Palatal fistula is a challenging complication following cleft palate repair. We investigated the usefulness of collagen matrix in the prevention of postoperative fistula. We performed a retrospective cohort study of patients with cleft palate who underwent primary palatoplasty (Furlow’s double opposing z-plasty) in Seoul National University Children’s Hospital. Collagen Graft and Collagen Membrane (Genoss, Suwon, Republic of Korea) were selectively used in patients who failed complete two-layer closure. The effect of collagen matrix on fistula formation was evaluated according to palatal ratio (cleft width to total palatal width) and cleft width. A total of 244 patients (male, 92 and female, 152; median age, 18 months) were analyzed. The average cleft width was 7.0 mm, and the average palatal ratio was 0.21. The overall fistula rate was 3.6% (9/244). Palatal ratio (p = 0.014) and cleft width (p = 0.004) were independent factors impacting the incidence of postoperative fistula. Receiver operating characteristic curve analysis showed that the cutoff values in terms of screening for developing postoperative fistula were a palatal ratio of 0.285 and a cleft width of 9.25 mm. Among nonsyndromic patients with values above those cutoffs, the rates of fistula development were 0/5, 1/6 (16.7%), and 4/22 (18.2%) for those who received Collagen Graft, Collagen Membrane, and no collagen, respectively. Collagen matrix may serve as an effective tool for the prevention of palatal fistula when complete two-layer closure fails, especially in wide palatal clefts. The benefit was most evident in Collagen Graft with thick and porous structure.

Autologous reconstruction using abdominal flaps remains the most popular method for breast reconstruction worldwide. We aimed to evaluate a prediction model using machine-learning methods and to determine which factors increase abdominal flap donor site complications with logistic regression. We evaluated the predictive ability of different machine learning packages, reviewing a cohort of breast reconstruction patients who underwent abdominal flaps. We analyzed 13 treatment variables for effects on the abdominal donor site complication rates. To overcome data imbalances, random over sampling example (ROSE) method was used. Data were divided into training and testing sets. Prediction accuracy, sensitivity, specificity, and predictive power (AUC) were measured by applying neuralnet, nnet, and RSNNS machine learning packages. A total of 568 patients were analyzed. The supervised learning package that performed the most effective prediction was neuralnet. Factors that significantly affected donor-related complication was size of the fascial defect, history of diabetes, muscle sparing type, and presence or absence of adjuvant chemotherapy. The risk cutoff value for fascial defect was 37.5 cm2. High-risk group complication rates analyzed by statistical method were significant compared to the low-risk group (26% vs 1.7%). These results may help surgeons to achieve better surgical outcomes and reduce postoperative burden.

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The lateral arm flap is an alternative to the conventional radial forearm flap and has been widely used due to advancements in flap characteristics. Especially, the fasciocutaneous flap has been widely used in head and neck reconstruction due to its versatile characteristics and surgical feasibility. This flap has successfully undergone several useful modifications based on various anatomical studies. Here, the authors aimed to verify the versatility and reliability of free lateral arm flap reconstruction of numerous head and neck defects. Twelve patients (6 men and 6 women; mean age, 66 years) with various types of lateral arm flaps from May 2017 to April 2019 were included. The anatomical reconstruction area was widely distributed across the facial subunits, tongue and oral cavity, and hypopharynx, among others. The flap varied in size from 3 × 5 cm to 17 × 7 cm, and the average pedicle length was 5.58 cm. The versatility of the lateral arm flap enabled successful coverage of various defects in all cases. Among 12 patients, the donor site outcome was rated as excellent and good by 2 and 10 patients, respectively. Three patients complained of post-operative hypoesthesia, which was subsequently resolved. The lateral arm flap is a unique and extremely versatile soft tissue free flap. Its versatility facilitates continuous modification of the flap and its application in various areas in different forms with excellent contour outcomes. The authors successfully verified the evolving methods and advantages of lateral arm flaps in the treatment of various head and neck defects.

Purpose: Epidermoid cysts are common benign skin neoplasms derived from the pilosebaceous apparatus that usually develop in hair-bearing regions such as the head and neck. Epidermal cysts rarely occur in the extremities, especially in the palmoplantar region. Therefore, they can be easily misdiagnosed as warts or calluses. Here, we present our experience treating epidermal cysts in the extremities, including a very rare case of malignant transformation into squamous cell carcinoma. Methods: This retrospective study enrolled all patients who underwent excision of epidermoid cysts in the upper and lower extremities from March 2006 to April 2021.Results: Among 249 patients, there were 10 (seven male and three female patients) who had epidermal cysts in the extremities (4.0%). All four plantar cysts were located in weight-bearing areas. One palmar epidermal cyst occurred 33 years after the trauma. There was one case of a highly recurrent epidermal cyst on the heel that was eventually diagnosed as squamous cell carcinoma arising from the cyst lining on excisional biopsy. After wide excision with a margin of 2 cm, the resulting defect was reconstructed using a free thoracodorsal artery perforator flap. Conclusion: Epidermoid cysts in the extremities, especially the palmoplantar region, are rare. Detailed history taking, including underlying diseases and trauma history, is helpful for diagnosis. Complete excision is necessary to avoid relapse and to confirm the final diagnosis, especially in cases suspected of malignant transformation arising from epidermoid cysts.

OBJECTIVE Posterior distraction osteogenesis (DO) is widely accepted for the treatment of craniosynostosis. The aim of this study was to quantitatively compare the effect of DO on the cranial vault according to the age of the patient and direction of distraction. METHODS This was a retrospective study of patients with craniosynostosis who underwent DO in the anteroposterior direction. Postdistraction changes in intracranial volume (ICV), anteroposterior distance, biparietal distance, cranial height, and frontal bossing angle were measured using Mimics software on CT scans. Craniometric data were analyzed using a multivariate regression model. RESULTS Thirty-two patients (16 anterior and 16 posterior DOs) were included in the study. The mean ICV increase in the anterior and posterior DO group was 211 cm3 (range 142–281 cm3) and 214 cm3 (range 150–279 cm3), respectively. Patients who were aged 1 year or younger showed a greater percentage increase in ICV than patients older than 1 year. In the anterior DO group, a more balanced increase in both anterior and posterior anteroposterior distance was observed in patients aged 1 year or younger when compared to patients older than 1 year. In the posterior DO group, a bigger expansion and smoother contour in the posterior cranial fossa was observed in patients aged 1 year or younger. CONCLUSIONS Both anterior and posterior DO are effective surgical options for expanding the cranial vault in patients with craniosynostosis. Early distraction appeared to show greater morphological changes in the growing cranial vault than those predicted with the vector of distraction.

Pressure sores are common but troublesome for both patients and clinicians. They can range from mild to severe and must be managed accordingly. Despite advancements in both non-surgical and surgical intervention, no standard treatment protocol has yet been established. Since pressure sores can occur in a variety of clinical settings, treatment must be individualized to the patient’s circumstances. Recently, acellular dermal matrix (ADM) has been utilized as an alternative treatment for non-healing wounds. In the present report, we describe the case of a non-ambulatory patient in whom a large pressure sore located near the anus was completely cured using CG paste, an injectable ADM.

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