0.6 out of 5. Tumor location, nipple-tumor distance, tumor volume, tumor-breast volume ratio, radiotherapy, and chemotherapy had no significant effects on cosmetic results or complications. There were no major complications requiring reoperation. Conclusions Breast reconstruction using the round block technique after BCS can lead to good cosmetic results without major complications regardless of the tumor location, nipple-tumor distance, radiotherapy, or chemotherapy. Below the maximum tumor volume (79.2 mL) and the maximum tumor-breast volume ratio (14%), favorable results were consistently obtained.

Background: The pathoanatomy and biomechanics of elbow instability have been previously reported; however, few researchers have dealt with the operative management and clinical consequence of recurrent elbow instability. Recent studies on arthroscopic lateral collateral ligament (LCL) complex repair have reported successful outcomes similar to those achieved by open repair. We aimed to determine the validity of arthroscopic repair of the LCL complex in elbows with unstable dislocation with or without intra-articular fracture. Methods: Eighteen consecutive patients who had undergone arthroscopic repair of the LCL complex for unstable dislocation of the elbow with or without intra-articular fracture and who were followed for at least 12 months were included in the study. Ligament injury combined with coronoid and/or radial head fractures were treated with arthroscopic technique. Pain, range of motion, clinical outcomes based on the Mayo Elbow Performance Score (MEPS), and surgical complications were evaluated. Results: At 12 months follow-up, all 18 patients demonstrated complete settlement of the instability and mean (and standard deviation) extension of 1.7 ± 3.8°, flexion of 138.3 ± 3.8°, supination of 88.6 ± 5.3°, and pronation of 88.2 ± 5.6°. The average MEPS was 97.7 ± 3.9 points and according to this validated outcome score. However, slight widening (2 mm) of the radiocapitellar joint space was accompanied in one patient, although the varus stress test and pivot shift test were not observed. One patient showed delayed union of the anteromedial facet fracture, and two patients showed pin site irritation, which was a complication of arthroscopic coronoid fracture fixation and was fully resolved after pin removal. Conclusion: In patients with unstable elbow dislocation, with or without an intra-articular fracture, arthroscopic repair of the LCL complex is an effective and alternative treatment option that can restore elbow stability and have satisfactory clinical and radiographic results.

The umbilicus is of paramount aesthetic importance for the abdomen, and its absence can be psychologically distressing to patients for cosmetic reasons. An aesthetically-pleasing umbilicus tends to be small and vertically oriented in nature, with superior hooding and shadow, inferior retraction and slope, and a position at the topmost level of the iliac crest. A 42-year-old woman had undergone delayed breast reconstruction using a transverse rectus abdominis myocutaneous (TRAM) flap. Unfortunately, the patient developed umbilical necrosis following surgery. She underwent complete surgical debridement, which resulted in a large vertical scar. Delayed umbilical reconstruction was performed with four transposition flaps. The patient underwent follow-up at 11 months postoperatively, and the umbilicus had a satisfactory appearance. This case shows that using four transposition flaps can yield sufficient depth and an aesthetically pleasing shape for the umbilicus.

Objective The use of different expressions between physicians frequently results in confusion in the process of diagnosis and treatment of patients with headaches due to problems in the nose and nasal cavity. The aim of this study was to assess the terminologies that have been used most frequently to standardize these terminologies. Methods Terminologies that are most frequently used in general, including rhinogenic migraine, sinus headache, rhinogenic contact point headache, middle turbinate headache syndrome, and rhinogenic headache, were found by searching PubMed, Web of Science, and Google Scholar. These terminologies were objectively assessed on the basis of existing research and definitions and the range of diagnoses by organizations with public credibility. Results There were many terminologies in use for headache related to nose; however, these were not logical expressions and only partly explained the phenomenon. Among the terms, "rhinogenic headache" was most appropriate in expressing and describing the related symptoms. Conclusion The results indicated that the term "rhinogenic headache" is most appropriate for describing pain in the nose and eyes in patients with deformation within the nose or the nasal cavity due to external injuries or underlying diseases related to nose as observed on computed tomography.

Temporal hollowing occurs to varying degrees after pterional craniotomy. The most common cause of temporal hollowing is a bony defect of the pterional and temporal regions due to the resection of the sphenoid ridge and temporal squama for adequate exposure without overhang. The augmentation of such bony defects is important in preventing craniofacial deformities and postoperative hollowness. Temporal cranioplasty has been performed using a range of materials, such as acrylics, porous polyethylene, bone cement, titanium, muscle flaps, and prosthetic dermis. These methods are limited by the risk of damage to adjacent tissue and infection, a prolonged preparation phase, the possibility of reabsorption, and cost inefficiency. We have developed a method of temporal augmentation using a calvarial onlay graft as a single-stage neurosurgical reconstructive operation in patients requiring craniotomy. In this report, we describe the surgical details and review our institutional outcomes. The patients were divided into pterional craniotomy and onlay graft groups. Clinical temporal hollowing was assessed using a visual analog scale (VAS). Temporal soft tissue thickness was measured on preoperative and postoperative computed tomography (CT) studies. Both the VAS and CT-based assessments were compared between the groups. Our review indicated that the use of an onlay graft was associated with a lower VAS score and left-right discrepancy in the temporal contour than were observed in patients undergoing pterional craniotomy without an onlay graft.

Surgical-site infection (SSI) is a common postoperative complication, primarily caused by Staphylococcus aureus. S aureus produces hyaluronidase which degrades hyaluronic acid (HA). HA prevents bacterial proliferation and has anti-inflammatory effects to promote wound healing. We evaluated the effect of HA injection with systemic antibiotics for prevention and treatment of SSIs caused by S aureus. An open wound was created on the dorsum of 40 rats. The wound bed was sutured with S aureus inoculated thread. The test group was injected with HA (HA group), and the control group received a subcutaneous injection of normal saline (NS group). All groups were then treated with intraperitoneal cefazolin injection. The sutures were removed 2 days after the procedure. Gross pathology, bacterial count, and wound histology were assessed at days 2, 4, 6, and 8 postprocedure. The HA group showed a significant reduction in the wound area compared with the control group on gross pathology (at days 8 postprocedure, 36.54% ± 6.12% vs 50.59% ± 5.50%, P < .001). The HA group showed significantly better wound healing than the control group on histological analysis, including assessment of abscess, neutrophilic infiltration, and necrosis (4.2 ± 1.2 vs 11.5 ± 2.1, P < .001). The HA group showed a lower bacterial count compared with the NS group, but the result was not significant statistically (at days 6 postprocedure, 5.11 ± 0.31 vs 5.91 ± 0.35 logCFU/mL, P = .706). In conclusion, immediate local injection of HA in wounds can reduce SSI occurrence and promote wound healing in an animal model.

Background: Several comparative studies have documented the outcomes of negative pressure drain use after thyroidectomy. However, these previous studies did not focus on scar formation. The aim of this study was to compare thyroidectomy outcomes with and without negative pressure drain use in terms of scar formation.Methods: Nine hundred seventy-five patients who underwent thyroidectomy between January 2012 and December 2013, at Kosin University Gospel Hospital were enrolled in this study. Patients were assigned to one of two groups at the surgeon's discretion: the negative pressure drain group (n=515) or the no drain group (n=460). Medical records were reviewed, and the incidence and severity of scar formation were compared. We estimated patient satisfaction seven months postoperatively based on aesthetic and functional outcomes using the patient and observer scar assessment scale.Results: The incidence of mild scarring was higher in the no drain group, but this difference was not statistically significant (p=0.069). The incidence of severe scarring was significantly higher in the negative pressure drain group (5.83%, p

Free tissue transfer is a useful method to cover soft tissue defects following trauma or tumor excision. At the time of transfer of the pedicle, its status is not investigated. Therefore, kinking of the pedicle can occur, and pedicle injuries can result from surgical instruments. The authors would like to introduce a simple, safe, and effective method to overcome these problems using a Penrose drain. The present method can help reconstructive microsurgeons with the transfer of pedicle vessels through a tunnel without torsion or injury.

Background and objective Accurate assessment of burn depth is important for determination of treatment modality. Laser Doppler imaging (LDI) is known to be an objective and effective measurement tool in burn depth assessment. Our study evaluated the diagnostic accuracy of LDI across enrolled studies and subgroups. Methods A systematic literature review and meta-analysis were performed using MEDLINE, EMBASE, and Cochrane databases. Data from LDI cases were extracted from all primary studies and categorized into four cell values (true positives, false positives, true negatives, and false negatives). Subgroup analyses were performed according to perfusion units of LDI, clinical criteria of superficial and deep burns during the treatment period, and publication date of enrolled studies. Results The search strategy identified 321 publications. After screening, 10 articles were selected for review. The pooled sensitivity and specificity of LDI in all enrolled studies and subgroups were found to be similarly high. However, the sensitivity of LDI in our meta-analysis was not as high as that identified in previous studies. Conclusion Although LDI in burn depth assessment was identified as an accurate measurement tool in this meta-analysis, careful clinical assessment should be performed along with LDI in patients with deep burns.

Background: Age-related changes have been studied for lower and middle facial bones. Although the forehead comprises one-third of the facial area, no studies have investigated age-related changes in the upper part of the face or forehead. The purpose of this study was to use three-dimensional computed tomography (3D CT) to investigate age-related changes in the frontal bone. Methods: A retrospective review was performed for patients who underwent 3D CT scan of facial bones. Patients were divided by gender and age (20 to 40 years, 41 to 60 years, and above 60 years). The frontal bone curvature was evaluated by the length of frontal bone and by two frontal bone angles in relation to the Frankfurt horizon. Results: In both genders, aging was associated with increasing lower slope length. In elderly men (>60 years), the upper slope angle was significantly higher when compared to younger male subjects. Women demonstrated similar age-related changes, but the differences were only statistically significant for the middle and older age groups. Conclusion: This study demonstrates quantifiable age-related changes in the frontal bone. These findings contribute to the understanding of age-related changes of the facial soft tissues. The mean measurements in each age group can be used as a reference when planning forehead reconstruction.

Hyung Suk Yi, Hyo Seong Kim, Sung Tack Kwon, Eui Cheol Jeong Department of Plastic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea Department of Plastic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea

113 Copyright c 2014 The Korean Fracture Society. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Received October 30, 2013 Revised December 2, 2013 Accepted December 18, 2013 Address reprint requests to: Jae-Sung Yoo, M.D. Department of Orthopedic Surgery, Dankook University Hospital, 201 Manghyang-ro, Dongnam-gu, Cheonan 330-715, Korea Tel: 82-41-550-6579ᆞFax: 82-41-556-3238 E-mail: idbabe@naver.com