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Background Adipose tissue damage of cryopreserved fat after autologous fat transfer is inevitable in several processes of re-transplantation. This study aims to compare and analyze the survivability of adipocytes after thawing fat cryopreserved at -20℃ by using thawing methods used in clinics. Methods The survival rates of adipocytes in the following thawing groups were measured: natural thawing at 25℃ for 15 minutes; natural thawing at 25℃ for 5 minutes, followed by rapid thawing at 37℃ in a water bath for 5 minutes; and rapid thawing at 37℃ for 10 minutes in a water bath. The survival rates of adipocytes were assessed by measuring the volume of the fat layer in the top layers separated after centrifugation, counting the number of live adipocytes after staining with trypan blue, and measuring the activity of mitochondria in the adipocytes. Results In the group with rapid thawing for 10 minutes in a water bath, it was observed that the cell count of live adipocytes and the activity of the adipocyte mitochondria were significantly higher than in the other two groups (P Conclusions It was shown that the survival rate of adipocytes was higher when the frozen fat tissue was thawed rapidly at 37℃. It can thus be concluded that if fats thawed with this method are re-transplanted, the survival rate of cryopreserved fats in transplantation will be improved, and thus, the effect of autologous fat transfer will increase.

Background Liposuction is a procedure to reduce the volume of subcutaneous fat by physical force. Intracellular storage fat is composed of triglyceride, whereas circulating fat particles exist as cholesterol or triglycerol bound to carrier proteins. It is unavoidable that the storage form of fat particles enters the circulation system after these particles are physiologically destroyed. To date, however, no studies have clarified the fatal characteristics of fat embolism that occurs after the subclinical phase of free fat particles. Methods A mixture of human lipoaspirate and normal saline (1:100, 0.2 mL) was injected into the external jugular vein of rats, weighing 200 g on average. Biopsy specimens of the lung and kidney were examined at 12-hour intervals until postoperative 72 hours. The deposit location and transport of the injected free fat particles were confirmed histologically by an Oil Red O stain. Results Inconsistent with previous reports, free fat particles were transported from the intravascular space to the parenchyma. At 24 hours after infusion, free fat particles deposited in the vascular lumen were confirmed on the Oil Red O stain. At 72 hours after infusion, free fat particles were accumulated compactly within the parenchymal space near the perivascular area. Conclusions Many surgeons are aware of the fatal results and undiscovered pathophysiologic mechanisms of free fat particles. Our results indicate that free fat particles, the storage form of fat that has been degraded through a physiological process, might be removed through a direct transport mechanism and phagocytotic uptake.

Keloid is a scar tissue that undergoes recovery and excessive growth over the origi- nal wounds when the collagen is excessively accumulated in the dermis during the wound healing process. The common sites of keloid occurrence include the anterior thorax, shoulder, upper extremities and ear. To our knowledge, however, there are few cases of keloid that occurs in the axilla. In addition, there are fewer cases of ke- loid that bilaterally occurs at the operated sites postoperatively in individuals with no past or family history. 21-year-old male had undergone subdermal shaving for the management of osmidrosis but had not received appropriate scar management dur- ing the military service. He visited us with a keloid-like scar formed in the bilateral ax- illae. We excised the scar tissue and treated it with local steroid injection and postop- erative axilla compression. In histopathological report, no flattening of the overlying epidermis, and presence of keloid collagen which confirms diagnosis of keloid. We report our clinical experience with a rare case of keloid occurring in the axilla and treatment process.

It has been known that the post-burn scar may cause symptoms including pigmentation, pruritus, pain, and contracture, and result in psychosocial depression of individuals due to the loss of physical functions and dysmorphia depending on the location and severity of the burn scar, leading to substantial disruption in social life. In the particular case of hand and extremities where burn occurs frequently, although there have been a great deal of literature concerning the recovery of functional loss due to the burn contracture, the interest in the aesthetic recovery of the burning scar on the hand tends to be gradually increasing lately, reflecting the words “the hand is the secondary face”. The aesthetic treatments of the post-burn scar on the hand include tattoo, punch grafting, epidermal graft after dermabrasion, chip skin graft and thin sheet skin graft [1-6]. However, the tattoo generated different skin color, and the simple skin graft may result in regrettable outcomes such as prominent scar around the boundary of the burn site, collapse of skin graft site, donor site scar, and pigmentary degeneration over time. Accordingly, we aim to confirm the outcomes of the thin splitthickness skin graft with a thickness of less than 8/1,000 inches that was carried out following the tangential excision of burn scar using an electrical dermatome for the aesthetic improvement of the post-burn scar of the hand.

Background Electrical burns are one of the most devastating types of injuries, and can be characterized by the conduction of electric current through the deeper soft tissue such as vessels, nerves, muscles, and bones. For that reason, the extent of an electric burn is very frequently underestimated on initial impression. Methods From July 1999 to June 2006, we performed 15 cases of toe tissue transfer for the reconstruction of finger defects caused by electrical burns. We performed preoperative range of motion exercise, early excision, and coverage of the digital defect with toe tissue transfer. Results We obtained satisfactory results in both functional and aesthetic aspects in all 15 cases without specific complications. Static two-point discrimination results in the transferred toe cases ranged from 8 to 11 mm, with an average of 9.5 mm. The mean range of motion of the transferred toe was 20° to 36° in the distal interphalangeal joint, 16° to 45° in the proximal interphalangeal joint, and 15° to 35° in the metacarpophalangeal joint. All of the patients were relatively satisfied with the function and appearance of their new digits. Conclusions The strategic management of electrical injury to the hands can be both challenging and complex. Because the optimal surgical method is free tissue transfer, maintenance of vascular integrity among various physiological changes works as a determining factor for the postoperative outcome following the reconstruction.

A 35-year-old man visited us with a chief complaint of painful swelling of the finger. A physical examination revealed a palpable mass, measuring approximately 2 cm×1 cm, on the dorsoradial side of the base of the middle phalanx of the right index finger (Fig. 1A). Upon history taking, we found that the mass had formed 7 to 8 years before and had since grown slowly. The mass had a firm, hard, discrete, and immobile consistency. An X-ray revealed a translucent, osteolytic lesion at the base of the middle phalanx; this lesion was eccentrically located to the cortex (Fig. 1B). The lesion was a mass with an ovoid shape and was parallel to the long axis of the bone; it had a slightly marginal sclerotic border. Moreover, it exhibited expansile growth to the adjacent soft tissue on the dorsoradial side. On the basis of these findings, we made a 2-cm straight, longitudinal incision on the radial side of the dorsum of the middle phalanx, thus confirming the presence of a bulging well-circumscribed cartilaginous-appearing mass (Fig. 2A). We performed an extensive, aggressive curettage of the lesion. The resulting bony defect was filled using iliac bone graft and screw fixation. In the resected specimen, there was a yellowish-white lobulated mass of 2 cm×1 cm×1 cm in size (Fig. 2B). On histopathological examination the mass mainly had a myxomatous appearance and was characterized by the lobular arrangement of stellate or spindle-shaped cells. The lobule was well circumscribed by fine fibrous septa and was composed of the central hypocellular area and the peripheral hypercellular area (Fig. 3). On the basis of these findings, we established a diagnosis of chondromyxoid fibroma (CMF). In the 15-month postoperative follow-up, the patient underwent an uneventful course without recurrent or metastatic episodes. Fig. 1 Preoperative findings. (A) Clinical photograph of the right index finger with a visible mass protruding from the dorsoradial side of the middle phalanx. (B) Preoperative anteroposterior X-ray film of the right index finger reveals radiolucent tumor in ... Fig. 2 Intraoperative findings. (A) Incision planning with exposure of the mass. (B) Resected specimen (2 cm×1 cm×1 cm). Fig. 3 Histopathology and immunohistochemistry findings. The tumor shows alternating hypocellular and hypercellular areas. The hypocellular areas form lobules composed of loosely arranged cells in the gray-blue chondromyxoid matrix and surrounded by hypercellular ... CMF was first described by Jaffe and Lichtenstein in 1948, and it is a rare, slowly growing benign bone tumor of cartilaginous origin. It accounts for less than 1% of all the primary bone tumors and less than 2% of benign bone tumors. Approximately 80% of the total cases occur in individuals aged 36 years or younger. There is no gender-related difference. To date, no definite etiologies have been documented. It is known that approximately 75% of the total cases of CMF affect the bones of the lower extremities. In particular, it occurs most frequently in the tibia and femur around the knee joint. Thus far, its incidence in the hand has been described to be very rare. Most cases of CMF typically originate from the metaphysis and may then extend to the epiphysis and diaphysis. The most common clinical manifestations of CMF include swelling and pain at the sites of primary tumor growth, but there are also some asymptomatic cases. Plain radiography shows that CMF has a round-to-oval medullary lesion with a well-defined margin and is parallel to the long axis of the bone. The tumor with a thin scalloped, sclerotic border has an eccentric location in the metaphysis and a translucent, osteolytic, bubbly appearance. Furthermore, it shows a slightly expansile growth to the adjacent soft tissue. For establishing the diagnosis of chondromyxoid fibroma, histopathological examinations are essential. In a nutshell, CMF is a firm, white, lobulated, well-circumscribed solid tumor mass that is sharply demarcated from the adjacent bone marrow. Light microscopy revealed that CMF is composed of three zones: myxomatous, fibrous, and chondroid zones. Histopathologically, it is characterized by the multilobular arrangement of stellate or spindle-shaped cells in an abundant myxoid background or chondroid intracellular material. These lobules are composed of the central hypocellular area and the peripheral hypercellular area. Surgical excision is the first-line choice for chondromyxoid fibroma, for which only simple curettage is performed or a bone graft is used for filling the cavitary defect following curettage. Although variable depending on the reports, the recurrence is estimated at approximately 25%. Postoperatively, regular follow-up including radiography is necessary. A good prognosis of CMF has been documented. In addition, it has been reported that CMF shows no distant metastasis [1,2,3,4,5].

Superficial acral fibromyxoma (SAF) was first reported by Fetsch et al. [1] in 2001; they described the distinctive soft tissue tumor, which had common clinical, histopathologic, and immunohistochemical features, in 37 patients [1-5]. To date, however, few cases of SAF have been described in the literature. A 54-year-old man presented with a 1-year history of a slowly growing lesion on the volar surface of the left second toe and complained of tenderness when walking. On physical examination, the patient had a skin-colored quadrangular mass, measured as approximately 4 cm×4 cm×2 cm in size (Fig. 1A). It was a nodular lesion with a well-defined margin, but had no erosion, eschar, or bleeding. In addition, it did not invade the periungual or subungual region. Furthermore, it had a soft surface with soft tissue adhesion. There were no notable findings on radiography nor a family history. However, the patient did have a several-year history of tinea pedis. The patient scratched the itching area, resulting in alternating wound healing and scarring. The patient was tentatively diagnosed with hypertrophic scar or keloid, for which we performed a complete resection of the mass (Fig. 1B). On histopathology, the mass was located underneath the hyperkeratinized epidermis, and it extended into the dermal and subcutaneous layer. Its cross-section showed a yellowish-white, jelly-like substance. Its histopathologic findings included a fascicular or storiform arrangement of spindle-shaped or stellate-shaped tumor cells in the myxocollagenous matrix (Fig. 2A). These findings were suggestive of proliferative fibroblasts. Accentuated microvasculature was present in the matrix, accompanied by the overall presence of mast cells throughout the lesion. However, there was no marked presence of other inflammatory cells. Moreover, there was no dysplasia or hyperplasia of the tumor cells. On immunohistochemistry, the tumor cells were positive for CD34 and negative for desmin, S100, and epithelial membrane antigen (EMA) (Fig. 2B). The patient was eventually diagnosed with SAF. At a 12-month follow-up, there were no notable complications or recurrence (Fig. 3). Fig. 1 Preoperative and intraoperative clinical photos. (A) Preoperative clinical photo showing a 4 cm×4 cm×2 cm solitary skin-colored mass on the volar side of the left second toe. (B) Resected specimen. Fig. 2 Findings of histopathologic and immunohistochemical stains. (A) Collection of spindle-shaped fibroblasts in a myxocollagenous matrix that blend into primarily myxoid areas of fibrous stroma (H&E, ×200). (B) Immunohistochemical stains (×200) ... Fig. 3 Postoperative view. Good cosmetic results were achieved without recurrence (12 months later). SAF is a solitary, nodular, slowly-growing, asymptomatic soft-tissue tumor with a well-defined margin. It is a rare tumor entity that mainly affects the soft tissue of the extremities and commonly occurs as a small nodule in the periungual or subungual regions of the fingers or toes. It has a predilection for middle-aged adults, showing a male predilection with a male-to-female ratio of 2:1. In addition, the mean age of onset is estimated at 43 years. It can take 3 months to 30 years until a diagnosis of SAF is confirmed. SAF is known to invade the nail, but causes no bone destruction on radiography. Grossly, the tumor has a semispherical polypoid or a verrucous shape. It also contains a grayish-white or yellowish-white jelly-like substance on cross-sections [1-5]. Histopathologically, SAF is a non-encapsulated, well-circumscribed tumor. It commonly occurs in the dermis and sometimes extends into the subcutaneous layer. In the myxoid or myxocollagenous matrix, spindle-shaped or stellate-shaped fibroblast-like cells undergo a proliferation of moderate degree. There is an irregular, loose, fascicular or storiform arrangement of the tumor cells accompanied by the overall presence of mast cells. It has no other inflammatory cells [1-5]. The myxoid matrix of the lesion is highlighted by alcian blue (pH 2.5) stain. On immunohistochemistry, it is positive for CD34, CD99, and vimentin but negative for S-100 protein, α-smooth muscle actin, glial fibrillary acidic protein, keratin, and human melanoma black-45. There is variability in the immunoreactivity for CD10 and EMA [1-5]. Differential diagnoses of SAF include tumors with myxoid lesions (myxoid fibrous histiocytoma, superficial angiomyxoma, myxoid dermatofibrosarcoma protuberans, low-grade myxofibrosarcoma, and myxoid neurofibroma) and those mainly affecting the fingers and nails (sclerosing perineurioma, acquired digital fibrokeratoma, and periungual fibroma) [1-5]. Immunohistochemistry plays a particularly important role in the differential diagnosis of myxoid lesions with similar histopathologic features. Myxoid fibrous histiocytoma is negative for CD34 and positive for factor XIIIa. Superficial angiomyxoma is positive for CD34 and is negative for S100, which is similar to the immunohistochemical findings of SAF, but it is negative for both SMA and muscle specific actin. Myxoid dermatofibrosarcoma protuberans is positive for CD34 and vimentin, and is negative for EMA, desmin, and XIIIa. Low-grade myxofibrosarcoma is positive for vimentin, but it is negative for CD34 and desmin. Myxoid neurofibroma is a tumor of neural origin, showing positive immunohistochemistry for S100, which is of help in making a differential diagnosis of SAF [1-5]. It is known that SAF has a benign natural course, for which the standard treatment modality is complete surgical removal. Incomplete surgical removal might cause a recurrence. Patients with SAF should be under regular follow-up. Prescott et al. reported that SAF had nuclear pleomorphism or mitotic activity showing malignant potential, but its malignant transformation or metastasis has not been described [1-5].

Basal cell carcinoma (BCC) is one of the most common skin malignancies. Its well-known etiologic factors include ultraviolet (UV) exposure, ionizing radiation, arsenal exposure, and genetic predisposition. Moreover, its etiological association with trauma or scar tissue has also been documented [1-3]. A 39-year-old woman visited us with the chief complaint of a hypertrophic scar occurring in the right supratip region (Fig. 1A). The patient had no past history of having abnormal symptoms or diseases in the right supratip region, but presented with a 10-month history of acne-like pustules. The patient also stated that the inflammation waxed and waned as the scars were frequently irritated during wound healing. Thereafter, residual scars gradually protruded and were suggestive of hypertrophic scarring, for which the patient visited us to undergo a scar revision. On physical examination, the patient had a round, protruding, solid, hard nodular lesion, measuring approximately 0.7 cm×0.7 cm in size. Grossly, the nodule showed a well-defined margin and a smooth surface, which was accompanied by depigmentation as well as mild capillary dilatation. There were no such findings as erosion, eschar, or bleeding. The patient also had no subjective symptoms such as pruritus or pain. Clinically, the patient was tentatively diagnosed with hypertrophic scarring occurring after recurrent episodes of trauma. First, considering that the patient was a young unmarried woman, we wished to minimize the postoperative nasal deformity and scar formation. We therefore decided to induce epithelialization following the tangential resection of the nodule. Following a resection of the nodule, however, we could not completely rule out the possibility of a tumor because it is well established that skin tumors commonly occur on the nose. We therefore performed a histopathologic examination, and the patient was diagnosed with nodular BCC (Fig. 2). The patient then underwent a complete resection of the tumor at a subcutaneous depth involving a 2-mm safe margin. The site of the defect was reconstructed using a bilobed flap (Fig. 1B). Currently, at 18 months postoperatively, the patient has been undergoing regular follow-up. The patient had no recurrence, and cosmetic outcomes were satisfactory (Fig. 1C). Fig. 1 Clinical photos. (A) Preoperative view. A well-defined, 0.7 cm×0.7 cm round, skin-colored nodule on the nasal dorsum. (B) Intraoperative view. Surgical design using a bilobed flap. (C) Postoperative view. Good cosmetic results 12 months after ... Fig. 2 Histologic findings. (A) Histologic image showing a tumor mass composed of nests of basaloid cells (H&E, ×4). (B) Tumor nests showing peripheral palisading nuclei and peritumoral fibrosis (H&E, ×200). BCC occurs frequently in the head-and-neck regions including the face; common sites of occurrence include the nose and eyelid. In addition, most cases occur in adults aged 40 years or older, and they also show a predilection toward body areas that are vulnerable to long-term sunlight exposure. Presumably, this might be because the long-term, excessive exposure to physicochemical irritants might induce the occurrence of skin malignancies [2]. In 1828, Jean-Nicholas Marjolin et al. first described the possible role of trauma in the pathogenesis of skin malignancies. Since then, several authors have reported the malignant transformation of a wound or scar tissue. "Marjorlin's ulcer" was originally coined to describe the cancer originating from a burn injury scar. However, its usage has since been extended to describe all malignancies arising from scar tissue [3]. In 1986, Noodleman and Pollack [3] reported that there was a relationship with trauma in 7.3% of 1,774 cases of BCC. More recently, Ozyazgan and Kontas [1] reported that trauma and scar tissue play a role in the pathogenesis of BCC. In Korea, two cases of BCC have been reported to have arisen from trauma [4]. To date, however, few reports have addressed this subject compared with about the number of reports on squamous cell carcinoma arising from scar tissue. The length of time that elapses from the onset of trauma until a tumor occurs can vary, ranging from several weeks to several decades. Many types of trauma have been documented as causes of BCC, such as burn injury scars, vaccination sites, chicken pox scars, tattoo sites, sharp or blunt physical injury, skin exposed to polycyclic aromatic hydrocarbons, lupus vulgaris, chronic stasis ulcers, sites of cold injury, site of hair transplantation, lesions of epidermolysis bullosa, colostomy sites, dog bites, electrical burns, and gunshot wounds [1-5]. Little is known about the pathophysiology of the malignant transformation of scar tissue [1,3]. However, reports suggesting various types of involvement of trauma in the pathophysiology of BCC have included the following: 1) The BCC incidentally occurs with no etiological association with the trauma. BCC is a very common disease entity. Therefore, based on the recognition of major skin trauma or wounds, patients spontaneously consider the BCC to have occurred in association with the trauma. However, there is no actual correlation between the two phenomena [3]. 2) The skin becomes more vulnerable to UV exposure because of the atrophy and decreased perfusion in the trauma-induced scar tissue. Thus, the nutritional supply is compromised, which eventually leads to a lack of ability to repair DNA damage [3]. 3) With chronic irritation to the damaged skin tissue, malignant transformation occurs. The damaged skin tissue releases toxins that may cause cellular mutation. Chronic wounds exposed over the long-term to these toxins become more vulnerable to malignant transformation [5]. 4) In cases of tumors arising from dense scar tissue, immunological privilege prevents lymphocyte infiltration. This interferes with the immune surveillance system. Thus, the tumor can protect itself from human defense mechanisms until its growth reaches a significant level [3]. 5) In the presence of trauma, the epidermal cells are implanted into the dermis. This triggers the occurrence of foreign body reactions in the dermis, alters the normal wound healing activity of the tissue, and renders the tissue more vulnerable to damage [5]. In cases of BCC arising from trauma or scar tissue, the degree of malignancy is not relatively higher than that due to other causes [1,3]. Therefore, standard treatment modalities are performed for the management of BCC. Our case highlights that BCC may also occur even after the trauma. Therefore, clinicians must rule out the possibility of malignant transformation when they examine patients with traumatic scars located on body surfaces that are vulnerable to sunlight exposure.

A keloid is one of the most frustrating clinical problems in wound healing. Keloids form following dermal injury and exhibit exuberant and indefinite growth of collagen. Many theories have been propounded in trying to explain some of the vagaries of keloids. From one of the theories, keloid scars may develop at any age; patients between 10 and 30 years of age (reproductive age) are the most affected population, and there may be a hormonal influence because keloid scars tend to grow during puberty and pregnancy, and resolve during menopause [1]. In our experience, pregnancy-related recurrent keloids have arisen from the ear, despite the patient's successful completion of our treatment. The case presented here illustrates the possible connection between keloid formation and hormonal changes during pregnancy. A 27-year-old pregnant female visited our clinic due to progressive growth of her left auricular keloid. Three years prior to the visit, she had developed a scar on her left auricle after treatment for acute inflammation caused by an ear piercing procedure at a non-medical institute. She showed no other particular medical history. She also reported that the lesions appeared and became larger after the first trimester of pregnancy (Fig. 1). On physical examination, the left auricle showed a keloid of nearly circular appearance, approximately 2.2 cm in diameter, with a mean thickness of about 1.5 cm, extending from the superior pole of the auricle down to the middle ear. The skin surface of the keloid was irregular and showed dispersed minute superficial ulcer with itching sensation. Fig. 1 Preoperative photo showing a keloid after the first pregnancy. Because of pregnancy, we waited to perform a core extirpation of the keloid until 6 months after delivery. Compression on the auricle was performed postoperatively in combination with the application of scar care ointment. Even after 1 month, the clinical result remained obviously acceptable where the core extirpation had been performed. Two years later, the patient returned with a huge enlargement of the left auricular keloid. Similar to the previous keloid, it appeared and became bigger (2.2×1.7 cm) simultaneously with child bearing. She remembered that the keloid started to enlarge rapidly in her first trimester of her second pregnancy, with mild itching and redness. She was asked to return after her delivery (Fig. 2). Fig. 2 Preoperative photo showing a keloid after the second pregnancy. Accordingly, she underwent core extirpation 6 months after her second delivery, and compression treatment was performed postoperatively in combination with the application of scar care ointment. The patient was satisfied with the results at postoperative 4 months. The scar tissues, sized at 2.0×1.5 cm and 2.0×1.0 cm, were excised over repeated core extirpations. In both histopathologic reports, no flattening of the overlying epidermis, presence of keloidal collagen, or a prominent fascia-like fibrous band occurred, which confirms the diagnosis of keloid (Fig. 3). Fig. 3 (A) First pregnancy. Histopathologic photograph showing thepresence of keloidal collagen and a prominent fascia-like fibrous band, which confirms the diagnosis of keloid (H&E, ×100). (B) Second pregnancy. Histopathologic photograph showing ... Up to the present, the clinical outcome has shown a clean and satisfactory auricle. The patient has not undergone another pregnancy nor presented any additional keloid growth; specifically, she has reported that her lobular keloid remains inactive. In most known series of keloids, there is a higher incidence in women, with an apparent peak in the immediate post-pubertal years. Lane et al. [2] reported in his study that those who had ear piercings at 11 years of age or above were more likely to develop keloids (80%) than were those who had ear piercings under 11 years of age (23.5%). Because of this observation, the possibility of a female hormonal influence on keloid formation has been advanced. In a study of connective tissue tumors, Geschichter and Lewis [3], bioassayed a single keloid of an ear that had been preserved in formalin; they reported that this keloid tissue contained large amounts of estrogen and gonadotropic substances. However, no confirmation of their work has appeared in the literature. Jacobsson [4] reported a case of a woman whose 4-year-old scar became hypertrophic during pregnancy. Reviewing the different actions of pregnancy hormones, it appears that estrogens are the hormones most likely involved in the keloidal tendency that may accompany pregnancy [5]. The ovaries and adrenal cortex of mature women produce estrogens. In pregnancy, the major site of production is the placenta. Our patient noted rapid enlargement and irritation of her keloid, which began in the first trimester of pregnancy. This supports our view on the effect of hormonal influence in scar or keloidal tissue during pregnancy, and agrees with the concept that regression of symptoms occurs after delivery. It is known that auricular and lobular keloids appear on account of inflammation caused by an unhygienic ear piercing procedure. However, we report our treatment experience in a case with recurrent keloids during pregnancy after showing no particular change at the time of treating the inflammation. We conclude that pregnancy is the strongest risk factor for keloid recurrence in addition to the three clinical risk factors identified through a review of the literature: treatment history, timing of keloid growth, and timing of regression.

Soft tissue chondroma is a rare benign tumor, and it mainly affects hands and feet. Its prevalence reaches the highest level in individuals aged between 30 years and 60 years. In addition, it is known that there is no sex-related difference in its incidence. Repeated microtrauma has also been reported to be responsible for its occurrence. A 72-year-old woman visited us with a chief complaint of a 3-year-history of a palpable, skin protuberance on the left third toe. The patient had a past history of taking surgical excision for skin protuberance at the department of dermatology of other hospital. Thereafter, however, the patient received resection of the skin protuberance again because of its recurrence. Nevertheless, the patient had a palpable mass at the surgical sites and complained about discomfort in the toe. Therefore, the patient visited us. On physical examination, the patient had a round, ill-defined skin protuberance with a diameter of approximately 1 cm. On palpation, it was a rather solid mass. In addition, the patient had a scratch on the skin surface (Fig. 1). On preoperative plain radiography, the patient had a calcified lesion with a diameter of

Moll's cyst is one of the apocrine sweat gland cysts that occur on the margin eyelid. Thus far, however, only a few cases of Moll's cyst occurring in the orbital septum have been reported [1]. A 29-year-old woman complained of gradual swelling of the right upper eyelid. The patient had a history of undergoing blepharoplasty 7 years ago at another hospital. However, the patient had no other notable findings such as trauma. Upon physical examination, the patient was found to have a protruded mass when she had her eyes closed (Fig. 1). Ultrasonography revealed that the isoechoic mass was 1.6 cm×0.6 cm in size and had a well-defined margin and a fluid-containing lesion (Fig. 2). Under local anesthesia, we made a transverse incision along the double-eyelid line. The mass presented in the orbital septum. Through an incision of the orbital septum, we exposed the mass (Fig. 3). The mass was encapsulated by a transparent, white fibrous tissue. We carefully dissected it while paying special attention to not damage the levator aponeurosis. The patient wanted a mild blepharoptosis correction at the same time; therefore, we performed surgery on both eyes. Postoperatively, the mass contained a transparent fluid in the unilocular capsule. Histopathological examinations revealed that the tumor was composed of two layers of cuboidal epithelium. These two layers had a columnar shape (Fig. 4). Further, a 1-year follow-up revealed that the patient had no notable findings without recurrence (Fig. 5). Fig. 1 Preoperative findings: When the patient's eyes are closed, the protruded mass (yellow arrow) on the right upper eyelid becomes noticeable; this mass was soft, pliable, and round. Fig. 2 Preoperative ultrasonography: 1.6 cm×0.6 cm in size, an isoechoic mass with a well-defined margin and fluid-containing lesion (yellow arrow) on the lateral side. Fig. 3 Intraoperative findings. The cystic mass was in the orbital septum, surrounded by the periorbital fat. It contained fluid and was encapsulated by transparent, white fibrous tissue. Fig. 4 Histopathological findings. The tumor was composed of two layers of cuboidal epithelium surrounded by adipose fibrous tissue. The two layers of cuboidal epithelium had a columnar shape (H&E, ×200). Fig. 5 Postoperative findings (1 year later). The patient had no notable findings without recurrence. Moll's cyst may also occur in the orbital septum because of congenital factors. That is, it occurs when there are disturbances in the development of the epidermis that should have developed on Moll's gland in the embryonic stage [2]. Further, it has been reported that Moll's cyst may also occur as a result of the epidermal invagination of the eyelid from certain acquired causes such as trauma or other iatrogenic factors [3]. Our case developed this cyst for acquired reasons and not congenital ones. This is attributed to the following: Moll's cyst occurs very rarely in the orbital septum. Concurrent deformities of the adjacent tissue may also occur during the growth to the adult stage in congenital cases of Moll's cyst. The patient complained of the discomfort on the eyelid only recently. The patient had a history of blepharoplasty. Moll's cyst is surrounded by a thin white wall and contains a transparent fluid. Histologically, a cuboidal epithelium composed of two layers of secretory cells forms the inner wall of the cyst, and the rest of the cyst undergoes a fibrotic change. Of the two layers of secretory cells, the inner layer is composed of columnar epithelium and protrudes into the cyst. Further, its apical portion contains an eosinophilic substance. These findings are similar to those of Moll's gland [4]. In the current case, the clinical characteristics and histopathological findings were typically suggestive of Moll's cyst. In other words, we witnessed a rare case of Moll's cyst occurring in the orbital septum.

Ectopic nail is a very rare disease entity where the nail grows in other places than the nail bed due to the abnormal location or direction of the nail matrix. Since it was first reported in 1931, approximately 50 cases have been described in the literature. It is generally classified into two types: congenital ectopic nail due to genetic aberrations and the acquired one, also known as posttraumatic ectopic nail. The former accounts for most cases [1-3]. An 8-year-old girl visited us with a chief complaint of nail deformity in the left thumb (Fig. 1A). At the age of 2 years, the patient sustained a soft tissue crushing injury because of the entrapment of the distal phalanx of the left thumb in a chink in the door. Three months after spontaneous wound healing, the patient developed a swelling of the nail root accompanied by a hard eschar. Afterwards, the patient presented with a nail-like keratotic lesion. It had grown persistently up to the time of presentation at our clinic with a similar rate of growth as the normal nail. However, the patient presented with no other symptoms such as pain or tenderness. The patient had normal radiological findings (Fig. 1B). On physical examination, the patient had an additional nail-like keratotic lesion 7 mm×5 mm in size, growing in the eponychium, whose location was remote from the normal nail. The clinical impression was posttraumatic ectopic nail. Under intravenous anesthesia, we made a 1-cm longitudinal incision from the radial edge of the lunula to the proximal side, taking care not to damage the matrix of the normal nail. We found a fully developed the ectopic nail unit separate from the normal one. There was no adhesion between the ectopic and normal nail units. Thus, using a No. 15 blade, we successfully removed the ectopic nail plate including its matrix en bloc (Fig. 2A, B). On histopathology, the nail bed was slightly stained with the hematoxylin-eosin (H&E) dye. In addition, there was an underlying presence of the nail matrix without a granular layer. Based on these findings, the patient was diagnosed with posttraumatic ectopic nail (Fig. 2C). At the most recent follow-up (6 months), it was determined that the patient had undergone an uneventful course without recurrent episodes or complications. Fig. 1 Preoperative findings of the case. (A) A solitary, localized, well-demarcated, 7 mm×5 mm, whitish hyperkeratotic nail-like skin lesion on the center of the left thumb. (B) No underlying bone deformity is visible on plain radiography. Fig. 2 Intraoperative view and histologic findings. (A) Exposure and identification of the ectopic nail. (B) Excision of the ectopic nail and its matrix. (C) Histopathologic findings showing keratotic squamous epithelium in a fully-developed nail unit (H&E, ... Ectopic nail, also termed onychoheterotopia, is a pathologic condition characterized by the persistent growth of the ectopic nail plate due to the presence of the ectopic nail matrix in other regions than the normal nail bed. Little is known about the exact pathogenesis of ectopic nail, for which various hypotheses have been proposed. According to Ohya et al., an ectopic nail is a teratoma that is formed by stray germ cells (cited in Jeong et al. [2]). According to Kikuchi et al. [4], the pathogenesis of ectopic nail is closely associated with rudimentary nail or hidden polydactyly. According to some reports, it is associated with congenital palmar nail syndrome, Pierre Robin syndrome, or the aberration of the long-arm of chromosome 6. This provides a possibility that its pathogenesis might have a familial tendency or genetic inheritance. On the other hand, posttraumatic ectopic nail may occur as a result of acute single overwhelming injury or chronic repeated minor injury. That is, posttraumatic ectopic nail occurs when the germinal matrix of the nail is split and its split section is implanted in the skin [1-4]. Clinical characteristics of ectopic nail include the small outgrowth of a deviant nail or complete double fingernail malformation. In congenital cases, an ectopic nail typically grows alongside the normal nail. Due to the abnormal location of the nail matrix, however, it may also be deviated from the normal nail. Congenital ectopic nail most commonly affects the palmar aspect of the fifth finger, followed by the palmar surface of the fourth finger, the first and third finger, and the second digit in decreasing order. On the other hand, posttraumatic ectopic nail affects the dorsal aspect of the finger the most commonly. However, few case reports have shown that it occurs in the toe or other body regions than the finger or toe [1-4]. Most cases of ectopic nail are asymptomatic, but their clinical findings may include pain, pruritis, and swelling. It may also invade the normal nail matrix, thus disturbing the growth of the normal nail and causing a nail deformity. In addition, due to its contact with the underlying bone, it may also disturb the intramembranous ossification, thus leading to bone deformity [1-4]. Lew et al. [5] reported that ectopic nail is radiologically characterized by such findings as hypoplasia, thinning, or depression of the phalanx. It has also been reported that these radiological findings gradually disappear over time after surgical excision without causing serious problems. Radiological findings with an ectopic nail may vary depending on the depth and location of its matrix [2,5]. A diagnosis of ectopic nail is routinely made based on its typical clinical and histopathologic findings. Its histopathological findings are similar to those of the normal nail. That is, an ectopic nail is histopathologically characterized by the presence of keratotic squamous epithelium, a corneous plate, and a matrix in a fully-developed nail unit. The ectopic nail is devoid of a nail bed but it also has a nail matrix [1-4]. The differential diagnosis should include foreign body reactions, rudimentary polydactyly, teratoma, hamartoma, split nail deformity, cutaneous horn, polyonychia associated with syndactyly, epidermolysis bullosa, and congenital ectodermal dysplasia [1-4]. The standard treatment regimen for ectopic nail is surgical excision. To prevent recurrence, the matrix of an ectopic nail should be removed. According to a review of the literature, however, there are few cases of recurrence after surgical excision [1-4]. Because ectopic nail is an extremely rare condition, it is likely to be overlooked during diagnosis. Based on its typical clinical and histopathologic findings, however, it may be easily diagnosed. Moreover, it may also be easily corrected with surgical excision. It is therefore mandatory to accurately understand the clinical characteristics of ectopic nail.

수부는 전체 체표면적의 5% 이하를 차지 하지만 기능적 역 할이 매우 중요하여 외상 후 기능적 장애를 최소화하기 위해 많은 노력이 이루어져 왔다. 손상 정도나 부위에 따라 단순봉 합부터 피부이식술, 국소피판술, 유리피판술 등 여러 수술 방 법들이 적용되어 왔다. 이 중 피부이식술은 결손을 동반한 상 처를 치유하는 가장 간단하면서도 유용한 방법으로 많이 이용 되어 왔다. 전층 피부이식의 경우 샅고랑(groin) 부위에서 얻 은 전층 피부를 사용하는 경우가 많았으나, 이식한 피부는 시 간이 경과 하면서 과색소침착이 생기게 되어 미용상의 부조화 를 보이는 경우가 많았다. 수부는 얼굴부위와 함께 항상 노출 되는 부위이기 때문에 미용적 특성에 대한 고려가 필요하다. 따라서 이 같은 부조화를 해결하기 위해 많은 다양한 부위에 서 피부이식편을 얻고자 하는 시도가 이루어져 왔으며 현재까 지 이식편의 제공부위로 발바닥, 발목, 손목, 손의 새끼두덩 (hypothenar) 등이 제시되고 있다. 저자들은 눈꺼풀, 코, 뺨 등 안면부의 다양한 결손을 재건하는데 이용되는 후이개부 전 층 피부이식술이 수술 후 색소침착이 적어 주위 조직과 피부 색의 조화가 우수하다는 점에 착안하여 수부의 전층 피부이식 술에 후이개부를 공여부로 사용하여 좋은 결과를 얻었기에 문 헌고찰과 함께 보고한다. The Usefulness of Retroauricular Full Thickness Skin Graft in Hand Reconstruction

Background Lipomas can be categorized into deep and superficial lipomas according to anatomical depth. Many cases of forehead lipomas are reported to be deep to the muscle layer. We analyze ultrasound in delineating depth of forehead lipomas. Methods A retrospective review was performed for all patients who underwent excision of forehead lipomas between January 2008 and March 2013 and for whom preoperative ultrasound study was available. Sensitivity and specificity of ultrasound imaging was evalauted against depth finding at the time of surgical excision. Results The review identified 42 patients who met the inclusion criteria. Preoperative ultrasound reading was 18 as deep lipomas and 24 as superficial. However, intraoperative finding revealed 2 of the 18 deep lipomas to be superficial and 13 of the 24 superficial lipomas to be deep lipomas. Overall, ultrasonography turned out to be 69% (29/42) accurate in correctly delineating superficial versus deep lipomas. Conclusion Lipomas of the forehead tend to be located in deeper tissue plane compared to lipomas found elsewhere in the body. Preoperative ultrasonography of lipomas can be helpful, but was not accurate in identifying the depth of forehead lipomas in our patient population. Even if a forehead lipoma is found to be superficial on ultrasound, operative planning should include the possibility of deep lipomas.

프레스 기계는 플라스틱이나 금속 등의 가공재가 들어 있는 금형에 강한 힘을 가함으로써 재료를 성형하는 기계이다. 그 중에서 천공 프레스 기계는 상대적으로 작은 접촉면적에 강한 압력을 가해 타공하는 기계로서 조작 및 작업이 쉬워 널리 사 용되고 있다. 하지만 사용 과정에서 작업자의 부주의로 수부 의 손상이 발생할 위험이 있다. 천공 프레스에 의한 수지의 손 상은 금형의 형태에 따라 분절 절단(segmental amputation) 손상 형태를 보이는 경우가 많다. 그리고 작은 면적에 강한 압 력이 작용하므로 절단부 조직의 손상 정도가 심하지 않은 경 우가 많아서 수지의 분절 손상이 발생한 경우, 손상 부위의 원 위부는 반대측의 정상 수지 동맥을 통해 혈액순환이 온전하게 유지될 가능성이 높다. 이러한 경우 수지의 손상을 효과적으 로 재건해야 윈위부의 정상 조직들을 보존할 수 있다. 절단부 조직을 보존한 경우 재접합술을 시행하여 좋은 결과가 보고된 바 있다. 따라서 절단부 조직이 있는 경우 재접합술을 우선으 로 고려하며, 절단부 조직이 없거나 절단부 조직의 압궤 손상 이 심하여 재접합술을 할 수 없을 경우 결손 부위를 적절한 수 술 방법으로 재건하여야 한다. 저자들은 천공 프레스 기계에 의해 수지의 중간 부위에서 분절 절단 손상 후 손상 부위의 원위부 혈류 순환이 유지되는 Reconstruction of Digits Injured by Punch Press Machine

www.e-acfs.org pISSN 2287-1152 eISSN 2287-5603 124 Copyright © 2013 The Korean Cleft Palate-Craniofacial Association 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. Correspondence: So-Min Hwang Aesthetic, Plastic and Reconstructive Surgery Center, Good Moonhwa Hospital, 119 Beomil-ro, Dong-gu, Busan 601-803, Korea Tel: +82-51-630-0199 / Fax: +82-51-630-0145 / E-mail: blueorange1009@hanmail.net Received August 31, 2013 / Revised September 19, 2013 / Accepted October 7, 2013 양성 종양으로 오인된 낭선암종 1례

www.kcpca.or.kr ISSN 2287-1152 60 Copyright © 2012 The Korean Cleft Palate-Craniofacial Association 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. 다비공증: 증례보고

www.kcpca.or.kr ISSN 2287-1152 68 Copyright © 2012 The Korean Cleft Palate-Craniofacial Association 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. 외접근 비교정술 후 발생한 단순 포진 바이러스 감염 치험례

일반적으로 인체에서 발생되는 양성 종양은 악성 종양에 비 해 크기가 자라는 속도가 느리고 비침습적이며 재발률이 낮고 생명에 위협적이지 않은 것으로 알려져 있다. 그러나 때때로 임상에서 조직학적으로 양성 종양에 해당되지만, 종양의 크기 가 크거나 종양의 특성상 임상적으로는 악성 종양 못지않게 침습적이고 공격적인 성향을 가지는 양성 종양을 만나게 되는 경우가 있다. 특히 수부에 발생하는 종양은 병리조직학적으로 양성 종양에 해당하더라도 크기가 클 경우 주변 건이나 인대, 혈관, 신경 등을 침범하여 수술적 제거가 쉽지 않아 임상적으 로 합병증을 남기거나, 재발하는 경우가 발생하기도 한다. 이 에 저자들은 드물지만 수부에 발생한 3 cm 이상의 거대 양성 종양을 제거한 뒤 다시 재발한 임상 4예를 분석하여, 수부에 발생한 거대 양성 종양의 치료 후 재발을 막는데 도움이 되고 자 한다.

www.e-acfs.org pISSN 2287-1152 eISSN 2287-5603 104 Copyright © 2012 The Korean Cleft Palate-Craniofacial Association 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. 비골 골절에서 외측 비골 절골술의 적용

www.e-acfs.org pISSN 2287-1152 eISSN 2287-5603 156 Copyright © 2012 The Korean Cleft Palate-Craniofacial Association 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. 이마에 발생한 석회화된 지방종