Perfect facial and body symmetry is an important aesthetic concept which is very difficult, if not impossible, to achieve. Yet, facial asymmetries are commonly encountered by plastic and reconstructive surgeons. Here, we present a case of posttraumatic facial asymmetry successfully treated with a unique concept of facial flap repositioning. A 25-year-old male patient visited our department with severe posttraumatic facial asymmetry. There was deviated nasal bone and implant to the right, and the actual facial appearance asymmetry was much more severe compared to the computed tomography, generally shifted to the right. After corrective rhinoplasty, we approached through intraoral incision, and much adhesion from previous surgeries was noted. We meticulously elevated the facial flap of both sides, mainly involving the cheeks. The elevated facial flap was shifted to the left, and after finding the appropriate location, we sutured the middle portion of the flap to the periosteum of anterior nasal spine for fixation. We successfully freed the deviated facial tissues and repositioned it to improve symmetry in a single stage operation. We conclude that facial flap repositioning is an effective technique for patients with multiple operation history, and such method can successfully apply to other body parts with decreased tissue laxity.

LV-OP-3-3Introduction: The prognostic value of PIVKA-II has been insufficiently elucidated. This study is aimed to determine the prognostic value of preoperative serum PIVKA-II after hepatectomy for hepatitis B related HCC. Methods: The nationwide multicenter database of the Korean Liver Cancer Association was reviewed. Patients with hepatitis B related HCC who underwent liver resection as a first treatment after initial diagnosis between 2008 and 2014 were selected. Comparative analysis between low versus high PIVKA-II was performed. Survival outcomes of propensity score-matched groups were compared. Kaplan-Meier and multivariable analyses were performed to identify risk factors for disease-specific survival. Univariable and multivariable Cox proportional hazards regression were used. Results: Among 6,770 randomly selected patients with hepatitis B related HCC, 987 patients were included. The disease-specific 5-year survival rate was 84.6% in patients with PIVKA-II of 106.5 mAU/mL or less compared with 76.3% for those with a level exceeding 106.5 mAU/mL (p = 0.041). After propensity score matching, the two groups were well balanced (n = 263, each). In univariable analysis, high PIVKA-II (> 106.5 mAU/mL) was a significant predictor for worse survival (hazard ratio [HR], 1.527; p = 0.047). In multivariable analysis, lymph node positivity (HR, 6.123; p = 0.023), hyponatremia (< 135 mEq/L) (HR, 4.187; p = 0.002), tumor size ≥ 5.0 cm (HR, 3.399; p < 0.001), preoperative ascites (HR, 3.874; p = 0.001), microvascular invasion (HR, 2.639; p = 0.001), thrombocytopenia (< 100 × 103/µL) (HR, 2.620; p = 0.001), and multiple HCC (HR, 2.068; p = 0.007) were independent predictors for worse disease-specific survival, but not preoperative high PIVKA-II. Conclusions: Preoperative high PIVKA-II is significantly associated with worse disease-specific survival after hepatectomy for hepatitis B related HCC, nonetheless, not a strong prognostic factor.

Purpose Although protein-induced vitamin K absence or antagonist II (PIVKA-II) has been used as a diagnostic tool for hepatocellular carcinoma (HCC), its prognostic value remains unclear. Methods This was a nationwide multicenter study using the database of the Korean Liver Cancer Association. Patients with hepatitis B-related HCC who underwent liver resection as the first treatment after initial diagnosis (2008–2014) were selected randomly. Propensity score matching (1:1) was performed for comparative analysis between those with low and high preoperative PIVKA-II. Univariable and multivariable Cox proportional-hazards regression were used to identify prognostic factors for HCC-specific survival. Results Among 6,770 patients, 956 patients were included in this study. After propensity score matching, the 2 groups (n = 245, each) were well balanced. The HCC-specific 5-year survival rate was 80.9% in the low PIVKA-II group and 78.7% in the high PIVKA-II group (P = 0.605). In univariable analysis, high PIVKA-II (>106.0 mAU/mL) was not a significant predictor for worse HCC-specific survival (hazard ratio [HR], 1.183; 95% confidence interval [CI], 0.76–1.85; P = 0.461). In multivariable analysis, hyponatremia of <135 mEq/L (HR, 4.855; 95% CI, 1.67–14.12; P = 0.004), preoperative ascites (HR, 4.072; 95% CI, 1.59–10.43; P = 0.003), microvascular invasion (HR, 3.112; 95% CI, 1.69–5.74; P < 0.001), and largest tumor size of ≥5.0 cm (HR, 2.665; 95% CI, 1.65–4.31; P < 0.001), but not preoperative high PIVKA-II, were independent predictors for worse HCC-specific survival. Conclusion Preoperative PIVKA-II is not an independent prognostic factor for HCC-specific survival after liver resection for hepatitis B-related HCC.

No abstract