Publications by authors named "Nae-Ho Lee"

52 Publications

Useful Extension of a Retroauricular Hairline Incision in a Parotidectomy Provides Coverage of a Preauricular Skin Defect.

Ear Nose Throat J 2020 Oct 13:145561320957509. Epub 2020 Oct 13.

Department of Plastic and Reconstructive Surgery, 65377Medical School of Jeonbuk National University, Jeonju, Republic of Korea.

This report outlines the treatment of an 82-year-old man with squamous cell carcinoma of the left cheek. The wide excision and simultaneous superficial parotidectomy were planned. Various incision methods have been widely introduced such as retroauricular hairline incision, modified Blair incision, or face-lift incision. For coverage of preauricular skin defect and parotidectomy, we modified retroauricular hairline incision that the end of the incision was bent to make transposition flap. The operation has been successfully finished using this extension of a retroauricular hairline incision.
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http://dx.doi.org/10.1177/0145561320957509DOI Listing
October 2020

Prognosis of Patient With Resorbable Plates and Screws Under the Incision Site.

J Craniofac Surg 2020 Oct;31(7):e694-e695

Department of Plastic and Reconstructive Surgery, Medical School of Jeonbuk National University.

Various resorbable plates and screws were used for facial bone fractures because of several strengths. However, there are few studies on their clinical course and long-term follow-up concerning their degradation and resorption time. The authors present rare case of long term follow-up of resorbable plates and screws under the incision site.
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http://dx.doi.org/10.1097/SCS.0000000000006609DOI Listing
October 2020

Protruding Meningioma of the Forehead With Extensive Hyperostosis Mimicking Skull Osteoma.

J Craniofac Surg 2020 Sep;31(6):e542-e544

Department of Plastic and Reconstructive Surgery, Medical School of Jeonbuk National University, Jeonju.

Meningioma is the most common intracranial benign tumor in adults. Hyperostosis accompanies about 4.5% of meningiomas. The authors report a rare case of hyperostotic meningioma that may have been misdiagnosed as giant osteoma.A 42-year male visited our clinic due to an egg-sized, hard mass on his left forehead. The mass suspected to be giant osteoma was about 4.2 × 4.0 cm sized, hard, non-movable, and non-tender. But based on radiologic findings, the mass was diagnosed as meningioma with extensive hyperostosis.Without neurologic symptoms, the diagnosis of meningioma associated with hyperostosis can be challenging and be misdiagnosed as fibrous dysplasia and osteoma by simple examination without enhanced CT and MRI.Therefore, although osseous lesions are strongly suspected to be osteomas, surgeons should consider other diagnoses, and if necessary, use contrast enhanced CT or MRI to differentiate these bony lesions.
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http://dx.doi.org/10.1097/SCS.0000000000006472DOI Listing
September 2020

Reconstruction of Congenital Cranial Defect Using Autologous Bone Graft in Aplasia Cutis Congenita.

J Craniofac Surg 2020 May/Jun;31(3):e245-e247

Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University.

Many methods have been devised to repair cranial defects. Here, we report the use of a simple technique for the repair of a congenital cranial defect associated with aplasia cutis congenita (ACC).A newborn baby at 39 weeks of gestation was consulted with a scalp and cranial defect at the vertex measuring 3 × 1.5 cm. A 3-D CT scan of the skull confirmed the presence of a cranial defect at the sagittal suture and a normal brain structure. On the 13 day of life, the newborn was taken to an operating room. An autologous bone graft was harvested from adjacent normal parietal bone and grafted into the debrided congenital cranial defect. The soft tissue defect was then covered by rotation flaps.The postoperative 3-D CT scan presented a well-positioned autologous bone graft. At 1 month postoperatively, the skull contour was normal and there was no palpable defect.We report a successful surgical outcome for a congenital cranial and soft tissue defect in ACC treated using an autologous bone graft and rotation flaps. Although conservative therapy may be an alternative option, we recommend appropriate surgical reconstruction in patients at risk of potentially fatal complications.
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http://dx.doi.org/10.1097/SCS.0000000000006175DOI Listing
August 2020

Usefulness of Ramified Cephalic Vein Graft in the Wrist for Connection With Concomitant Vein in Head and Neck Reconstruction.

J Craniofac Surg 2020 Jan/Feb;31(1):e30-e32

Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University.

A vein graft in head and neck reconstruction is essential in some circumstances. The cephalic vein in the wrist has a suitable caliber for both a concomitant vein and the internal jugular vein (IJV). A vein graft involving the cephalic vein and its branches was used in 2 cases of head and neck reconstruction. The ramified distal vein was anatomized with a concomitant vein, and the proximal larger vein was anastomosed with the IJV using an end-to-side technique. After placement of vein grafts using the cephalic vein, the flaps were stable with no venous complications. To overcome the size difference between concomitant veins and the IJV, the authors recommend the cephalic vein including its distal branches in the wrist area.
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http://dx.doi.org/10.1097/SCS.0000000000005837DOI Listing
March 2020

Squamous cell carcinoma of the renal pelvis presenting as an integumentary neoplasm of the flank: A case report.

Medicine (Baltimore) 2019 Sep;98(36):e17049

Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Research Institute of Clinical Medicine of Chonbuk National University, Department of Orthopedic Surgery.

Rationale: Although chronic pyelonephritis and urolithiasis are established risk factors for squamous cell carcinoma (SCC), only a minority of patients with chronic urolithiasis eventually develop SCC. It is believed that the chronic irritation leads to squamous cell metaplasia that may subsequently develop into SCC. Although studies show that SSC generally spreads locally with associated symptoms of lymphadenopathy, metastasis to the lungs and liver have also been reported. However, cases spreading to the flank have yet to be reported. Therefore, the use of reconstructive techniques for the repair of extensive soft tissue defects in the flank region after extended retroperitoneal resection, is unknown.

Patient Concerns: We report a 54-year-old man who presented with a 1-month history of an enlarged skin mass on the right flank.

Diagnoses: The patient was subsequently diagnosed with metastatic SCC involving the patient's integumentary system near the flank region proximal to the right kidney following percutaneous nephrostomy.

Interventions: The skin mass and the surrounding muscle tissue of the right flank were excised with a wide resection margin including radial nephrectomy. The soft tissue defect after resection was reconstructed using a unilateral gluteus maximus myocutaneous V-Y advancement flap.

Outcomes: No recurrence of the SSC was found on follow-up CT performed 12 months postoperatively.

Lessons: In patients with long-standing nephrolithiasis complicated by staghorn stone-related infections, biopsies from suspicious lesions detected during percutaneous nephrolithotomy may facilitate early diagnosis. The modified gluteus maximus V-Y advancement flap may be a useful technique for the reconstruction of extensive soft-tissue defects involving the flank region.
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http://dx.doi.org/10.1097/MD.0000000000017049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739005PMC
September 2019

Can we predict vascular status and culture result based through wound status in diabetic foot infection?

Medicine (Baltimore) 2019 Mar;98(12):e14892

Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University.

Diabetic foot infection (DFI) should be treated by a multidisciplinary team to prevent amputation and morbid status. As physicians encountering DFI in outpatient clinic, a proper selection of antibiotic treatment and diagnostic approach for a vascular status is essential. We retrospectively investigated the patients with DFI from 2016 to 2017. All patients were examined for vascular status, wound status, and pathologic culture preceding the treatment. No statistical significance was observed between PEDIS grade 1 and 2 and 3 and 4 in culture status and culture results. Association analysis between vascular status and other variables, such as wound score and culture results, has no significant difference. Through these results, the helpful epidemiologic result of microbiology and necessity of examination for peripheral arterial disease were verified.
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http://dx.doi.org/10.1097/MD.0000000000014892DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709238PMC
March 2019

Usefulness of a Longitudinal Fixing Method with Two Bulldog Vascular Clamps for End-to-Side Anastomosis in Head and Neck Reconstruction.

Plast Reconstr Surg 2019 03;143(3):675e-677e

Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University, and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea.

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http://dx.doi.org/10.1097/PRS.0000000000005358DOI Listing
March 2019

3-Dimensional Volumetric Analysis of Relationship Between the Orbital Volume Ratio and Enophthalmos in Unoperated Blowout Fractures.

J Oral Maxillofac Surg 2019 Sep 11;77(9):1847-1854. Epub 2018 Oct 11.

Professor, Department of Plastic and Reconstructive Surgery, Chonbuk National University Hospital, Chonbuk National University College of Medicine, Jeonju, Republic of Korea; and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea.

Purpose: Blowout fractures are common in midfacial trauma and often involve other parts of facial bones. Sometimes, patients have complications caused by inadequate management. Surgical indications, such as clinical symptoms, can be inaccurate owing to post-traumatic swelling or hematoma formation. Previous studies on the prediction of enophthalmos used the orbital volume ratio (OVR) or only the volume of herniated tissue. This study examined which of these values is more predictive of the degree of enophthalmos. In addition, the predictive values for a 2-mm enophthalmos in unoperated blowout fractures were assessed.

Patients And Methods: A total of 191 patients underwent nonoperative treatment for blowout fractures at our institution; they were divided into 2 groups according to the degree of enophthalmos (>2 mm vs 0 to 2 mm) and were further divided into 3 subgroups according to the location of the fracture (inferior, medial, or inferomedial). Multifactor logistic regression analysis was performed to determine the relationship between the degree of enophthalmos and these values.

Results: We observed a correlation between the OVR and the degree of enophthalmos, as well as a correlation between the volume of herniated tissue and the degree of enophthalmos. Regarding the anatomic location of herniation, the orbital floor was found to be more correlated with the amount of enophthalmos.

Conclusions: The OVR is a more reliable predictor than measurement of the volume of herniated tissue. The relationship found between radiologic examination findings and the degree of enophthalmos can be used as a surgical indication in addition to consideration of the anatomic location.
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http://dx.doi.org/10.1016/j.joms.2018.09.040DOI Listing
September 2019

Use of resorbable mesh and fibrin glue for restoration in comminuted fracture of anterior maxillary wall.

Arch Craniofac Surg 2018 Sep 20;19(3):175-180. Epub 2018 Sep 20.

Department of Plastic and Reconstructive Surgery, Chonbuk National University Hospital, Chonbuk National University College of Medicine, Jeonju, Korea.

Background: The facial bone has a complex structure compared to other bones, and various types of fractures can occur due to its characteristics. Among them, in comminuted fractures of anterior maxillary wall, multiple depressed and impacted bony segments cannot be reduced easily when performing internal fixation using plates and screws or wires, and inadequate restoration leads to a range of complications. This paper introduces an alternative technique using a resorbable mesh with fibrin glue to restore comminuted fractures of anterior maxillary wall.

Methods: Thirteen patients were diagnosed with comminuted fractures of anterior maxillary wall between March 2017 and February 2018 in the authors' hospital. All patients with comminuted fractures of anterior maxillary wall underwent restoration using resorbable mesh with fibrin glue. The patients' demographics, causes of facial trauma, mean operation time, length of hospital stay, follow-up period, and complications were recorded.

Results: No major complications and only one hypoesthesia of the skin area was noted. Three months after surgery, the hypoesthesia recovered completely. After surgery (mean, 3.9 months; range, 2-12 months), computed tomography showed that the bone fragments in all patients were fixed successfully in their anatomical places.

Conclusion: In comminuted fractures of anterior maxillary wall, the use of a resorbable mesh with fibrin glue can be an advantageous and effective method for a successful restoration without complications.
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http://dx.doi.org/10.7181/acfs.2018.01942DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6177669PMC
September 2018

Buried umbilicus with inflammation due to retained rubber foreign body after liposuction: A case report.

Medicine (Baltimore) 2018 Jun;97(25):e10800

Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea Division, of Plastic surgery, Department of Surgery, Mayo Clinic, Rochester, MN.

Introduction: Liposuction is one of the most widely performed aesthetic surgeries. It is mainly used for the correction of deep and superficial fat accumulations and remodeling of the body contour.

Case Presentation: We present a rare case of unusual rubber foreign body found within the periumbilical area during the reconstruction of buried umbilicus after liposuction.A 61-year-old female had undergone a liposuction surgery 10 years ago. Last year, she experienced signs of inflammation around the periumbilical area. The patient was treated with antibiotics and daily dressing at a local clinic. However, her symptoms did not improve with treatment.After admission, we decided to reconstruct the umbilicus and explore the previous operative site. During reconstruction of umbilicus, we finally discovered a rubber foreign body in the periumbilical area and buried umbilicus.

Conclusion: Retained surgical foreign body can clinically manifest as acute reaction, such as an inflammatory response, infection, or abscess within days or weeks after the operation. Patients may complain of pain and discomfort, even months or years after the procedure.Our patient had suffered from delayed inflammation due to retained surgical foreign body after liposuction surgery. We emphasize the need for excellent communication within the surgical team to prevent the incidence of retained surgical bodies.
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http://dx.doi.org/10.1097/MD.0000000000010800DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023665PMC
June 2018

Effectiveness of aspiration or deroofing for blister management in patients with burns: A prospective randomized controlled trial.

Medicine (Baltimore) 2018 Apr;97(17):e0563

Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University.

Background: Health care providers commonly encounter blisters when treating burn patients. The question as to whether burn blisters should be drained or deroofed has long been debated. To our knowledge, there has been no controlled, randomized clinical trial to determine which treatment is the best management option.

Methods: Between March 2016, and September 2016; 40 patients with burn blisters greater than 6-mm were enrolled in our study. Patients were randomized into 2 groups: aspiration group and deroofing group. The number of days to complete re-epithelialization was noted. Patient and Observer Scar Assessment Scale data were recorded from subjects and investigators at 4 time points. Pain during dressing changes was evaluated using a visual pain scale. Bacterial cultures were also obtained.

Results: Average number of days to complete wound healing was 12 days in the aspiration group and 12.55 days in deroofing group. On the Patient and Observer Scar Assessment Scale, investigators found that the aspiration group scars demonstrated improvements in relief and thickness while subjects rated aspiration scars better in terms of pain. Patients with palm/sole blister in the deroofing group scored higher than aspiration group on the visual analogue pain score but it was also not statistically significant (2.66 vs 3.25). The overall incidence of colonization with microorganisms in each group was not significant (15% vs 40%).

Conclusion: Neither aspiration nor deroofing is a superior treatment of burn blister. However, some objective indicators suggest that aspiration treatment might be more effective than deroofing treatment.
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http://dx.doi.org/10.1097/MD.0000000000010563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944508PMC
April 2018

Delayed diagnosis of xanthogranulomatous pyelonephritis in a quadriplegic patient with uncontrolled cutaneous fistula: A case report.

Medicine (Baltimore) 2018 Jan;97(2):e9659

Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.

Rationale: Xanthogranulomatous pyelonephritis (XGP) is a chronic destructive granulomatous inflammation that is characterized by urinary tract obstruction and invasion of the renal parenchyma. Although rare, XGP can lead to fatal complications, including perinephric inflammation, psoas abscess, and cutaneous fistula.

Patient Concerns: A quadriplegic patient initially presented to the hospital with a chronic open wound and cutaneous fistula.

Diagnoses: Abdominal computed tomography revealed a renal obstructing stone and enlarged right kidney with a perinephric fluid collection that communicated with the cutaneous fistula.

Interventions: The patient underwent a right nephrectomy at the department of urology.

Outcomes: Two months after surgery, the patient was clinically well with no discharging fistula.

Lessons: The XGP accompanied by complications requires an immediate evaluation and early diagnosis. In this case, the diagnosis was delayed because the state of quadriplegia rendered no symptoms of XGP.
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http://dx.doi.org/10.1097/MD.0000000000009659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5943861PMC
January 2018

Predictive Laboratory Findings of Lower Extremity Amputation in Diabetic Patients: Meta-analysis.

Int J Low Extrem Wounds 2017 Dec 16;16(4):260-268. Epub 2017 Nov 16.

1 Medical School of Chonbuk National University, Jeonju, Republic of Korea.

Lower extremity amputation is a source of morbidity and mortality among diabetic patients. This meta-analysis aimed to identify significant laboratory data in patients with diabetic foot ulcer with high rates of lower extremity amputation. We performed a systematic literature review and meta-analysis using MEDLINE, EMBASE, and Cochrane databases. We extracted and evaluated 11 variables from the included studies based on amputation rates. This study used the Newcastle-Ottawa Scale to assess the quality of the studies. The search strategy identified 101 publications from which we selected 16 articles for review. We identified HbA1c, fasting blood glucose, white blood cells, C-reactive protein, and erythrocyte sedimentation rate as predictive variables of higher major amputation rate. Although further investigation of long-term and prospective studies is needed, we identified 5 variables as predisposing factors for higher major amputation in diabetic patients through meta-analysis.
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http://dx.doi.org/10.1177/1534734617737660DOI Listing
December 2017

Does Low-Dose Heparin Have a Significant Role in Free Flap Surgery?

Arch Craniofac Surg 2017 Sep 26;18(3):162-165. Epub 2017 Sep 26.

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

Background: It is controversial issue that heparin decreases thrombosis for microsurgical anastomosis, and its effective role is under discussion. This study is for proving whether low-dose heparin is preventing thrombosis in free flap reconstruction.

Methods: Through chart reviews of 134 patients, using low-dose heparin for free tissue transfer from 2011 to 2016, retrospective analysis was performed. 33 patients received low-dose heparin therapy after surgery. And 101 patients received no-heparin therapy. Complications included flap necrosis, hematoma formation, dehiscence and infection.

Results: In no-heparin therapy group, comparing the flap necrosis revealed 16 cases (15.84%). And, flap necrosis was 6 cases (18.18%) in low-dose heparin therapy group. The statistical analysis of flap necrosis rate showed no significant difference (=0.75). The results showed that there was no significant difference of flap necrosis rate between two groups.

Conclusion: In this study, patients in the low-dose heparin group had no significantly lower rates of flap failure compared with no-heparin group. This suggests that low-dose heparin may not prevent thrombosis and subsequent flap failure to a significant extent.
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http://dx.doi.org/10.7181/acfs.2017.18.3.162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647843PMC
September 2017

Unusual Aspergillus Infection After Dermal Filler Injection.

J Craniofac Surg 2017 Nov;28(8):2066-2067

*Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University †Research Institute of Clinical Medicine, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea ‡Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.

According to a great desire for facial rejuvenation, dermal filler is promising for improving people's appearance without surgery. In a society of plastic surgery, injection of dermal filler is one of the most common procedures for a younger appearance. An increase in patients who have filler injection has been paralleled by a rise in various adverse reactions. Formation of inflammatory or infected nodules is one of the most common long-term complications. Infections can be increased because of improper disinfection of the patient's skin, a poor injection technique, decreased general immunity, and the presence of pathogens. The majority of bacteria are aerobic or facultative aerobic bacteria. This expectation of pathogens is critical for deciding on the antibiotic treatment before confirming the pathogen by microbial culture. The authors experienced unusual culture results in a patient with a chronic inflammatory nodule with abscess formation. The authors report a unique Aspergillus-cultured infection after filler injection.
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http://dx.doi.org/10.1097/SCS.0000000000004034DOI Listing
November 2017

Risk of major limb amputation in diabetic foot ulcer and accompanying disease: A meta-analysis.

J Plast Reconstr Aesthet Surg 2017 Dec 5;70(12):1681-1688. Epub 2017 Aug 5.

Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea.

Background: Limb amputation in diabetic patients raises important issues regarding low quality of life and survival rates. This meta-analysis aimed to identify predictive factors accompanying diseases with high major amputation rates in diabetic patients.

Methods: A systematic literature review and meta-analysis were performed using MEDLINE, EMBASE and Cochrane databases. Eight variables were extracted from the included studies and evaluated according to major amputation rates. The Newcastle-Ottawa scale (NOS) was utilized to assess the quality of the studies.

Results: The search strategy identified 101 publications. After screening, 10 articles were selected for review. Hypertension, ischemic heart disease, cerebrovascular disease, and peripheral vascular disease were identified as predictive variables of higher major amputation rates.

Conclusions: Although further investigation of long-term and prospective studies is needed, we identified four variables as predisposing factors for higher major amputation in diabetic patients through meta-analysis.
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http://dx.doi.org/10.1016/j.bjps.2017.07.015DOI Listing
December 2017

Influence of Epidemiologic and Patient Behavior-Related Predictors on Amputation Rates in Diabetic Patients: Systematic Review and Meta-Analysis.

Int J Low Extrem Wounds 2017 Mar;16(1):14-22

1 Medical School of Chonbuk National University, Jeonju, Republic of Korea.

Amputation of patients with diabetic foot is a major issue worldwide, particularly from a medical and economic standpoint. This meta-analysis aimed to identify significant risk factors of high amputation rate among epidemiologic and patient behavior-related predictors in diabetic patients. A systematic literature review and meta-analysis were performed using MEDLINE, EMBASE, and Cochrane databases. Seven variables were extracted from the included studies and evaluated based on amputation rate. The Newcastle-Ottawa scale was used to assess the quality of the studies. The search strategy identified 101 publications. After screening, 33 articles were selected for review. Male sex and smoking were identified as significant risk factors of high amputation rate of diabetic foot. Although further investigation of long-term and randomized controlled studies is needed, we identified 2 variables as significant risk factors for high amputation rate in diabetic patients in this meta-analysis.
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http://dx.doi.org/10.1177/1534734617699318DOI Listing
March 2017

Demarcative Necrosis Along Previous Laceration Line After Filler Injection.

J Craniofac Surg 2017 Jul;28(5):e481-e482

*Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National, University †Research Institute of Clinical Medicine-Biomedical Research Institute of Chonbuk National, University Hospital, Jeonju, Republic of Korea.

In recent years, fillers have been widely used for soft tissue augmentation. Although they are generally considered to be safe, many complications have been reported to date. Nose and nasolabial fold augmentations with fillers can lead to an implementation of nasal skin necrosis, possibly caused by intravascular embolism and/or extravascular compression. Herein, we present a case of a successfully treated patient who experienced skin necrosis after an injection of dermal fillers into the nasolabial fold. Interestingly, we discovered that the patient had experienced a laceration 8 years ago around the area in which the filler was injected.
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http://dx.doi.org/10.1097/SCS.0000000000003791DOI Listing
July 2017

Iatrogenic Through-and-Through Conchal Defect Secondary to Auricular Cartilage Graft.

Aesthetic Plast Surg 2017 Feb 28;41(1):56-59. Epub 2016 Dec 28.

Department of Plastic and Reconstructive Surgery, Chonbuk National University Medical School, 20, Geonji-ro, Deokjin-Gu, Jeonju-si, 561-712, Republic of Korea.

Background: Over the past few years, conchal cartilage has been most often used in rhinoplasty. The donor site complications following conchal cartilage graft harvesting are scar formation, hematoma formation, and delayed wound healing, although hematoma is one of the most important and common complications. A complete conchal defect as a complication of auricular cartilage graft harvesting has not been previously reported in the literature. The authors report an unusual case of an iatrogenic conchal defect resulting from conchal cartilage graft harvesting that was treated using a posterior auricular island flap.

Methods: A 24-year-old male with a left conchal inflammation and perforation visited our plastic surgery department after receiving augmentation rhinoplasty and tip plasty using a conchal cartilage graft. A tight dressing had been applied to the ear, and postoperative infection was uncontrolled, which resulted in iatrogenic conchal perforation.

Results: A tie-over bolster dressing has been widely used to prevent hematoma following conchal cartilage graft harvesting with an associated donor site complication. However, a tight tie-over dressing and inappropriate postoperative care can cause complete through-and-through conchal defects. The posterior auricular island flap provides an elegant means of reconstructing conchal defects.

Conclusions: In the described case, aesthetic reconstruction of a conspicuous iatrogenic conchal defect was achieved with minimal scarring using the posterior auricular island flap. To the best of our knowledge, this report is the first to describe reconstruction of an iatrogenic defect in the concha as a complication of auricular cartilage graft harvesting.

Level Of Evidence V: 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/s00266-016-0764-0DOI Listing
February 2017

Negative Pressure Wound Therapy as Effective and Comfortable Management After Treatment of Osmidrosis.

Aesthetic Plast Surg 2017 Feb 28;41(1):121-125. Epub 2016 Dec 28.

Department of Plastic and Reconstructive Surgery, Chonbuk National University Hospital, 20, Geonji-ro, Deokjin-Gu, Jeonju-Si, Chonbuk, 561-712, Republic of Korea.

Although osmidrosis has been widely discussed in respect to its treatment modalities, there has been no definite consideration of postoperative management after the treatment of osmidrosis. We have tested the 40-125 mmHg range of negative pressure. We present negative pressure wound therapy (NPWT) of 70 mmHg for postoperative management in osmidrosis because NPWT has a role in removing fluid, such as blood or seroma, and diminishing the dead space between the skin and subcutaneous tissue. Patients who receive NPWT have shown successful treatment outcomes and no skin necrosis or hematoma formation. Additionally, NPWT could improve postoperative daily activity compared with conventional compressive dressings.

Level Of Evidence V: 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/s00266-016-0726-6DOI Listing
February 2017

Efficacy of 2 Representative Topical Agents to Prevent Keloid Recurrence After Surgical Excision.

J Oral Maxillofac Surg 2017 Feb 25;75(2):401.e1-401.e6. Epub 2016 Oct 25.

Professor, Department of Plastic and Reconstructive Surgery, Chonbuk National University Hospital, Jeonju, Korea.

Purpose: Keloids are difficult to remove successfully and there is no universally accepted treatment. After surgical excision of the keloid, there are various management methods for prevention of keloid recurrence, such as intralesional injection, radiation, and topical agents. A few studies have compared topical agents with other treatments. The aim of this study was to investigate effective topical agents for the prevention of recurrent keloid after surgical excision.

Materials And Methods: Eligible articles were sought using core databases, including Medline, Embase, and Cochrane databases, up to April 2016. The predictor variables were mitomycin C (MC) and imiquimod cream treatment after keloid excision. The outcome variable was keloid recurrence rate.

Results: The search strategy identified 120 publications. After screening, 9 articles were selected for review. Articles were divided into 2 groups: MC and imiquimod cream. The recurrence rate after surgical excision in the MC group was estimated to be 16.5%, and that in the imiquimod cream group was estimated to be 24.7%.

Conclusion: If intralesional injection or radiation is not available, then MC or imiquimod 5% cream could be an effective alternative in preventing keloid recurrence.
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http://dx.doi.org/10.1016/j.joms.2016.10.009DOI Listing
February 2017

Direct cutaneous lateral thoracic artery perforator misdiagnosed as second thoracodorsal artery perforator.

Microsurgery 2017 09 22;37(6):724-725. Epub 2016 Oct 22.

Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University, Jeonju, Korea.

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http://dx.doi.org/10.1002/micr.30125DOI Listing
September 2017

Osmidrosis Treatment Approaches: A Systematic Review and Meta-Analysis.

Ann Plast Surg 2017 Mar;78(3):354-359

From the *Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University; and †Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeounju, Republic of Korea.

Background: There are many treatment modalities associated with osmidrosis. The purpose of this study was to identify and compare effective osmidrosis treatments.

Methods: A systematic literature review and meta-analysis were performed using MEDLINE, EMBASE, and Cochrane databases. The osmidrosis treatment modalities were extracted as predictor variables, and recurrence and complications were extracted as outcome variables. Subgroup analysis was performed with regard to combined curettage, and fixed and random effect models were applied.

Results: Forty studies published prior to February 2016 were identified. The group that received surgery had the lowest incidence of recurrence as 3.0%, followed by the liposuction and laser groups (5.5%, 8.2%, respectively). The liposuction group had the lowest incidence of complications (hematoma, 1.6%; necrosis, 1.5%), followed by the surgery (hematoma, 1.9%; necrosis, 2.1%) and laser groups (hematoma, 3.1%; necrosis, 4.5%). When combining curettage, the recurrence rate was lower in the surgery (P = 0.06) and liposuction groups (P < 0.01).

Conclusions: Surgery treatment has been demonstrated as the most effective result for treating osmidrosis. Liposuction has been identified as the most effective treatment, with the lowest number of associated complications. Combining the curettage method was an effective option for lowering recurrence rate in surgery and liposuction treatments. Finally, laser treatment was not significantly associated with benefits.
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http://dx.doi.org/10.1097/SAP.0000000000000911DOI Listing
March 2017

Biomechanical Analysis of Barbed Suture in Flexor Tendon Repair versus Conventional Method: Systematic Review and Meta-Analysis.

Plast Reconstr Surg 2016 Oct;138(4):666e-674e

Jeonju and Gwangmyeong, Korea.

Background: The barbed suture technique uses newly developed materials for flexor tendon repair. In this study, the authors examine the effectiveness of using barbed sutures in flexor tendon repair compared with conventional methods.

Methods: A systematic literature review and meta-analysis was performed using MEDLINE, Embase, and Cochrane databases. Barbed suture and conventional suture methods were extracted as predictor variables, and maximum force, gap formation force, and cross-sectional area were extracted as outcome variables. Subgroup analyses were performed according to the source of suture materials and the number of strands. The Newcastle-Ottawa Scale was used to assess the quality of studies. Publication bias was evaluated using funnel plots.

Results: The search strategy identified 86 publications. After screening, 12 articles were selected for review. Barbed sutures are comparable in effectiveness to conventional methods in terms of maximum force, gap formation force, and cross-sectional area. In the subgroup analysis, barbed sutures also have comparable effects to conventional methods in terms of maximum force and gap formation force.

Conclusions: The authors' meta-analysis found that the use of barbed sutures in flexor tendon repair was competitive compared to conventional methods in terms of maximum force and gap formation force. Long-term in vivo studies are needed to confirm these findings.

Clinical Question/level Of Evidence: Therapeutic, V.
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http://dx.doi.org/10.1097/PRS.0000000000002573DOI Listing
October 2016

Predisposing factors for poor prognosis of angiosarcoma of the scalp and face: Systematic review and meta-analysis.

Head Neck 2017 02 10;39(2):380-386. Epub 2016 Aug 10.

Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University, Jeonju, Korea.

Background: Angiosarcoma of the scalp and face is an aggressive tumor with a high rate of local recurrence. Although many previous studies have demonstrated risk factors for poor prognosis, debate remains. We identified the predisposing factors for poor prognosis through comprehensive review of selected studies with meta-analysis.

Methods: A systematic literature review and meta-analysis were performed using MEDLINE, EMBASE, and Cochrane databases. Nine variables were extracted from the included studies and evaluated based on a 5-year survival rate. The Newcastle-Ottawa scale was used to assess the quality of the studies.

Results: The search strategy identified 89 publications. After screening, 11 articles were selected for review. Age, size, site of tumor, margin status, and surgery associated with poor angiosarcoma prognosis were identified.

Conclusion: Although further investigation of long-term and prospective studies is needed, we identified 5 variables as predisposing factors for poor prognosis of angiosarcoma through meta-analysis. © 2016 Wiley Periodicals, Inc. Head Neck 39: 380-386, 2017.
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http://dx.doi.org/10.1002/hed.24554DOI Listing
February 2017

Carpal Tunnel Syndrome and Motor Dysfunction Caused by Tophaceous Gout Infiltrating 12 Tendons.

J Clin Rheumatol 2016 Aug;22(5):272-3

From the Departments of *Plastic and Reconstructive Surgery and †Radiology, Chonbuk National University Medical School, Jeonju, Korea.

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http://dx.doi.org/10.1097/RHU.0000000000000366DOI Listing
August 2016

Is obesity a predisposing factor for free flap failure and complications? Comparison between breast and nonbreast reconstruction: Systematic review and meta-analysis.

Medicine (Baltimore) 2016 Jun;95(26):e4072

Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University, Jeonju-si, Chonbuk, Republic of Korea.

Obesity is a risk factor for postoperative morbidity in breast reconstruction. Although existing studies about nonbreast reconstruction are limited, previous research has demonstrated that obesity is not an important factor in poor outcomes in nonbreast reconstruction. Our study evaluates the effects of obesity on postoperative morbidity in nonbreast reconstruction in comparison to breast reconstruction. A systematic literature review and meta-analysis was performed using Medline, EMBASE, and Cochrane databases. Obesity was extracted for predictor variables and partial, total loss of flap, and complication were extracted for outcome variables. Subgroup analyses were performed according to reconstruction site. The Newcastle-Ottawa scale (NOS) was used to assess the quality of the studies, and the Cochrane risk of bias tool was used. Publication bias was evaluated using funnel plots. The search strategy identified 944 publications. After screening, 19 articles were selected for review. Partial flap loss, total flap loss, and complications in breast reconstruction occurred significantly more often in obese patients in comparison to nonobese patients (OR = 2.479, P = 0.021 for partial loss, OR = 3.083, P = 0.002 for total loss, OR = 2.666, P = 0.001 for complications). In contrast, partial flap loss, total flap loss, and complications in nonbreast reconstruction were not significantly different in obese patients in comparison to nonobese patients (OR = 0.786, P = 0.629 for partial loss, OR = 0.960, P = 0.961 for total loss, and OR = 1.009, P = 0.536 for complications). In contrast to the relationship between obesity and poor outcomes in breast reconstruction, our study suggests the obesity is not a predisposing factor for poor outcomes in nonbreast reconstruction. Long-term studies are needed to confirm these findings.
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http://dx.doi.org/10.1097/MD.0000000000004072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4937963PMC
June 2016

A Comparison of the Effectiveness of Triamcinolone and Radiation Therapy for Ear Keloids after Surgical Excision: A Systematic Review and Meta-Analysis.

Plast Reconstr Surg 2016 Jun;137(6):1718-1725

Jeonju, Republic of Korea.

Background: The ear is a common site for keloid formation, usually after trauma or ear piercing. This study is a meta-analysis to identify effective treatments for ear keloids after surgical excision.

Methods: A systematic literature review and meta-analysis were performed using core databases. Postoperative adjuvant treatment modalities for ear keloids and recurrence rates were extracted and analyzed. Fixed and random effect models were applied.

Results: Twenty-five studies published before August of 2015 were identified. The recurrence rate after surgical excision of an ear keloid in the triamcinolone group was estimated as 15.4 percent (95 percent CI, 9.4 to 24.1 percent; p < 0.001). The recurrence rate in the radiation therapy group was estimated as 14.0 percent (95 percent CI, 9.6 to 19.9 percent; p < 0.001).

Conclusion: Although a large-scale, randomized study is required for confirmation, both triamcinolone and radiation therapy provided outstanding treatment for ear keloids after surgical excision without a significant difference between the two treatments.
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http://dx.doi.org/10.1097/PRS.0000000000002165DOI Listing
June 2016

A Rare Case of Pulmonary Epithelioid Hemangioendothelioma Presenting with Skin Metastasis.

Arch Plast Surg 2016 May 18;43(3):284-7. Epub 2016 May 18.

Department of Pathology, Chonbuk National University Medical School, Jeonju, Korea.

Epithelioid hemangioendothelioma (EHE) is a well-differentiated and rare vascular tumor. Systemic metastases are uncommon. Herein, we present a patient with skin metastasis of pulmonary EHE (PEH) that was treated by wide excision. A 76-year-old male was evaluated due to pulmonary thromboembolism and a solitary pulmonary nodule. A biopsy was performed and pathological examination of the mass confirmed EHE. No metastasis was observed. The patient returned to care approximately two years later due to a painful nodule in the right lower leg. A skin biopsy showed metastatic EHE from the lung. We used a safety margin of 1 cm based on clinical experience, because no prior case had been reported regarding the resection margin appropriate for primary cutaneous EHE and skin metastases of PEH. At four months after surgery, the patient recovered without complications or recurrence. Skin metastasis of PEH is extremely rare, and only two cases have been reported in the literature. In this case, we report a rare case of PEH with histologically diagnosed skin metastasis that was successfully treated by curative resection. It is expected that this case report will provide a helpful contribution to the extant data regarding PEH metastases.
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http://dx.doi.org/10.5999/aps.2016.43.3.284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876159PMC
May 2016