Renal cell carcinoma (RCC) represents 2% to 3% of human cancers and is aggressive, with metastatic capability. The frequent metastatic sites are lung, bone, and liver. Reports of RCC metastatic to skin, and especially scalp are rare. Here we present an 83-year-old woman who was diagnosed with RCC 19 years prior and had a metastatic scalp lesion. An 83-year-old woman presented with a red-to-purple, protruding lesion at the right parietotemporal area. Twenty-three years ago, a right renal mass was incidentally discovered on ultrasound through a routine medical examination. She underwent right nephrectomy for RCC 4 years later. Five months after nephrectomy, new lung nodules were observed. Fifteen years after nephrectomy, metastatic lesions were found in the pelvic bone. She visited dermatology department for evaluation of the new scalp lesion, a year before she first visited our department. Despite chemotherapy, the mass was gradually enlarged. She consulted the plastic surgery department for management of the metastatic RCC was successfully treated with total excision including a 1-cm safety margin, local flap, and STSG coverage. Complete healing was observed, without evidence of recurrence during a 7-month followup. Metastases to the skin are rare, but must be kept in mind because of its high metastatic ability and poor prognosis.

Background: Autologous fat is considered an ideal filler material, and the use of cryopreserved fat grafts is promising in terms of flexibility and efficiency. Therefore, cryopreserved fat grafts have become more common in recent years; however, their complications require further consideration. Methods: We evaluated 53 patients who underwent facial lipofilling at our institution to confirm the clinical usefulness and safety of cryopreserved fat. Fresh fat injections with or without cryopreserved fat were administered. At one or more sites, 22 patients had a single fresh fat injection, four patients had two or more fresh fat injections, 16 patients had one fresh fat injection followed by one cryopreserved fat injection, six patients had one fresh fat injection followed by two cryopreserved fat injections, and five patients had two fresh fat injections and one or more cryopreserved fat injections. Results: In total, 281 sets of injection procedures were performed at various sites, of which 170 involved one fresh fat injection, 89 involved one fresh fat injection and one cryopreserved fat injection, and 11 involved one fresh fat injection and two cryopreserved fat injections. One patient experienced self-resolving inflammation as a complication after the second injection in the right cheek. No statistically significant differences were found between the fresh and cryopreserved fat injections. Conclusion: We suggest that cryopreserved fat is a useful and safe resource for multiple fat injections, with advantages including aseptic fat handling and the delicacy of the technique.

Chronic wounds are defined as wounds that fail to heal completely at the pace and order observed in normal phases of wound healing. Whereas acute wounds proceed through the normal stages of wound healing, the healing process in chronic wounds does not allow for regeneration and repair. Collagen, essential for all phases of the wound-healing cascade, only exists at lower levels in chronic wounds than in normal tissue or acute wounds, as do other extracellular matrix components. Therefore, application of collagen-based matrices is believed to modulate the chronic wound environment and contribute to wound healing in a variety of ways. The collagen-based matrices facilitate chemotaxis and migration of cells such as fibroblasts. These biomaterials provide the structural scaffold, which encourages new tissue regeneration and protects proteins involved in the process of wound healing, thereby restoring the wound environment to normal and promoting the healing. We used collagen-based matrices for the treatment of chronic wounds with various etiologies, including surgical wounds, diabetic ulcers, traumatic wounds, chronic vascular ulcers, and in preparation for skin grafts. The clinical results in the case report suggest that collagen-based matrices could be a reasonable treatment option for chronic wounds.

Extravasation occurs when an intravenous drug is inadvertently administered into the perivascular space or subcutaneous tissue. This can have various consequences, from local irritation to severe tissue loss. Extravasation occur more frequently in neonatal populations, especially in younger gesta tional ages and with lower birth weights. There is no established method of treatment for extravasa tion. Conservative treatments such as saline wash, wet dressing, hyaluronidase, and hydrogel dressing should be performed. Recently, two fullterm newborns have been reported to successfully treat skin necrosis with recombinant human basic fibroblast growth factor. We report for the first time that ex travasation in extremely very low birth weight infants can be successfully treated with recombinant human epidermal growth factor. Key Word: Extravasation of diagnostic and therapeutic materials, Sodium bicarbonate, Infant, Extre mely low birth weight, Epidermal growth factor 서론 혈관 외 누출은 정맥으로 주입된 약물이 의도치 않게 혈관 주위 공간 또는 피하 조직으로 투여되었을 때 발생한다. 이것은 국소적인 자극부터 심각한 조직 손실에 이르기까지 다양한 결과를 초래할 수 있다. 조직 손상의 중증도는 약물의 특성, 조직에 남아있는 기간, 혈관 외 로 유출된 양, 유출된 부위뿐만 아니라 환자의 상대적 크기에 따라서도 다르다. 1 혈관 외 유 출의 생리는 아직 완전히 밝혀지지는 않았지만 두 가지 주요 이론이 존재한다. 바로 카테터 의 이탈 또는 혈관 투과성의 증가이다. 2 혈관 외 유출의 발생률에 대한 기존의 연구들을 살펴보면, 소아 중환자실에서 654명 중 179명(28%)에서 혈관 외 유출이 발생하였고, 3 다른 연구에서는 조직 손상이 발생하지 않은 경우까지 포함하면 신생아에서 70%까지 발생한다고 보고하였다. 4 신생아를 대상으로 31개 기관에서 시행한 연구에서는 조직 괴사가 발생한 혈관 외 유출의 유병률은 1,000명당 38명 (28명/742명)이었으며, 이들 중 70%가 26주 미만의 미숙아였다. 이들 중 4%는 신생아 중환 자실 퇴원 시 미용적으로나 기능적으로 상당한 흉터를 가지게 되었다. 5 신생아에서는 혈관 외 유출과 가장 관련이 많은 약물은 정맥영양이었다. 6 31개 기관에 서 시행된 연구에서 혈관 외 유출 28건 중 14건이 정맥영양과 관련이 있었고, 2건이 중탄산 염과 관련이 있었다. 5 중탄산염은 10% 이상 포도당, 정맥영양, 칼슘 글루코네이트(calcium gluconate)와 같이 고장성 물질로 혈관 외 유출 시 조직 괴사를 일으킬 수 있다. 7 혈관 외 유출에 대하여 확립된 치료 방법은 아직 존재하지 않는다. 6 주로 생리식염수 세척 과 습윤 드레싱, 히알루로니다제(hyaluronidase), 하이드로젤(hydrogel) 드레싱과 같은 보 존적 치료를 시행하며, 2 최근 2명의 만삭 신생아에서 재조합 인간 염기성 섬유아세포성장

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