Publications by authors named "Joon-Seok Lee"

86 Publications

Osteogenesis of 3D-Printed PCL/TCP/bdECM Scaffold Using Adipose-Derived Stem Cells Aggregates; An Experimental Study in the Canine Mandible.

Int J Mol Sci 2021 May 21;22(11). Epub 2021 May 21.

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea.

Three-dimensional (3D) printing is perceived as an innovative tool for change in tissue engineering and regenerative medicine based on research outcomes on the development of artificial organs and tissues. With advances in such technology, research is underway into 3D-printed artificial scaffolds for tissue recovery and regeneration. In this study, we fabricated artificial scaffolds by coating bone demineralized and decellularized extracellular matrix (bdECM) onto existing 3D-printed polycaprolactone/tricalcium phosphate (PCL/TCP) to enhance osteoconductivity and osteoinductivity. After injecting adipose-derived stem cells (ADSCs) in an aggregate form found to be effective in previous studies, we examined the effects of the scaffold on ossification during mandibular reconstruction in beagle dogs. Ten beagles were divided into two groups: group A (PCL/TCP/bdECM + ADSC injection; = 5) and group B (PCL/TCP/bdECM; n = 5). The results were analyzed four and eight weeks after intervention. Computed tomography (CT) findings showed that group A had more diffuse osteoblast tissue than group B. Evidence of infection or immune rejection was not detected following histological examination. Goldner trichrome (G/T) staining revealed rich ossification in scaffold pores. , , and gene expressions were determined using real-time polymerase chain reaction. Group A showed greater expression of these genes. Through Western blotting, group A showed a greater expression of genes that encode ColI, Osteocalcin, and Runx2 proteins. In conclusion, intervention group A, in which the beagles received the additional ADSC injection together with the 3D-printed PCL/TCP coated with bdECM, showed improved mandibular ossification in and around the pores of the scaffold.
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http://dx.doi.org/10.3390/ijms22115409DOI Listing
May 2021

Delayed unilateral hematoma after reconstructive and aesthetic breast surgery with implants in Asian patients: two case reports.

Gland Surg 2021 Apr;10(4):1515-1522

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.

Hematomas represent one of the postoperative complications in patients undergoing reconstructive or aesthetic breast surgery with a silicone implant. Although there are few reports of intracapsular hematoma, those presenting late hematoma after reconstructive and aesthetic augmentation surgeries are rarer. This study reported two Asian patients with late hematoma after reconstruction and aesthetic breast surgery. A 54-year-old female patient underwent bilateral nipple-sparing mastectomy with immediate breast reconstruction using anatomically shaped textured implant for intraductal carcinoma in August 2019. Contralateral nipple-sparing mastectomy was performed for the gene mutation on the left breast, which was immediately reconstructed with an anatomically shaped textured implant. In a 1-year postoperative magnetic resonance imaging evaluation, an extracapsular hematoma was found on the right side, which was removed following the removal of both implants. Another case was a 63-year-old female patient who underwent augmentation of both breasts with smooth round implants and experienced right unilateral swelling and painless firmness about 30 years postoperatively. A preoperative magnetic resonance imaging evaluation showed both intracapsular and extracapsular ruptures on the right breast and a bulging implant herniation on the left breast. During the operation, hematoma, implants, and capsule were all removed. The excised capsule was sent for histological evaluation. Slightly dark colored blood was emptied before removing the semisolid-state intracapsular hematoma. In both cases, the patients responded well postoperatively and were discharged to their homes with no postsurgical complications, including seroma, or additional hematoma on the breasts. The etiology of late hematoma following breast augmentation or reconstruction has been poorly characterized. Further reports are needed to clearly establish the reasons for this increase in late hematoma formation.
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http://dx.doi.org/10.21037/gs-20-854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102217PMC
April 2021

Oscillatory shear stress promotes angiogenic effects in arteriovenous malformations endothelial cells.

Mol Med 2021 03 31;27(1):31. Epub 2021 Mar 31.

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Korea.

Background: Vascular endothelial cells (ECs) are subject to continuous shear stress due to blood circulation. Mechanical stress due to high shear flow can also cause arteriovenous malformation (AVM) when ECs respond hyper-sensitively to shear flow. This study was conducted to test the hypothesis that angiogenesis could be promoted in response to mechanical stress via regulation of pro-angiogenic factors in AVM cells.

Methods: ECs were extracted from the tissue samples from six AVM patients and six normal patients. Shear stress at 7 dynes/cm2 were applied for 24 h. Before and after application of shear stress to each group, RT-PCR was performed to access the expression levels of angiopoietin2(AGP2), aquaporin1(AQP1) and TGFβR1. Immunofluorescences was also performed to evaluate the level of protein expressions.

Results: In both normal and AVM tissues, AGP2 and TGFβR1 under the shear stress showed increased expression in the ECs compared to the non-sheared samples. When AVMs and normal arterial vasculature were compared, the expression levels of both AGP2 and TGFβR1 in AVMs were higher when compared to normal arterial vasculature with or without shear stress. Immunofluorescence-based protein analysis also confirmed shear-induced AGP2 and TGFβR1 in both samples of normal and AVM patients.

Conclusions: AVMs exhibited higher sensitivity to shear stress by producing higher expressions of some marked genes and proteins that regulate the endothelial functions upon exposure to shear stress. While the physiological mechanism for AVMs remain elusive, our study shows the plausibility of physical stress imposed by the shearing flow can cause the occurrence of AVMs.
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http://dx.doi.org/10.1186/s10020-021-00291-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011119PMC
March 2021

Strategy for salvaging infected breast implants: lessons from the recovery of seven consecutive patients.

Arch Plast Surg 2021 Mar 15;48(2):165-174. Epub 2021 Mar 15.

Department of Plastic and Reconstructive Surgery, Kyungpook National University, Daegu, Korea.

Background: In recent years, implant-based breast reconstruction has been performed because of its simplicity, short operation time, and rapid recovery of patients. Several studies have reported treatment methods for implant surgery-related infection, which is a serious complication. The aim of this study was to introduce our strategy for salvaging infected implants and to evaluate its effectiveness.

Methods: The authors performed a retrospective study of 145 cases from 132 patients who underwent implant-based breast reconstruction from January 2012 to December 2018. Empirical antibiotics were immediately administered to patients with suspected infections. The patients then underwent salvage treatment including appropriate antibiotics, ultrasonography-guided aspiration, debridement, antibiotic lavage, and implant exchange through a multidisciplinary approach. Patient demographics, operative data, duration until drain removal, adjuvant treatment, and complications were analyzed.

Results: The total infection rate was 5.5% (8/145). A longer indwelling catheter period and adjuvant treatment were significantly associated with infection. The salvage treatment showed a success rate of 87.5% (7/8). Seven patients who received early aggressive salvage treatment recovered from infection. One patient with methicillin-resistant Staphylococcus aureus, who received salvage treatment 11 days after symptom onset, did not respond to drainage and antibiotic treatment. That patient subsequently underwent explantation.

Conclusions: In implant-based breast reconstruction, prevention of infection is of the utmost importance. However, if an infection is suspected, proactive empirical antibiotic therapy and collaboration with the necessary departments are required. Through a multidisciplinary approach and proactive early management, swift and appropriate salvage should be performed.
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http://dx.doi.org/10.5999/aps.2020.01578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007469PMC
March 2021

A prospective comparison study of early functional outcomes after implant-based breast reconstruction: subpectoral versus prepectoral technique.

Ann Palliat Med 2021 Mar 26;10(3):2520-2529. Epub 2021 Feb 26.

Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.

Background: After skin-sparing mastectomy, direct-to-implant breast reconstruction is divided into a subpectoral and prepectoral techniques. However, there is still lack of studies that have compared the functional recovery after reconstruction based on the two techniques. Therefore, this study was conducted as a prospective comparison of the functional recovery and quality of life between the two techniques.

Methods: Patients who had undergone mastectomy for breast cancer were grouped based on whether the approach during direct-to-implant reconstruction was subpectoral or prepectoral. Functional outcomes were evaluated pre-operatively, 2 weeks, 1, 3, and 6 months post-operation. The evaluation included range of motion of the shoulder, maximal muscle power of the shoulder, pain intensity (measured by the visual analogue scale), disability of the upper extremity (measured by the Disabilities of the Arm, Shoulder and Hand questionnaire), quality of life (measured by the 36-Item Short-Form Health Survey), and mood status [measured by the hospital anxiety and depression scale (HADS)]. Repeated-measures analysis of variance was performed to evaluate changes in functional assessments.

Results: In the subpectoral/prepectoral groups, the average age, body mass index (BMI), preoperative breast volume, and implant volume were 45.5/45.1 years, 22.6/22.7 kg/m2 , 244.5/206.0 cm3 , and 258.6/ 234.8 cm3 , respectively. There were no significant differences in functional assessments between the two groups before the operation. There were significant differences in visual analogue scale, Disabilities of the Arm, Shoulder and Hand (DASH) scores, and time interaction effects between the two groups. In post-hoc analysis, the prepectoral group exhibited lower visual analogue scale and DASH scores than those in the subpectoral group at 2 weeks post-operation.

Conclusions: The prepectoral group showed favorable recovery of pain intensity and disability of the upper arm at the early phase post-operation. Both groups functionally recovered at 6 months post-operation. Therefore, the prepectoral technique can be considered as a useful alternative technique, compared to the classic subpectoral technique.
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http://dx.doi.org/10.21037/apm-20-1550DOI Listing
March 2021

A Workhorse Flap for Covering Moderate-sized Defects after Breast-conserving Surgery: Supercharged Lateral Thoracodorsal Flap.

Plast Reconstr Surg Glob Open 2021 Feb 3;9(2):e3381. Epub 2021 Feb 3.

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Jung-gu, Daegu, South Korea.

The lateral thoracodorsal (LTD) flap technique is a type of oncoplastic breast surgery that involves transposition of tissue from the lateral aspect of a partial mastectomy defect. It is a relatively simple procedure and shows lower donor morbidity and good aesthetic outcomes. Complications, such as fat necrosis and wound dehiscence due to poor circulation, may occur at the distal part of the flap. We used a supercharged LTD flap to reduce this problem. In this study, the outcomes of the LTD flap over 13 years were reviewed.

Methods: We performed a retrospective study of 86 patients who underwent an LTD flap procedure between 2007 and 2019. We analyzed patient information using medical chart review and classified patients into groups according to lateral thoracic artery perforator supercharging. The incidence of complications, such as fat necrosis and wound dehiscence, was also analyzed.

Results: The mean tumor weight was 83.67 g, and defects had a moderate size, as they represented 25.02% of the total breast volume. Fat necrosis was noted in 19.4% of cases in the group without lateral thoracic artery perforator supercharging and 4% of cases in the group with supercharging, with a significantly lower rate in the supercharged group.

Conclusions: Our findings show that the LTD flap could be used to cover moderate-sized defects after breast-conserving surgery. Careful dissection to preserve the lateral thoracic artery perforator resulted in the reduction of complications, such as fat necrosis, and excellent aesthetic results.
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http://dx.doi.org/10.1097/GOX.0000000000003381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7929634PMC
February 2021

Aesthetic Scar-Less Mastectomy and Breast Reconstruction.

J Breast Cancer 2021 Feb;24(1):22-33

Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.

Surgical approaches in breast cancer have been changing to ensure both oncologic safety and cosmetic results. Although the concept of "oncoplastic breast surgery" has been accepted for decades, breast and plastic surgeons have been striving to develop more advanced surgical skills that ensure non-inferior oncologic outcomes with better cosmetic outcomes. Endoscopic or robotic devices, which are currently available only for chest or abdominal surgeries, could be used for breast surgery to ensure better cosmetic outcomes. The authors refer to this surgical concept as "aesthetic scar-less breast surgery and reconstruction," a term that encompasses the consequential concepts rather than naming it with simple technical words such as endoscopy-assisted or robot-assisted surgery. The "scar-less" term simply means leaving less of a scar, and better results can be expected by designing incisions on invisible areas. Herein, we summarize our experiences with various techniques of "aesthetic scar-less" surgery and review the existing literature on this topic.
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http://dx.doi.org/10.4048/jbc.2021.24.e11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920861PMC
February 2021

Natural course of fat necrosis after breast reconstruction: a 10-year follow-up study.

BMC Cancer 2021 Feb 16;21(1):166. Epub 2021 Feb 16.

Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Hoguk-ro 807, Buk-gu, Daegu, 41404, Republic of Korea.

Background: Although fat necrosis is a minor postoperative complication after breast reconstruction, occasionally it mimics to tumor recurrence in patients with breast cancer. Therefore, the surgeon should distinguish between benign fat necrosis and true local recurrence. The authors evaluated the clinical characteristics of fat necrosis after breast reconstruction and investigated the natural course of fat necrosis.

Methods: Between 2007 and 2013, a total of 362 patients underwent breast reconstruction after partial or total mastectomy for breast cancer in Kyungpook National University Hospital. Clinicopathologic characteristics and the occurrence of fat necrosis were assessed during surveillance for 10 years of mean follow-up period.

Results: There were 42 cases (11.6%) of fat necrosis after breast reconstruction with partial or total mastectomy which were confirmed by needle or excision biopsy. The fat necrosis was resolved after a mean period of 45.9 months (SD, ± 42.1) and 26 cases (61.9%) of fat necrosis were almost completely resolved (less than 5 mm) during 10-year follow-up period.

Conclusion: Based on the natural course of fat necrosis, the fat necrosis after breast reconstruction can be only monitored, if pathologic confirmation was done. More than half of the cases will be resolved within 2-3 years.
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http://dx.doi.org/10.1186/s12885-021-07881-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885495PMC
February 2021

Usefulness of Incisional Negative Pressure Wound Therapy for Decreasing Wound Complication Rates and Seroma Formation Following Prepectoral Breast Reconstruction.

Aesthetic Plast Surg 2021 Jan 20. Epub 2021 Jan 20.

Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Korea.

Background: Seroma is a common complication in prepectoral breast reconstruction. PICO dressing, a type of incisional negative pressure wound therapy (iNPWT), was used to reduce complications postoperatively.

Methods: This study was a retrospective cohort study that included patients who underwent prepectoral breast reconstruction between February 2017 and July 2019. There were two groups: one that received PICO dressing and a control group. The frequencies of overall complications, major seromas, and reoperations were analyzed. The durations and total amounts of seromas were also analyzed.

Result: Sixty patients were included in this study (PICO : 37 and non-PICO patients: 23). The overall incidence of complications, major seromas, and frequency of reoperations were lower in the PICO group compared to the non-PICO group (18.9% vs. 52.2%, p = 0.007; 16.2% vs. 43.5%, p = 0.020; 2.7% vs. 26.1%, p = 0.006, respectively). Univariate analysis was used to analyze the risk factors for complications due to the application of PICO dressing and showed statistically significant results for any complication. When univariate analysis was performed on risk factors for seroma, the duration of seroma showed statistical significance in association with PICO dressing status and mastectomy volume. The total number of patients who developed seroma was statistically correlated with age, PICO dressing status, and mastectomy volume.

Conclusions: PICO dressing after prepectoral breast reconstruction could be a useful tool for reducing the frequency of complications and major seroma, as well as the duration and total incidences of seroma.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-020-02115-0DOI Listing
January 2021

Correction of secondary unilateral cleft lip nasal deformity in adults using lower lateral cartilage repositioning, columellar strut, and onlay cartilage graft on the nasal tip with open rhinoplasty combined with reverse-U incision.

J Plast Reconstr Aesthet Surg 2021 05 6;74(5):1077-1086. Epub 2020 Nov 6.

Departments of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, 130 Dongdeok-ro, Daegu 41944, Republic of Korea. Electronic address:

A rhinoplasty technique involving lower lateral cartilage (LLC) repositioning and grafting of ear cartilage allows for nasal lengthening and nasal tip mobility. For better esthetic outcomes in patients with cleft lip nasal deformity (CLND), we combined cosmetic nasal tip plasty with standard techniques. We performed open rhinoplasty combined with reverse-U incision and V-Y plasty in 62 patients with secondary unilateral CLND from October 2013 to June 2018. Both LLCs were isolated, repositioned, approximated medially, and advanced with a Medpor strut, followed by tip suture technique. To further project and enhance the nasal tip and columella, application of ear cartilage onlay graft was used. As adjunctive procedures, septoplasty or osteotomy was carried out for correction of septal or nasal bone deviations, respectively. Photogrammetric evaluations of patients and statistical analyses were performed. Average age at operation was 23.5 years (range: 18-42 years). Of the 62 patients, 15 underwent dorsal augmentation with silicone implant. Two-layer conchal cartilage onlay grafting was performed to manage tip height. Outcomes in 34 patients were analyzed with pre- and postoperative photography. Nasal tip projection increased, alar base width index decreased, and alar and columellar symmetry significantly improved. No Medpor implant exposure or other adverse outcomes occurred. The proposed technique is effective for correcting secondary unilateral CLND and achieving a satisfying nasal appearance in adults.
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http://dx.doi.org/10.1016/j.bjps.2020.10.060DOI Listing
May 2021

A Prospective Study of the Efficacy of Cell-Assisted Lipotransfer with Stromal Vascular Fraction to Correct Contour Deformities of the Autologous Reconstructed Breast.

Aesthetic Plast Surg 2021 06 29;45(3):853-863. Epub 2020 Sep 29.

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Daegu, 41944, Korea.

Background: Autologous lipotransfer has increasingly become popular for breast reconstruction. Moreover, owing to the emergence of information regarding the efficacy of stromal vascular fraction (SVF) in terms of oncological safety and survival rate, procedures based on cell-assisted lipotransfer (CAL) have been widely employed recently. However, quantitative data of CAL with SVF are lacking. We evaluated the efficacy of CAL using SVF on survival rate in breast reconstruction.

Methods: A 12-month prospective study was conducted for 20 patients (20 breasts) requiring breast asymmetry correction due to volume deficit following autologous breast reconstruction using a transverse rectus abdominis myocutaneous flap or latissimus dorsi flap after total mastectomy. After the patients were equally divided into two groups-fat graft with SVF (Group 1, n = 10) and without SVF (Group 2, n = 10)-, the variance of breast volume was measured using three-dimensional scanning to analyze fat graft retention rate. Moreover, patient satisfaction and complications were investigated.

Results: Fat graft retention rate was higher in Group 1 than in Group 2 at both postoperative 6 months (73.8% vs. 62.2%; p = 0.03) and 12 months (65.4% vs. 48.4%; p = 0.03). Group 1 showed higher patient satisfaction. Regarding complications, fat necrosis occurred in 1 patient each in both groups. However, locoregional recurrence was not observed in any patient during follow-up.

Conclusions: CAL with SVF is effective in increasing survival rates of autologous fat grafts for correction of volume deficit after breast reconstruction. Moreover, it is associated with improved patient satisfaction in terms of the esthetic aspect.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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http://dx.doi.org/10.1007/s00266-020-01981-yDOI Listing
June 2021

Acellular dermal matrix combined with oxidized regenerated cellulose for partial breast reconstruction: Two case reports.

Medicine (Baltimore) 2020 Jul;99(31):e21217

Department of Surgery.

Rationale: Filling materials for partial defect of the breast have rarely been developed because of safety and durability.

Patient Concerns: Two female patients (ages, 53 and 50 years) with breast cancer underwent partial mastectomy with sentinel lymph node biopsy.

Diagnosis: Core needle biopsy revealed an invasive ductal carcinoma in both patients. Breast ultrasound showed hypoechoic nodules with irregular margins. Breast magnetic resonance imaging showed an irregularly shaped enhancing mass with duct extension in Patient 1 and irregularly shaped multifocal, enhancing masses with non-mass enhancement in Patient 2.

Intervention: A combination method using acellular dermal matrix and oxidized regenerated cellulose was used for partial breast reconstruction. The safety and cosmetic outcomes were evaluated for both patients.

Outcomes: There were no significant complications, and the breast shape and volume were well maintained, even 2 years after surgery. There was no postoperative tumor recurrence.

Conclusion: The combination of acellular dermal matrix and oxidized regenerated cellulose for partial breast reconstruction can be a good option based on oncological safety and cosmetic outcome.
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http://dx.doi.org/10.1097/MD.0000000000021217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402793PMC
July 2020

Correction of microtia with constriction features using a superficial temporal fascial flap combined with a rib cartilage graft.

Arch Plast Surg 2020 Jul 15;47(4):317-323. Epub 2020 Jul 15.

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.

Background: Microtia with constricted features is characterized by a short helical length of variable severity, upper antihelical or scaphal deficiency, and a downfolded upper ear. No consensus has been reached regarding the most appropriate surgical method for this condition. In this study, we aimed to introduce a simple and safe surgical method for the correction or reconstruction of upper helix ear deformities.

Methods: Between February 2011 and June 2014, eight patients with microtia with constricted upper helix ear deformity underwent reconstruction of the ear deformity. The upper ear helical framework was constructed by carving and curving the eighth rib cartilage harvested from the ipsilateral chest wall, covering this cartilage with a superficial temporal fascial flap, and adjusting the skin graft to align with the ear contour. To evaluate their satisfaction, patients were asked to complete a questionnaire regarding ear shape, symmetry, position, color, and overall outcome scored on a 5-point scale at 12 months postoperatively.

Results: None of the patients experienced severe complications in the reconstructed ear. The preoperative and postoperative vertical ear length ratios were 0.88 and 1.02, respectively. And the mean patient satisfaction scores for shape, symmetry, position, color, and overall outcome were 4.2, 4.5, 4.7, 4.4, and 4.6 out of 5 points, respectively. All patients expressed a high level of satisfaction at 12 months postoperatively.

Conclusions: Our technique provides a good alternative method for the reconstruction of moderate constricted upper helix ear deformities in patients who meet the surgical indications with satisfactory outcomes and few complications.
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http://dx.doi.org/10.5999/aps.2018.01165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398816PMC
July 2020

Combined treatment of surgery and sclerotherapy for sinus pericranii.

Arch Craniofac Surg 2020 Apr 20;21(2):109-113. Epub 2020 Apr 20.

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.

Sinus pericranii is a rare vascular anomaly characterized by abnormal venous communication between the inner and outer regions of the cranial cavity. Here, we report a case of sinus pericranii and venous malformations in the right periorbital region of a 2-year-old girl. Radiologic findings showed venous malformations in the right parietal region communicating with the superior sagittal sinus in the intracranial region. There were notable improvements following surgical resection for the abnormal venous lesions and several sclerotherapies. Presence of a bluish and pulsating mass on the scalp, which showed bruit on auscultation, may indicate sinus pericranii, which should be included in the differential diagnosis.
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http://dx.doi.org/10.7181/acfs.2019.00521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206457PMC
April 2020

Current status of and trends in post-mastectomy breast reconstruction in Korea.

Arch Plast Surg 2020 Mar 15;47(2):118-125. Epub 2020 Mar 15.

Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Korea.

Since April 2015, post-mastectomy breast reconstruction has been covered by the Korean National Health Insurance Service (NHIS). The frequency of these procedures has increased very rapidly. We analyzed data obtained from the Big Data Hub of the Health Insurance Review and Assessment Service (HIRA) and determined annual changes in the number of breast reconstruction procedures and related trends in Korea. We evaluated the numbers of mastectomy and breast reconstruction procedures performed between April 2015 and December 2018 using data from the HIRA Big Data Hub. We determined annual changes in the numbers of total, autologous, and implant breast reconstructions after NHIS coverage commenced. Data were analyzed using Microsoft Excel. The post-mastectomy breast reconstruction rate increased from 19.4% in 2015 to 53.4% in 2018. In 2015, implant reconstruction was performed in 1,366 cases and autologous reconstruction in 905 (60.1% and 39.8%, respectively); these figures increased to 3,703 and 1,570 (70.2% and 29.7%, respectively) in 2018. Free tissue transfer and deep inferior epigastric perforator flap creation were the most common autologous reconstruction procedures. For implant-based reconstructions, the rates of directto-implant and tissue-expander breast reconstructions (first stage) were similar in 2018. This study summarizes breast reconstruction trends in Korea after NHIS coverage was expanded in 2015. A significant increase over time in the post-mastectomy breast reconstruction rate was evident, with a trend toward implant-based reconstruction. Analysis of data from the HIRA Big Data Hub can be used to predict breast reconstruction trends and convey precise information to patients and physicians.
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http://dx.doi.org/10.5999/aps.2019.01676DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093270PMC
March 2020

Prepectoral breast reconstruction with complete implant coverage using double-crossed acellular dermal matrixs.

Gland Surg 2019 Dec;8(6):748-757

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.

Background: Prepectoral implant-based breast reconstruction involving full implant coverage with an acellular dermal matrix (ADM) is more convenient, provides better aesthetic results, and carries lower risk of complications than does the traditional dual-plane method with an ADM. However, the recently reported technique usually involves full wrapping of the implant using a single, large ADM. We aimed to clarify the usefulness of an implant covering technique using two double-crossed ADMs.

Methods: We retrospectively evaluated the records of 23 breast cancer patients who, between February 2017 and March 2018, received skin-sparing or nipple-sparing mastectomy followed by immediate prepectoral implant-breast reconstruction. We assessed preoperative characteristics, cancer treatment parameters, incidence of postoperative complications (necrosis, capsular contracture, infection), and patient satisfaction at 12 months postoperatively.

Results: This cohort (mean age, 45.5 years; body mass index, 22.1 kg/m; preoperative breast volume, 315.7 cc, excised mass weight, 291.4 g; silicone implant size, 252.4 cc) included 11 patients with ductal carcinoma in situ and 12 with invasive ductal carcinoma. Postoperatively, one patient received radiotherapy and nine received chemotherapy. Among postoperative complications, we noted capsular contracture (1/23, 4.3%), wound dehiscence (2/23, 8.7%), and seroma (3/23, 13.0%). Good patient satisfaction (mean score, 4.2-4.8 on the KNUH Breast Reconstruction Satisfaction Questionnaire) was obtained in all categories (breast symmetry, reconstructed breast size, shape, feel, pain, scar, self-confidence, sexual attractiveness, and overall satisfaction).

Conclusions: Prepectoral breast reconstruction involving complete implant coverage with double-crossed ADMs represents a good alternative to the traditional dual-plane subpectoral method, providing good patient satisfaction without adverse outcomes.
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http://dx.doi.org/10.21037/gs.2019.12.10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989914PMC
December 2019

Stability of lingual plate osteotomy in orthognathic surgery for patients with severe facial asymmetry: A retrospective analysis with 1-year follow-up.

J Craniomaxillofac Surg 2020 Feb 7;48(2):156-161. Epub 2020 Jan 7.

Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, South Korea. Electronic address:

This study aimed to evaluate the stability of lingual plate osteotomy after sagittal split ramus osteotomy (SSRO) in patients with severe facial asymmetry. It included 20 patients undergoing lingual plate osteotomy between January 2011 and January 2017. Cephalometric X-ray imaging and three-dimensional computed tomography (3DCT) were performed before the operation and then 1 day and 1 year after the operation. The relapse rate and postoperative complications were assessed. The operation time was compared between lingual plate osteotomy and transoral angle osteotomy. Specific values measured on cephalometric X-ray and 3DCT images showed significant changes 1 day after the operation, with 47.9% correction occurring in the occlusal plane angle (mean ± SD = 1.74 ± 0.84°, p < 0.05). However, no significant differences were found between measurements taken 1 day and 1 year after the operation, with a 5% change seen in the occlusal plane angle (mean ± SD = 0.1 ± 0.24°, p = 0.61), suggesting that the surgical outcomes can be well maintained for at least 1 year after surgery. Three patients experienced numbness postoperatively but recovered within 1 year. The operation time for lingual plate osteotomy was shorter than that for transoral angle osteotomy. Our findings indicate that lingual plate osteotomy after SSRO is stable, effective, and safe in patients with severe facial asymmetry.
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http://dx.doi.org/10.1016/j.jcms.2019.12.014DOI Listing
February 2020

Combined surgical and medical treatment in an adolescent with severe gynecomastia due to excessive estradiol secretion: a case report.

BMC Pediatr 2019 12 26;19(1):515. Epub 2019 Dec 26.

Department of Plastic and Reconstructive Surgery, Kyungpook National University, School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea.

Background: Gynecomastia develops due to the reversed estradiol-to-Testosterone ratio in adolescence, and symptoms typically improve within 2 years. The causes vary widely, including estrogen excess and tumors, and surgical treatment is usually given in late adolescence because postoperative symptoms may recur in adolescents. This study reports a case of a pediatric patient with severe gynecomastia due to excessive estradiol secretion who showed a positive outcome after receiving surgical treatment combined with aromatase inhibitor administration.

Case Presentation: A 9-year old boy visited to the Department of Pediatric Endocrinology for breast budding. At that time, the patient showed breasts at Tanner stage II and no abnormality on hormone tests. During a follow-up, both gynecomastia had progressed to Tanner stage III-IV at age 13. Tamoxifen 10 mg bid was administered; however, the condition rapidly progressed to Tanner stage V at 13.5 years. The evaluation of pathologic gynecomastia showed an increase of estradiol to 296 pg/mL with normal range 10 ~ 36 pg/mL and microlithiasis in both testes. As the condition worsened, total mastectomy was performed at the age of 13.5 years. Based on the assessment that elevated aromatase activity had induced breast budding, we changed the medication to anastrozole (Arimidex) 1 mg once a day, after which the estradiol level improved to 38.5 pg/mL and was maintained well in the two-year postoperative follow-up.

Conclusions: This case report shows a combined plastic surgery and appropriate medical management bring a positive outcome in severe gynecomastia patient.
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http://dx.doi.org/10.1186/s12887-019-1887-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6931246PMC
December 2019

Comparison between ultrasound-guided aspiration performed using an intravenous cannula or a conventional needle in patients with peri-prosthetic seroma.

Medicine (Baltimore) 2019 Dec;98(51):e18511

Department of Surgery.

Background: Peri-prosthetic seroma after implant insertion for breast reconstruction is a common but difficult-to-manage complication. This study aimed to compare peri-prosthetic seroma duration and the number of aspirations associated with intravenous cannula with those associated with conventional needle.

Methods: Seventy-one patients who underwent skin- or nipple-sparing mastectomy and implant insertion were treated for peri-prosthetic seroma. When peri-prosthetic seroma was detected, ultrasound-guided aspiration was performed either by using an intravenous cannula (n = 35) or a conventional needle (n = 36); however, the method adopted was randomly selected. We analyzed the participants' clinicopathologic factors after medical record review.

Results: There were no significant intergroup differences in mean age (P = .052), mean body mass index (P = .601), total clinical tumor size (P = .107), pathologic tumor size (P = .269), specimen weight (P = .147), implant size (P = .313), or operation time (P = .595). However, the mean total peri-prosthetic seroma volume was significantly higher (105.80 vs 88.58, P = .015) but the number of aspirations was lower (4.48 vs 5.80, P = .043) in the intravenous cannula group than in the conventional needle group. Mean peri-prosthetic seroma volume per aspiration was nonsignificantly higher in the intravenous cannula group (26.92 vs 19.14, P = .291).

Conclusion: Ultrasound-guided aspiration performed using an intravenous cannula was comparable to the procedure performed using a conventional needle. Furthermore, the former method can be safer and effective alternative to manage peri-prosthetic seroma.
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http://dx.doi.org/10.1097/MD.0000000000018511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6940179PMC
December 2019

The Effects of Helmet Therapy Relative to the Size of the Anterior Fontanelle in Nonsynostotic Plagiocephaly: A Retrospective Study.

J Clin Med 2019 Nov 14;8(11). Epub 2019 Nov 14.

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 702701, Korea.

Helmet therapy is an important nonsurgical approach for patients with nonsynostotic plagiocephaly, but its effectiveness may depend on certain anatomical features. We retrospectively examined the effects of helmet therapy according to the size of the anterior fontanelle. Two hundred patients with nonsynostotic plagiocephaly who underwent helmet therapy between 2016 and 2018 were included. Data regarding age at treatment onset and treatment duration were collected. Patients were divided into two groups depending on the age at treatment initiation: the 12-23 weeks group and the >23 weeks group. Patients were also divided based on the anterior fontanelle size to analyze the effects of helmet therapy according to the severity of plagiocephaly in each group as the change in the cranial vault asymmetry index (CVAI). Therapeutic effects were evaluated using the cranial vault asymmetry (CVA), CVAI, anterior symmetry ratio, posterior symmetry ratio (PSR), and overall symmetry ratio at baseline and treatment completion. Treatment initiation at age 12-23 weeks resulted in better effects than that after age 24 weeks. There were no sex-dependent differences in therapeutic effects. Greater changes in the CVA, CVAI, and PSR were associated with larger anterior fontanelles. Therefore, the anterior fontanelle size could be a prognostic factor for estimating helmet therapy outcomes.
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http://dx.doi.org/10.3390/jcm8111977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912406PMC
November 2019

Long-Term Outcomes of the Minimal Skin Incision Technique for Correcting Severe Microform and Minor-Form Cleft Lip With Philtrum Reconstruction Through the Intraoral Incision.

J Craniofac Surg 2020 Jan/Feb;31(1):79-84

Department of Plastic and Reconstructive Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea.

Background: Because the traditional technique is known to cause visible scarring, it is challenging to yield optimal outcomes while treating a severe type of microform and minor-form cleft lip. The authors present a new refined technique with minimal skin incision and philtrum formation through an intraoral incision.

Methods: The surgical technique involves single Z-plasty or double or triple unilimb Z-plasty to restore an elevated cupid's bow peak and overlapping of an orbicularis oris muscle flap to create the philtrum through an intraoral incision. Cleft lip nasal deformity was corrected with reverse-U incision and V-Y plasty.

Results: Eighteen patients were operated between September 2008 and June 2017. Patient age at the time of surgery ranged from 3 to 12 months. The duration of follow-up ranged from 12 months to 7 years (mean, 36 months). The elevated cupid's bow was corrected by performing single Z-plasty in 6 patients, double unilimb Z-plasty in 7 patients, and triple unilimb Z-plasty in 5 patients. In all cases, the notch or elevated cupid's bow was corrected, the surgical scar was minimal, and philtrum reconstruction was satisfactory. Minor scar revision was performed in 4 patients. Cleft lip nasal deformity was corrected in fifteen patients.

Conclusions: The technique adopted here causes minimal scarring, facilitates the formation of an anatomical philtrum, preserves the continuity and function of the muscle, and presents sufficient elevation of the philtral column.
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http://dx.doi.org/10.1097/SCS.0000000000005963DOI Listing
March 2020

Surgical approach for venous malformation in the head and neck.

Arch Craniofac Surg 2019 Oct 20;20(5):304-309. Epub 2019 Oct 20.

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.

Background: Treatment for venous malformations of the head and neck includes sclerotherapy, surgical resection, or a combination of both. Surgical resection can remove or reduce the volume of vascular lesions; however, surgery can cause postoperative scarring and potential surgical complications. This study sought to determine the effectiveness of surgery for the treatment of venous malformations of the head and neck.

Methods: A retrospective review of the medical records of patients who received surgeries for venous malformations of the head and neck from January 2011 to July 2019 was performed. Using clinical photographs, preoperative and postoperative Doppler ultrasonography, outpatient clinic records, and operation records, the postoperative result and complications were evaluated for each case.

Results: Among patients who visited our vascular anomalies clinic, 43 patients (ratio of male to female= 24:19) received surgeries for venous malformations of the head and neck. Twenty-nine patients had undergone surgery only, five patients received sclerotherapy after surgery, and nine patients received surgery after preoperative sclerotherapy. In postoperative evaluations, the result was excellent in 24 patients, good in 18 patients, and poor in one patient. Four patients experienced a recurrence of lesions with lagophthalmos, drooping of the corner of the mouth, partial wound necrosis, and scar widening found in one patient each.

Conclusion: Because the head and neck region is the most exposed area in the body, more active implementation of surgical treatments with or without sclerotherapy is essential to reduce the functional and cosmetic impairments associated with venous malformations.
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http://dx.doi.org/10.7181/acfs.2019.00416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822077PMC
October 2019

Effect of Keratinocytes on Myofibroblasts in Hypertrophic Scars.

Aesthetic Plast Surg 2019 10 25;43(5):1371-1380. Epub 2019 Jul 25.

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 130 Dongdeokro, Jung-gu, Daegu, 41944, Korea.

Myofibroblasts play a central role in matrix formation and wound contraction during wound healing and undergo apoptosis at the end of the healing. Hypertrophic scarring is a pathologic condition in which myofibroblasts persist in the tissue. It has been hypothesized that abnormalities in epidermal-dermal crosstalk underlie this pathology. Therefore, in this study, we investigated whether myofibroblasts are affected by keratinocytes. Transforming growth factor beta-induced myofibroblasts (Imyo) and myofibroblasts from hypertrophic scar tissue (Hmyo) were characterized using microarrays. Keratinocytes were co-cultured with myofibroblasts, and quantitative PCR analysis was performed. We found that numerous extracellular matrix- and smooth muscle cell-associated genes were upregulated in Imyo and Hmyo respectively, and these findings suggest that Hmyo are fully differentiated myofibroblasts and that Imyo are less differentiated than Hmyo. Decreased collagen type 1 gene expression was found in keratinocytes co-cultured with Imyo and Hmyo; further, α-smooth muscle actin expression in Imyo increased in the presence of keratinocytes. These observations indicate that keratinocytes play a role in the development of pathological fibrosis in hypertrophic scar tissue by regulating the behavior of dermal fibroblasts and myofibroblasts. We believe that this study provides the basis for understanding the pathophysiology of hypertrophic scarring and identifying new therapeutic approaches for this dysfunction.No Level Assigned This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors - www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-019-01434-1DOI Listing
October 2019

Surgical Intervention for Refractory Donor-Site Seroma After Immediate Breast Reconstruction with Latissimus Dorsi Flap.

Aesthetic Plast Surg 2019 12 25;43(6):1515-1522. Epub 2019 Jul 25.

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Korea.

Donor-site seroma persisting for > 3 weeks is the most common complication of latissimus dorsi (LD) flaps for breast reconstruction after mastectomy. Conservative treatment is insufficient for refractory seroma resolution. We report the results of surgical intervention for refractory donor-site seroma. Between January 2012 and April 2018, 319 patients undergoing breast reconstruction using an LD flap at our hospital were treated with conservative therapy if seroma was found. Refractory seroma of > 3 months' duration was observed in five patients (1.6%). Before surgery, the precise location and extent of the capsule were determined using chest computed tomography, and surgical intervention was planned. An en bloc capsulectomy was performed after confirming the internal capsule. Simultaneously, a quilting suture, bolster suture, and fibrin sealant were applied to prevent recurrence. The mean age of the patients with refractory seroma was 45.4 ( ± 7.3) years, and their mean body mass index was 31.0 ( ± 6.2) kg/m. All patients underwent breast reconstruction with an extended LD flap or extended LD flap with a silicone implant after total mastectomy. During the follow-up period of ≥ 10.4 months, a mean of 34.4 ( ± 10.4) needle aspiration procedures were performed, and a mean of 12.8 ( ± 2.2) cc of seroma fluid was removed each time. Intraoperatively, the formation of a capsule with a well-defined border was confirmed; all patients showed complete resolution of donor-site seroma within 4 weeks after surgical intervention. Refractory donor-site seroma occurrence was rare in the cases assessed. Surgical intervention was successful in cases of refractory donor-site seroma unsuccessfully treated with conservative therapy and is thus one of the most effective methods for complete resolution of refractory seroma.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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http://dx.doi.org/10.1007/s00266-019-01458-7DOI Listing
December 2019

Colorimetric Recording of Thermal Conditions on Polymeric Inverse Opals.

Adv Mater 2019 Jul 5;31(30):e1901398. Epub 2019 Jun 5.

Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea.

Recording thermal conditions, i.e., temperature and time, is of great importance for various applications. Although thermometers can measure temperature and record its temporal change with electronic devices, they are nondisposable and not patch-type, restricting their uses. Here, photonic films are designed that record thermal condition through irreversible structural deformation and intuitively report it with color patterns. The photonic films are inverse opals made of negative photoresist on a solid support, where the cross-linking density of the photoresist is regioselectively adjusted. The photonic films show a gradual blueshift of structural color upon heating due to anisotropic compression of the inverse opal, of which the rate depends on temperature and cross-linking density. For single cross-linking density, thermal input is quantified from the color change in the form of coupled temperature and time. With multiple cross-linking densities in a single film, the multicolor pattern is developed, from which the temperature and time are decoupled and separately estimated for isothermal condition.
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http://dx.doi.org/10.1002/adma.201901398DOI Listing
July 2019

Partial Sternectomy to Prevent Rastelli Conduit Compression in Patients With Conotruncal Anomalies.

Ann Thorac Surg 2019 12 29;108(6):e389-e391. Epub 2019 May 29.

Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address:

This report describes 2 cases of redo cardiac surgery in adult patients with conotruncal anomalies (double-outlet right ventricle and transposition of the great arteries) with pulmonary stenosis who underwent the Rastelli procedure in childhood. Although the Rastelli operation is one of the best options for the patients, conduit stenosis has occasionally developed secondary to compression by the anterior chest wall. To prevent compression by the sternum, partial sternectomy with Rastelli conduit change was performed in these 2 patients.
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http://dx.doi.org/10.1016/j.athoracsur.2019.04.032DOI Listing
December 2019

Treatment of late solidified hematoma in back donor site after breast reconstruction with latissimus dorsi flap: report of three cases.

BMC Surg 2019 May 20;19(1):51. Epub 2019 May 20.

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu, 700-421, South Korea.

Background: Late solidified hematoma is a rare complication of breast reconstruction with latissimus dorsi (LD) flap. The majority of hematomas occur in the immediate postoperative period; however, some cases can occur at a distant point in time after surgery and do not have a definitive mechanism of injury or develop symptoms immediately after the triggering event. Moreover, treatment of hematoma has not yet been established.

Case Presentation: Breast reconstruction with LD flap has been performed between January 2014 and June 2018 in more than 275 cases. We report 3 cases of late solidified hematoma at the back-donor site that have developed years after breast reconstruction with LD flap, in which a surgical approach was performed because the solidified hematomas could not be treated with percutaneous aspiration.

Conclusions: We report successful surgical treatment and histological findings of late-onset solidified hematoma as a rare complication of Breast reconstruction with LD flap.
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http://dx.doi.org/10.1186/s12893-019-0516-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528295PMC
May 2019

Usefulness of the LigaSure™ small jaw sealing device for breast reconstruction with a latissimus dorsi flap.

J Plast Surg Hand Surg 2019 Oct 7;53(5):295-300. Epub 2019 May 7.

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University , Daegu , Korea.

Seromas are the most common complication of latissimus dorsi flap breast reconstruction. Electrocautery for flap elevation can cause seromas and injure the lymph or vessels of the surrounding tissues. Positive effects of the LigaSure Small Jaw (Medtronic [formerly Covidien], Minneapolis, MN, USA) sealing device were examined. Forty-three latissimus dorsi flap breast reconstruction patients were included. Twenty-three underwent surgery with electrocautery and 21 underwent surgery with LigaSure. The seroma formation rate, total drain volume, drainage indwelling periods at the breast site and donor site, operative time, and hospital stay duration were retrospectively compared. Associations between patient characteristics and these variables were analyzed. Seroma incidence rates were 9/23 (39.1%) and 3/21 (14.3%) for the control and experimental groups. One control group patient underwent surgical treatment; the rest underwent conservative treatment. A significant difference in latissimus dorsi flap elevation time was found between the control and experimental groups (105.6 minutes and 77.1 minutes;  = .026). A significant difference in the drainage indwelling periods of the latissimus dorsi donor site was found (13.1 days and 11 days;  = .006). Excised breast mass weight, latissimus dorsi flap weight, breast drain total volume/indwelling period, and latissimus dorsi drain volume/indwelling period showed statistically significant associations. Radiation and chemotherapy were not significantly associated with any variables. The LigaSure device for latissimus dorsi flap breast reconstruction can reduce seromas, operative time, and hospital stay. It is a reliable and useful surgical sealing device that does not cause injury to the surrounding tissues.
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http://dx.doi.org/10.1080/2000656X.2019.1612753DOI Listing
October 2019

Application of Cultured Epidermal Homograft (Kaloderm) for Wide Scar Treatment.

J Craniofac Surg 2019 Sep;30(6):e535-e539

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu.

Background: For the treatment of wide scars, laser resurfacing procedures are generally used. However, sometimes their results are not satisfactory. Many clinical studies have reported that cultured epidermal allogenic sheets promote rapid and good quality wound healing. Therefore, the authors applied a cultured epidermal homograft (CEH) for scar management and investigated its outcomes.

Methods: Thirty-two patients who received a CEH (Kaloderm) after laser resurfacing (n = 14, under general anesthesia; n = 18, under local anesthesia) between February 2016 and June 2017 were enrolled. Patients treated with dermabrasion using laser resurfacing (n = 60) without CEH in the same period were used as controls. Clinical grading of the scars was performed using a Patient and Observer Scar Assessment Scale (POSAS) at postoperative 12 months.

Results: The authors conducted a comparative analysis between the control and CEH groups. Evaluation based on Patient and Observer Scar Assessment Scale showed that the mean scores in control/CEH groups for the 7 observer components (vascularity, pigmentation, thickness, relief, pliability, surface area, and overall opinion) were 4.5/3.2, 3.3/2.8, 2.8/2.5, 3.6/3.5, 3.7/2.1, 2.3/1.9, and 3.2/2.7, respectively, with significant differences observed in vascularity, pliability, and surface area (P values = 0.033, 0.021, and 0.048, respectively). Meanwhile, the mean scores in control/CEH groups for 7 patient components (pain, itching sense, color, stiffness, thickness, irregularity, and overall opinion) were 4.1/2.3, 3/3.1, 2.2/2.1, 2.2/1.7, 3.6/3.5, 1.8/1.5, and 2.2/1.9, respectively, with significant differences between groups observed in pain, stiffness, and overall opinion in the paired t test (P values = 0.041, 0.020, and 0.048, respectively).

Conclusion: Cultured epidermal homograft provided good quality wound healing and improved scar pliability. Cultured epidermal homograft left less scarring with no pain or other specific complications. Therefore, dermabrasion with CEH is useful for scar management.
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http://dx.doi.org/10.1097/SCS.0000000000005485DOI Listing
September 2019

Comparisons among four types of absorbable plates used for internal fixation of zygomaticomaxillary complex fractures.

J Craniomaxillofac Surg 2019 Mar 17;47(3):383-388. Epub 2019 Jan 17.

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea. Electronic address:

Importance: Conventional plating systems include titanium plates for the fixation of facial bone fractures. However, titanium plates result in artifacts on computed tomography images and appear unstable on magnetic resonance images. Therefore, absorbable plates have been widely used for the fixation of facial bone fractures of late in Asia.

Objective: To compare stability and symmetry among four different absorbable plates used for internal fixation of zygomaticomaxillary complex fractures.

Participants: The subjects were patients with zygomaticomaxillary complex fractures that were diagnosed and treated by internal fixation with absorbable plates between January 2012 and April 2018. Patients aged ≤14 years and ≥76 years were excluded. Patients with other fracture types were also excluded. All patients underwent surgery within 2 weeks of the injury.

Intervention: Internal fixation was performed with one of four types of absorbable plates, namely Inion, Polymax, Osteotrans, and Biosorb.

Main Outcome Measures: The stability of the four plates was investigated by evaluation of the orbital height ratio (A'/A), zygoma angle (a'/a), distance (b'/b) from the midline, and gap (c) of the temporal process on three-dimensional facial computed tomography images obtained before, 3 weeks after, and 3-6 months after surgery. Any plate-associated complications were recorded.

Results: In total, 400 patients were enrolled, and there were 100 patients in each of the four groups. There were no significant differences with regard to postoperative stability and relapse among the four plates. Moreover, facial symmetry showed no changes over time in any group. Complications such as infection and sensory disturbance were not frequent. All plates except Biosorb were palpable for more than 6 months after surgery, with Osteotrans remaining palpable for several years.

Conclusions And Relevance: Our findings suggest that all four types of absorbable plates are useful for treating isolated zygomaticomaxillary complex fractures. While Biosorb is unsuitable for severe comminuted fractures. Polymax and Inion are not bendable at room temperature. It is important to select an appropriate absorbable plate according to each patient's condition and the fracture severity.
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http://dx.doi.org/10.1016/j.jcms.2019.01.014DOI Listing
March 2019