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Delivery technique for the pedicled transverse rectus abdominis myocutaneous flap 带蒂腹直肌横皮瓣的输送技术
IF 0.3 Q4 SURGERY Pub Date : 2022-10-30 DOI: 10.14730/aaps.2021.00367
J. Lee, H. Kwon, Won Suk Lee, Sang-Ha Oh
The pedicled transverse rectus abdominis myocutaneous (TRAM) flap is often used during breast reconstruction. After completely elevating the flap, a medial tunnel is created to connect the dissection area to the mastectomy defect. This tunnel should typically accommodate four of the surgeon’s fingers, although this may vary depending on flap volume. Wider tunneling facilitates flap delivery, but can damage the breast and inframammary fold. Therefore, we introduce a technique to move the flap easily and safely through a small tunnel. During breast reconstruction using a pedicled TRAM flap, a tunnel was made in the mastectomy defect along the meridian of the breast. This tunnel accommodated a width of three of the surgeon’s fingers (6 cm). After completely elevating the flap, it was inserted into a funnel with an inner surface made of polymeric vinyl and a hydrophilic coating. The flap was propelled into the mastectomy defect via the funnel. Our novel technique for pedicled TRAM flap delivery using a funnel was easy and safe, and it is deemed to be suitable for delivering a pedicled TRAM flap.
带蒂腹直肌肌皮瓣是乳房重建中常用的皮瓣。在完全抬高皮瓣后,形成一个内侧隧道,将解剖区域连接到乳房切除术缺损处。该通道通常应容纳外科医生的四个手指,尽管这可能因皮瓣体积而异。较宽的隧道有利于皮瓣的递送,但可能会损伤乳房和乳下折叠。因此,我们介绍了一种通过小隧道轻松安全地移动皮瓣的技术。在用带蒂TRAM皮瓣重建乳房的过程中,在乳房切除术后的缺损处沿着乳腺经线做了一个隧道。这个通道容纳了外科医生三根手指的宽度(6厘米)。在完全提升襟翼后,将其插入漏斗中,漏斗的内表面由聚合物乙烯基和亲水涂层制成。通过漏斗将皮瓣推进乳房切除术缺损处。我们的新技术使用漏斗输送带蒂TRAM皮瓣是简单和安全的,它被认为适合输送带蒂的TRAM皮瓣。
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引用次数: 0
An outbreak of devastating facial stigmata caused by a single unlicensed aesthetic practitioner 一名没有执照的美容医生造成了毁灭性的面部污点
IF 0.3 Q4 SURGERY Pub Date : 2022-10-30 DOI: 10.14730/aaps.2022.00563
Daiwon Jun, Da-Hoon Kim, M. S. Park, Y. J. Kim, J. H. Lee
Background The practice of medicine by uncertified personnel is a common concern in public healthcare. Although the introduction of the Korean National Health Insurance Service has significantly reduced the number of these cases, the problem persists in the field of aesthetics. Herein, we report an outbreak of devastating facial stigmata in patients treated with illegal cosmetic procedures.Methods During 1 week in November 2021, five patients presented to Bucheon St. Mary’s Hospital for the management of identical patterns of severe facial scarring. Each patient had been treated for “skin rejuvenation” by a single unlicensed practitioner. Months of needling therapy by the practitioner, aimed at resolving the problem, only aggravated the scarring. The victims visited our hospital after the practitioner ceased to answer their calls. The patients had similar presentations with multiple prominent scars on both cheeks. Ectropion of the right lower eyelid due to scar contracture was observed in one patient.Results Five monthly treatments with intralesional triamcinolone injection and laser therapy were performed. Despite thorough management, the patients were left with improved but distinctive stigmata on their faces.Conclusions Cases of illegal aesthetic procedures are difficult to prosecute because the patients have implicitly agreed to the procedure. Therefore, active legislative measures should be adopted to prevent further victimization. Public education on the dangers of illegal aesthetic practices is also necessary.
背景:在公共卫生领域,无证人员行医是一个普遍的问题。虽然国民健康保险制度的引入大大减少了这种情况,但美学领域的问题仍然存在。在这里,我们报告了破坏性的面部耻辱爆发的病人接受非法美容手术。方法在2021年11月的1周内,5名患者在富川圣玛丽医院接受了相同类型的严重面部瘢痕的治疗。每个病人都是由一个没有执照的医生治疗“皮肤再生”。为了解决这个问题,医生进行了几个月的针刺治疗,结果反而加重了疤痕。受害者在医生不接电话后来到我们医院。患者有相似的表现,双颊多处明显疤痕。右下眼睑因瘢痕挛缩而外翻1例。结果病灶内注射曲安奈德及激光治疗5个月。尽管进行了彻底的治疗,患者的脸上留下了改善但明显的污点。结论非法美容手术因患者已默示同意而难以起诉。因此,应采取积极的立法措施,防止进一步受害。对非法审美行为的危害进行公众教育也是必要的。
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引用次数: 0
A prospective comparison of prepectoral and subpectoral methods for immediate breast reconstruction with acellular dermal matrix: the cogwheel-shaped anterior wrapping method 胸前和胸下即刻乳房重建方法的前瞻性比较与脱细胞真皮基质:齿状前包覆法
IF 0.3 Q4 SURGERY Pub Date : 2022-10-30 DOI: 10.14730/aaps.2022.00570
Sun Eung Kim, Y. Chun, H. Park, Y. J. Kim, Y. Cheon
Background Prepectoral breast reconstruction has recently gained wide recognition for its advantages, such as rapid recovery and less pain. This study compared the effectiveness of and differences between the prepectoral and subpectoral breast reconstruction techniques.Methods Eighty-three patients (90 breasts) who underwent prepectoral or subpectoral breast reconstruction surgery between January 2019 and December 2020 were prospectively recruited. Patient demographics, comorbidities, oncological treatment, and intraoperative and postoperative data were evaluated to investigate the validity and stability of each surgical technique. The follow-up period was a minimum of 18 months.Results The surgical cohorts (22 prepectoral and 68 subpectoral) had comparable demographics. No significant differences in postoperative complications were observed between the two groups. The prepectoral group showed shorter operation times than the subpectoral group (mean: 97.27 and 127.63 minutes, respectively; P<0.001). Fewer days elapsed until drain removal and the total amount of drainage was less in the prepectoral group than in the subpectoral group (mean: postoperative day [POD] 8.95 and 10.06, respectively; P=0.048) and (501.72 mL and 671.19 mL, respectively; P=0.009). The numeric pain rating scale (NPRS) scores at POD 7 were significantly lower in the prepectoral group than in the subpectoral group (mean: 0.41 and 1.82, respectively; P=0.029). There were no statistically significant differences in the NPRS scores at POD 1 or the BREAST-Q questionnaire scores at 3 months.Conclusions Prepectoral breast reconstruction using acellular dermal matrix can feasibly replace the conventional subpectoral breast reconstruction technique and has the advantages of reducing operation time, length of hospitalization, and long-term postoperative pain.
背景乳房前重建术因其恢复快、疼痛少等优点近年来得到了广泛的认可。本研究比较了胸前和胸下乳房重建技术的有效性和差异。方法前瞻性招募2019年1月至2020年12月期间行胸前或胸下乳房重建手术的患者83例(90个乳房)。评估患者人口统计学、合并症、肿瘤治疗以及术中和术后数据,以调查每种手术技术的有效性和稳定性。随访期至少为18个月。结果手术队列(胸前22例,胸下68例)具有可比的人口统计学特征。两组术后并发症无明显差异。胸前组手术时间短于胸下组,平均分别为97.27分钟和127.63分钟;P < 0.001)。胸前组的引流时间和总引流量均少于胸下组(平均:术后日[POD]分别为8.95和10.06;P=0.048)、501.72 mL、671.19 mL;P = 0.009)。在POD 7时,胸前组的数值疼痛评定量表(NPRS)得分明显低于胸下组(平均值分别为0.41和1.82;P = 0.029)。POD 1时NPRS评分和3个月时BREAST-Q问卷评分差异无统计学意义。结论脱细胞真皮基质胸下乳房再造术可替代传统的胸下乳房再造术,具有缩短手术时间、缩短住院时间、减少术后长期疼痛等优点。
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引用次数: 0
Comments on “Usefulness of the eyeball exposure area as an eye measurement modality through a comparison between eyes with inborn double eyelids and operated double eyelids” 评“从先天性双眼皮和手术性双眼皮的比较看眼球暴露区作为眼睛测量方式的有用性”
IF 0.3 Q4 SURGERY Pub Date : 2022-07-30 DOI: 10.14730/aaps.2022.00507
K. Hwang
We would like to express our appreciation of Dr. Kun Hwang for his thoughtful comments and kind discussion about the different vertical and horizontal ratios of the human cornea [1]. From the frontal view of the eye, it is known that the horizontal distance of the cornea appears slightly wider than the vertical distance. This is because the top and bottom of the anterior cornea are slightly overlapped by the sclera. The resulting difference between the horizontal and vertical diameters of the cornea is about 10%, according to relevant references. Thus, if the measurement was based on a vertical standard, as the commenter pointed out, it would be necessary to adjust the values accordingly; however, in this study, the values were measured based on the horizontal diameter. Nonetheless, in Figure 1, the drawings of the corneal diameter as the reference point were incorrectly marked with vertical distances.
我们要感谢昆黄博士对人类角膜不同垂直和水平比例的深思熟虑的评论和友好的讨论[1]。从眼睛的正面看,已知角膜的水平距离看起来比垂直距离略宽。这是因为前角膜的顶部和底部被巩膜稍微重叠。根据相关参考文献,角膜的水平和垂直直径之间的差值约为10%。因此,如评论者所指出的那样,如果测量是以垂直标准为基础的,则有必要相应地调整数值;然而,在这项研究中,这些值是根据水平直径测量的。尽管如此,在图1中,作为参考点的角膜直径图纸被错误地标记为垂直距离。
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引用次数: 0
Atypical rupture of a Poly Implant Prothése implant and fluid shifting: a case report Poly Implant Prothése植入物不典型破裂及移位1例报告
IF 0.3 Q4 SURGERY Pub Date : 2022-07-30 DOI: 10.14730/aaps.2022.00458
Jae Chung Min, E. Kim
Women have undergone augmentation mammoplasty for decades, and if implant rupture is suspected, imaging modalities such as magnetic resonance imaging (MRI) and ultrasonography are available. The linguine sign, keyhole sign, and noose sign are all suggestive of rupture. However, earlier-generation implants with alternative filler materials demonstrate rupture signs that differ from those of today’s better-known implant materials. A 60-year-old female patient who had undergone augmentation mammoplasty 20 years ago presented with left breast swelling and pain in the lower-outer quadrant. Ultrasonography and MRI confirmed extracapsular diffuse wall enhancement with suspected, but not apparent, discontinuity in the patient’s left breast implant. Therefore, both implants were removed. It was determined that these were Poly Implant Prothése implants. The left breast implant differed from the contralateral implant in that it contained fluctuating fluid. This could be attributed to an osmotic gradient that caused the implant to swell and weakened the elastomer shell, resulting in micro rupture without a gross tear. Patients who undergo augmentation mammoplasty should have regular follow-up examinations, even if there are no symptoms. Furthermore, clinicians should be aware that some patients who have had breast augmentation mammoplasty may experience atypical symptoms and signs if the implant ruptures.
几十年来,女性一直在接受隆乳手术,如果怀疑植入物破裂,可以使用磁共振成像(MRI)和超声波等成像方式。舌根征、锁孔征和套索征都提示破裂。然而,具有替代填充材料的早期植入物显示出与当今更为知名的植入物材料不同的破裂迹象。一位60岁的女性患者,20年前接受了隆乳术,出现左乳房外象限下部肿胀和疼痛。超声和MRI证实,患者左乳房植入物存在疑似但不明显的不连续性囊外弥漫性壁增强。因此,两个植入物均被移除。已确定这些是Poly Implant Prothése植入物。左乳房植入物与对侧植入物的不同之处在于,它含有波动的液体。这可能是由于渗透梯度导致植入物膨胀并削弱弹性体外壳,导致微破裂而没有严重撕裂。接受隆乳手术的患者即使没有任何症状,也应该定期进行随访检查。此外,临床医生应该意识到,如果植入物破裂,一些接受过隆乳术的患者可能会出现非典型症状和体征。
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引用次数: 0
Unilateral autoinflation of a saline-filled breast implant initially diagnosed as capsular contracture: a case report and review of the literature 最初诊断为包膜挛缩的含盐乳房植入物单侧自身膨胀一例报告及文献回顾
IF 0.3 Q4 SURGERY Pub Date : 2022-07-30 DOI: 10.14730/aaps.2022.00437
Jangyoun Choi, Young Bin Yang, D. Oh
Spontaneous inflation of saline breast implants is a rare phenomenon. In this case report, we share our experience treating a patient who complained of asymmetric breasts from what appeared to be a straightforward case of capsular contracture. Spontaneous autoinflation of the right breast implant was subsequently found to be the cause of breast asymmetry and hardness. The presentation, diagnostic challenge, management, and mechanism of this rare phenomenon are presented here.
生理盐水乳房植入物的自发膨胀是一种罕见的现象。在这个病例报告中,我们分享我们的经验治疗病人抱怨不对称的乳房似乎是一个简单的病例包膜挛缩。随后发现右乳房植入物的自发自我膨胀是乳房不对称和硬度的原因。本文介绍了这种罕见现象的表现、诊断挑战、管理和机制。
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引用次数: 0
Preliminary results of alternative treatment for postmastectomy pain syndrome: stromal vascular fraction-enriched fat grafting 骨切除术后疼痛综合征替代治疗的初步结果:基质血管部分富集脂肪移植
IF 0.3 Q4 SURGERY Pub Date : 2022-07-30 DOI: 10.14730/aaps.2022.00451
Kyunghyun Min, I. Yoon, E. Kim
Postmastectomy pain syndrome (PMPS) is defined as chronic pain lasting more than 3 months after surgery. PMPS reduces the quality of life for patients and affects their daily life. Although the pathogenesis of PMPS has not been clearly elucidated, it is strongly suggestive of neuropathic pain caused by damage to the intercostobrachial nerve. While previous studies have used stromal vascular fraction (SVF)-enriched fat grafts in patients with neuralgia, few studies have used it for PMPS. Therefore, the present study evaluated the use of SVF-enriched fat, which includes adipose-derived stem cells with good differentiation capacity, in patients with PMPS to improve quality of life and reduce neuropathic pain. In three patients, the fat was mixed with concentrated SVF using a centrifuge and injected into the primary pain sites. After surgery, in all three cases, the subjective pain scale score decreased significantly over time.
术后疼痛综合征(PMPS)是指术后持续3个月以上的慢性疼痛。PMPS降低了患者的生活质量,影响了他们的日常生活。尽管PMPS的发病机制尚未明确阐明,但它强烈提示肋间臂神经损伤引起的神经性疼痛。虽然先前的研究已经在神经痛患者中使用富含基质血管部分(SVF)的脂肪移植物,但很少有研究将其用于PMPS。因此,本研究评估了在PMPS患者中使用富含SVF的脂肪(包括具有良好分化能力的脂肪来源的干细胞)来提高生活质量和减少神经性疼痛。在三名患者中,使用离心机将脂肪与浓缩的SVF混合,并注射到主要疼痛部位。手术后,在所有三种情况下,主观疼痛量表评分随着时间的推移显著下降。
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引用次数: 0
Dual cortical tunneling method for endoscopic forehead lift 内窥镜前额提拉术的双皮质隧道法
IF 0.3 Q4 SURGERY Pub Date : 2022-07-30 DOI: 10.14730/aaps.2022.00444
Mijung Kim, N. Lee, W. Tark, W. Lee, T. Roh, Wooyeol Baek
Background Endoscopic forehead lift with cortical tunneling is an effective option for rejuvenation of the upper third of the face. Although it has been considered safe and reliable, with relatively consistent long-term results, relapse and weakening of adhesion have been common problems.Methods We suggest the dual-tunneling method for overcoming these limitations. A total of 100 patients aged 17 to 65 years underwent forehead lifting with cortical tunneling by the senior author from August 2016 to December 2017. The single-tunnel method was applied in one half of the patients and the dual-tunnel method in the other half. Bilateral brow positions were measured immediately following surgery and 6 months later.Results For all cases, cortical tunneling was done at the central incision and both paramedian incisions; therefore, three tunnels were used in the control group and six tunnels in the experimental group. In the single-tunnel group, relapse distances were 2.39±0.83 mm for the medial brow and 3.26±0.91 mm for the lateral brow (6 months postoperatively; n=100). The dual-tunnel group showed significantly smaller (P<0.001) relapse distances, with values of 1.69±0.46 mm and 2.17±0.59 mm for the medial and lateral brow, respectively (6 months postoperatively; n=100). The experimental group did not show an increase in complications.Conclusions The dual-tunneling method, designed to minimize the cheese-wiring effect, uses a triangular plane to avoid a focal fixation. The fixation also includes the periosteum to hold the forehead tissue in place, inducing stronger adhesion.
背景:内窥镜前额提拉加皮质隧道术是面部上三分之一年轻化的有效选择。尽管它被认为是安全可靠的,并且具有相对一致的长期结果,但复发和粘附减弱一直是常见的问题。方法我们建议采用双重隧道法来克服这些限制。2016年8月至2017年12月,共有100名年龄在17岁至65岁之间的患者接受了资深作者的前额提升和皮质隧道术。其中一半患者采用单隧道法,另一半患者采用双隧道法。术后立即测量双侧眉骨位置,6个月后测量。结果所有病例均在正中切口和正中旁切口行皮质隧道术;因此,对照组使用了三个隧道,实验组使用了六个隧道。在单隧道组中,内侧眉和外侧眉的复发距离分别为2.39±0.83mm和3.26±0.91mm(术后6个月;n=100)。双隧道组的复发距离明显较小(P<0.001),内侧和外侧眉的复发距离分别为1.69±0.46 mm和2.17±0.59 mm(术后6个月;n=100)。实验组的并发症没有增加。结论双隧道法是为了最大限度地减少奶酪布线效应而设计的,使用三角形平面来避免焦点固定。固定还包括骨膜,以将前额组织固定到位,从而诱导更强的粘附力。
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引用次数: 0
Serratia marcescens infection in a patient after a fat graft: a case report 脂肪移植术后患者粘质沙雷菌感染1例报告
IF 0.3 Q4 SURGERY Pub Date : 2022-07-30 DOI: 10.14730/aaps.2021.00325
Sunje Kim, H. Kwon, C. Ahn, Yooseok Ha, Joo-Hak Kim, H. Kyung, Sang-Ha Oh, Hojun Yang, S. Song
Serratia marcescens is a Gram-negative, facultatively anaerobic bacillus that has been implicated in hospital-acquired infections. Because no previous cases of delayed infections caused by S. marcescens after autologous fat injection have been reported, we introduce a case report. A 74-year-old woman underwent fat injection for aesthetic purposes and visited our hospital for left cheek swelling after this procedure. Blood tests showed a slightly elevated white blood cell count. Facial computed tomography demonstrated an abscess and emergency surgery was performed. A work-up of the necrotic tissue and drained abscess contents was conducted. Cultures showed growth of S. marcescens. Based on the culture results , a proper antibiotic was prescribed. Follow-up blood tests showed normal findings, and there was no recurrent infection or inflammation. In most acute infections after a fat graft, Staphylococcus aureus or Staphylococcus epidermidis can be suspected, while mycobacterial infections are often suspected in cases of delayed infection and chronic inflammation. However, clinicians should keep in mind that there may be infections of uncommon bacteria. When an atypical delayed infection is suspected after an autologous fat graft, it is important to perform aseptic wound culture and biopsy as soon as possible, use appropriate antibiotics, and conduct proper surgical treatment.
粘质沙雷氏菌是一种革兰氏阴性的兼性厌氧杆菌,与医院获得性感染有关。由于既往未见自体脂肪注射后粘质葡萄球菌引起迟发性感染的报道,我们报道一例。一名74岁女性因美容目的接受脂肪注射,手术后因左脸颊肿胀来我院就诊。血液检查显示白细胞计数略有升高面部计算机断层扫描显示为脓肿,并进行了紧急手术。对坏死组织和排出的脓肿内容物进行检查。培养显示粘质葡萄生长。根据培养结果,处方合适的抗生素。后续血液检查结果正常,无复发性感染或炎症。在大多数脂肪移植后的急性感染中,可怀疑是金黄色葡萄球菌或表皮葡萄球菌,而在延迟感染和慢性炎症的病例中,常怀疑是分枝杆菌感染。然而,临床医生应该记住,可能会有不常见的细菌感染。当怀疑自体脂肪移植术后出现非典型延迟感染时,应尽快进行无菌伤口培养和活检,使用适当的抗生素,并进行适当的手术治疗。
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引用次数: 0
A rare case of a folded nasolabial flap for a full-thickness alar defect due to trigeminal trophic syndrome after herpes zoster infection 折叠鼻唇侧皮瓣治疗带状疱疹感染后三叉神经营养综合征引起的全层鼻翼缺损一例
IF 0.3 Q4 SURGERY Pub Date : 2022-04-30 DOI: 10.14730/aaps.2021.00185
H. Ryu, D. Lee, Jun Hyuk Kim, Hwanjun Choi
A 51-year-old man was referred for a skin defect with paresthesia and decreased pain in his right ala. He had a history of herpes zoster infection 3 weeks previously. Excisional biopsy and culture showed no evidence of skin malignancy or infection. He was diagnosed with trigeminal trophic syndrome (TTS) after herpes zoster infection. A two-stage folded nasolabial flap was used to reconstruct the defect. The patient was satisfied with the cosmetic outcomes of surgery, and there was no evidence of recurrence during the follow-up. TTS, a rare skin condition that presents with paresthesia, anesthesia, and facial ulceration, occurs after trigeminal nerve injury, which can be caused by herpes zoster infection in rare cases. TTS is an often-persistent condition with a high recurrence rate, causing cosmetic problems. Some surgical methods have been attempted, but our case presents the first use of a folded nasolabial flap to treat TTS. The flap was symmetric, without any nostril collapse. It is also noteworthy that the outcome was excellent with only a skin flap that did not use a bony framework. Herein, we report a rare case of TTS that occurred after herpes zoster infection and was successfully treated with a folded nasolabial flap.
一名51岁的男子因皮肤缺陷伴感觉异常和右耳疼痛减轻而被转诊。他在3周前有带状疱疹感染史。切除活组织检查和培养显示没有皮肤恶性肿瘤或感染的证据。他在带状疱疹感染后被诊断为三叉神经营养综合征(TTS)。采用两阶段折叠鼻唇皮瓣修复缺损。患者对手术的美容效果感到满意,随访期间没有复发的证据。TTS是一种罕见的皮肤病,表现为感觉异常、麻醉和面部溃疡,发生在三叉神经损伤后,在极少数情况下可能由带状疱疹感染引起。TTS通常是一种持续性疾病,复发率很高,会导致美容问题。已经尝试了一些手术方法,但我们的病例首次使用折叠鼻唇皮瓣治疗TTS。皮瓣对称,鼻孔没有塌陷。同样值得注意的是,只有一个没有使用骨框架的皮瓣,结果非常好。在此,我们报告了一例罕见的TTS病例,该病例发生在带状疱疹感染后,并用折叠鼻唇皮瓣成功治疗。
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引用次数: 0
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Archives of Aesthetic Plastic Surgery
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