Background: Reconstruction of large facial defects is challenging as both functional and cosmetic results must be considered. Reconstruction with forehead flaps on the face is advantageous; nonetheless, reconstruction of large defects with forehead flaps alone results in extensive scarring on the donor site. In our study, the results of reconstruction using a combination of forehead flaps and other techniques for large facial defects were evaluated.Methods: A total of 63 patients underwent reconstructive surgery using forehead flaps between February 2005 and June 2020 at our institution. Reconstruction of a large defect with forehead flaps alone has limitations; because of this, 22 patients underwent a combination of procedures and were selected as the subjects of this study. This study was retrospectively conducted by reviewing the patients’ medical records. Additional procedures included orbicularis oculi musculocutaneous (OOMC) V-Y advancement flap, cheek advancement flap, nasolabial V-Y advancement flap, grafting, and simultaneous application of two different techniques. Flap survival, complications, and recurrence of skin cancer were analyzed. Patient satisfaction was evaluated using questionnaires.Results: Along with reconstructive surgery using forehead flaps, nasolabial V-Y advancement flap was performed in nine patients, local advancement flap in three, OOMC V-Y advancement flap in two, grafting in five, and two different techniques in three patients. No patient developed flap loss; however, cancer recurred in two patients. The overall patient satisfaction was high.Conclusion: Reconstruction with a combination of forehead flaps and other techniques for large facial defects can be considered as both functionally and cosmetically reliable.

Introduction: Saddle nose deformities are typically reconstructed with cartilage grafts; however, conchal cartilage grafts are and associated with a risk of damage to the posterior auricular ligament and insufficient amounts, and costal cartilage grafts require invasive surgery under general anesthesia. We proposed a double-layer dermofat graft as an alternative to these methods.Patient concerns: Two patients with type IV saddle nose deformity underwent reconstruction with nasal augmentation with a double-layer dermofat graft harvested from the gluteal sulcus.Diagnosis: After operation, photogrammetric analysis demonstrated an improvement in the dorsal depression area, which corresponded to the angle between the sellion, most depressed point, and pronasale. Rhinoplasty Outcome Evaluation questionnaire was assessed. Interventions:The graft was divided into 2 sections; the first section was implanted transversely into the depressed nasal framework, and the second section was inserted vertically from the nasion to the supratip break for augmentation.Outcomes: Both patients reported high satisfaction with the Rhinoplasty Outcome Evaluation questionnaire. The mean preoperative angle between the sellion, most depressed point, and pronasale was 157.8°, and the mean postoperative angle at 6 months was 176.9°. Conclusion:The simple method double-layer dermofat graft technique demonstrated excellent outcomes in saddle nose deformity correction, did not require cartilage, and was easily performed under local anesthesia.

With the prevalence of malignant melanoma increasing gradually and the progressive westernization of the Asian lifestyle, it is important to analyze and follow up on the characteristics of malignant melanoma at regular intervals. We identified the characteristics of malignant melanoma by analyzing consecutive patients from a single medical center. We also examined the trend of malignant melanoma and prognostic factors in Asian patients. We investigated 200 consecutive patients with malignant melanoma in a single medical center between 2000 and 2022. Each patient’s sex and age, tumor stage, site of the primary lesion, histological subtype, Breslow thickness, Clark level, and period of survival were collected from the historical medical records of the patients and analyzed. Survival analyses were performed using the Kaplan–Meier method to investigate the prognostic factors. The ratio of man-to-woman was 1:1.53; the most common site of the primary tumor was the lower extremity (60%), and acral lentiginous melanoma was the most common histological subtype (61%). Malignant melanoma commonly occurs in the lower extremities, primarily in the form of the lentiginous subtype. In situ melanomas are most prevalent regarding Breslow thickness, while Clark Level 4 is the most common type of malignant melanoma. Sex and Breslow thickness were significantly associated with the survival rate. However, others were not significant prognostic indicators for survival in this cohort. This study confirmed that the epidemiology of malignant melanoma in Asian patients was maintained without significant change. We also confirmed several significant prognostic indicators for survival.

Fibrofolliculoma is a benign tumor characterized by a smooth, dome-shaped papule of size 2–4 mm. Most fibrofolliculomas occur as multiple lesions, and very rarely, they are solitary. Herein, we report a case of solitary fibrofolliculoma found in the alar rim, without the typical characteristics of a fibrofolliculoma. A 42-year-old man visited the hospital with a protruding lesion that had occurred 1 year previously. A mass of size 5× 7 mm was observed on the left alar rim. The tumor was dome-shaped and palpable. The patient did not have any similar lesions elsewhere. No family member was known to have such a lesion. An incisional biopsy was performed before surgery, and pathological examination revealed hyperkeratosis and dyskeratosis; however, an accurate diagnosis was not made. Complete resection was planned for the mass on the alar rim. The resected mass was subjected to permanent biopsy, and the pathological examination results led to the diagnosis of fibrofolliculoma. Therefore, when diagnosing a dome-shaped mass in the alar rim, despite the suspicion of a very rare disease, it is necessary to suspect fibrofolliculoma and consider the process from diagnostic examination to treatment.

In this study, we evaluated the outcomes of flap surgery and the incidence of acute kidney injury (AKI) in patients who underwent flap surgery using a fluid-restrictive strategy. We retrospectively reviewed the consecutively collected medical records of patients who underwent flap surgery using the fluid-restrictive strategy of our hospital. The patients were divided into 2 groups based on the period of flap surgery: 2011 to 2014 (initiation period of the fluid-restrictive strategy) and 2015 to 2020 (implementation period). Outcomes of flap surgery and the incidence of AKI were evaluated based on percentage changes in cumulative fluid balance to initial body weight (%FO) on post-operative day 7. A total of 140 patients were enrolled in the study; 50 (35.7%) underwent flap surgery in 2011 to 2014 and 90 (64.3%) in 2015 to 2020. In 2015 to 2020, the median %FO significantly decreased from 2.7 (interquartile range [IQR]: 0.8–7.1) to 0.1 (IQR: −2.2 to 3.4%, P < .001), whereas the success rate significantly increased from 53.3% to 70.5% ( P = .048) compared to 2011 to 2014. The incidence of AKI remained unchanged. In multivariate analysis, the odds ratio for success was 2.759 (95% confidence interval: 1.140–6.679) in 2015 to 2020 compared to 2011 to 2014. After successfully implementing the fluid-restrictive strategy, the success rate of flap surgery significantly increased without any further increase in the incidence of AKI. Our experience could serve as a model for implementing a fluid-restrictive strategy in flap surgery.