Kidakorn Kiranantawat

Background/Objectives: Solar elastosis, a key histopathological alteration in skin photodamage, results from chronic UV exposure and photoaging. Clinically, it manifests as deep wrinkles, laxity, and a dull complexion. The growing demand for effective treatments has spurred the development of numerous therapeutic strategies. This systematic review aims to synthesize and critically evaluate the scientific evidence regarding interventions for treating the clinical and histological manifestations of solar elastosis, to provide an updated overview and guide future clinical practice. Methods: PubMed, Scopus, ProQuest, and Web of Science databases were searched for articles published in the last ten years. Clinical studies on adults with signs of solar elastosis and photoaging, evaluating therapeutic interventions, were included. Primary outcomes were clinical and histopathological improvements, while secondary outcomes included skin elasticity, safety, and patient satisfaction. This review was registered in the PROSPERO database under registration number CRD420251086680. Results: Twenty-two studies, totaling 608 participants, were included. The analyzed therapies comprised a wide range of strategies, including energy-based devices (laser, radiofrequency), stem cell derivatives, bioactive topical compounds, and growth factor-rich plasma. Device-assisted and biologically augmented interventions consistently improved visible photoaging outcomes and skin elasticity, with selective histologic remodeling, heterogeneous effects on barrier function, and an overall acceptable safety profile, with mild and transient adverse events. Patient satisfaction was consistently high. Conclusions: Therapeutic strategies in solar elastosis and photoaging, particularly those combining energy-based devices with regenerative agents, have proven effective in improving the structural and functional aspects of photodamaged skin. Although the results are promising, the current literature is limited by methodological heterogeneity and small sample sizes. High-quality randomized controlled trials with long-term follow-up are needed to establish standardized, evidence-based protocols.

Lymphoscintigraphy evaluates the lymphatic system using radiocolloid compounds like ^99mTc-sulfur colloid and ^99mTc-nanocolloid, which vary in particle size and distribution timing. A local in-house Dextran kit (15–40 nm) was developed in 2005 and began clinical use in 2008 to localize sentinel lymph nodes; diagnose lymphedema; and detect lymphatic leakage. The normal drainage pattern remains unexplored. We retrospectively analyzed 84 upper extremity lymphoscintigraphies from 2008 to 2021. ^99mTc in-house Dextran was intradermally injected into both hands, followed by whole-body imaging at specified intervals (≤15 min; 16–30 min; 31–45 min; 46–60 min), with some receiving delayed imaging. Visual and quantitative analyses recorded axillary and forearm lymph nodes and liver, kidney, and urinary bladder activity. Results showed 92% (77/84) upper extremity lymphatic tract visualization within 45 min. Axillary node detection rates increased from 46% (≤15 min) to 86% (46–60 min). Delayed imaging further revealed nodes. Epitrochlear or brachial node visualization was rare (4%, 3/84). Hepatic, renal, and urinary bladder activity was noted in 54%, 71%, and 93% at 1 h, respectively. The axillary node uptake ratio was minimal (99mTc in-house Dextran, offering insights into its clinical application

Background: Autogenous costal cartilage becomes a favorable choice for nasal reconstruction and complicated aesthetic rhinoplasty, because of its ample supply, sufficient for most patients. However, a notable drawback is the potential for warping. The authors’ study aims to identify cutting planes that minimize warping. Methods: Two hundred seven costal cartilage grafts were obtained by slicing the extracted costal cartilages from 10 fresh cadavers along 3 main planes: cephalocaudal, anteroposterior, and parallel to the synchondrosis plane. Each of these major planes was further divided into grafts taken from both the central and peripheral portions. Furthermore, both subgroups were categorized into three thicknesses: 1, 2, and 3 mm. The warping angles of all grafts were then compared at various time intervals after the initial cutting. Results: Cephalocaudal cuts exhibited significantly greater warping than other planes. Anteroposterior cuts displayed the least warping, although this difference lacked statistical significance. Peak warping occurred at 30 minutes. Certain grafts continued to warp even at 1 month. Central grafts had less warping than peripheral ones, although the difference was not statistically significant. Conclusions: Cephalocaudal cuts yielded the highest warping angle. Surgeons seeking thin (3 mm) can be cut in the cephalocaudal plane with an acceptable warping angle, close to parallel with the synchondrosis plane. For curved cartilage, thin cephalocaudal cutting is recommended. In addition, the authors suggest placing the cartilage in normal saline for at least 30 minutes, allowing for maximum warping to occur.

Tumoral involvement of the carotid artery may require en‐bloc resection in order to achieve a better regional control. Among the carotid reconstruction methods at disposal, autologous tissues appear to be more reliable in cases with high risk of infection and poor tissue healing like in radiated necks. We describe a case of a 55 year old man, who suffered from recurrent squamous cell carcinoma in the neck region, invading the common carotid artery. After en‐bloc resection of the tumor together with skin, internal jugular vein, vagus nerve and common carotid artery, carotid reconstruction was performed with a flow‐through chimeric flap based on superficial femoral vessels (15 cm). After resection of the tumor, the flap was used to replace the soft tissue defect (23 × 12 cm). Anteromedial thigh skin paddle (8 × 5 cm) and sartorius muscle (12 × 3 cm) were included in the flap. The superficial femoral vessels were reconstructed with 8‐mm ringed polytetrafluoroethylene graft interposition. Thanks to an accurate surgical planning and a 2‐team approach, the ischemia time of the leg was 42 min and there were no limb ischemia nor pathologic neurological signs after surgery. During the 12‐month follow up, no other complication was registered. In our experience, microsurgical carotid reconstruction represents a reliable option with important advantages such as resistance to infection, optimal size matching, and good tissue healing between the irradiated carotid stump and the vascular graft.

Introduction Composite and large head and neck defects requiring extensive skin‐mucosa coverage are often reconstructed by combining flaps. Herein, we present a simple and reliable two‐stage fibula osteocutaneous (FOC) flap technique to improve the survival of a large skin paddle for oromandibular reconstructions. Methods From October 2011 to September 2016, 47 patients with through‐and‐through oromandibular defects were reconstructed using FOC flaps with large skin paddles. To ensure optimum survival of skin paddles, temporary orocutaneous fistula were left in place and closed during the second stage operation via de‐epithelialization of the skin paddle and suturing of mucosa. Demographic data, operative details, and postoperative complications were recorded. Results The skin paddle dimensions ranged from 20 to 31.5 cm in length and 12 to 17 cm in width with an average area of 430.4 cm² (range 300–504). The average time between the two stages and hospital stay were 10 days and 14 days, respectively. Complications at the donor site included wound dehiscence (n = 3, 6.4%), partial skin graft loss (n = 3, 6.4%) and hematoma (n = 2, 4.3%). Recipient site complications included two (4.3%) early postoperative venous congestions that resolved after elevation and three (6.4%) partial skin flap necrosis (less than 5% surface area). All complications resolved with bedside conservative management. There was only one take‐back for evacuation of recipient site hematoma (2.1%) but no flap loss. Conclusion Two‐staged large skin paddle FOC flaps can simplify reconstruction of extensive oromandibular defects by improving the reliability of the sizable skin paddle and negating the need for a second flap.

A rhinoplasty in Asians differs from a rhinoplasty performed in patients of other ethnicities. Surgeons should understand the concept of Asian beauty, the nasal anatomy of Asians, and common problems encountered while operating on the Asian nose. With this understanding, surgeons can set appropriate goals, choose proper operative procedures, and provide an outcome that satisfies patients. In this article the authors define the concept of an Asian rhinoplasty—a paradigm shift from the traditional on-top augmentation rhinoplasty to a structurally integrated augmentation rhinoplasty—and provide a step-by-step procedure for the use of Adobe Photoshop as a preoperative program to simulate the expected surgical outcome for patients and to develop a preoperative plan for surgeons.

The eyelid of Asians has its own unique characteristics. If the surgeon does not acknowledge this, aesthetically pleasing results will seldom be achieved. Here the authors review and summarize important up-to-date anatomical and relevant clinical studies of the Asian upper eyelid, aiming to help surgeons thoroughly understand its unique features, including Asian eyelid morphology, anatomical details, and the mechanisms of upper eyelid crease formation. Hopefully, an in-depth understanding of the Asian eyelid will aid surgeons to accomplish their work and lead to novel new techniques in this field.