Joo Hyoung Kim

Background: Indocyanine green lymphography (ICG L) and lymphoscintigraphy (LS) are widely used to stage breast cancer–related upper limb lymphedema (BCRL); however, both are primarily read qualitatively. We evaluated whether a pragmatic ICG time to axilla metric (elapsed time from hand injection to axillary visualization) correlates with MD Anderson (MDACC) ICG L stage and LS severity. Methods: In this retrospective observational study at a tertiary center (March 2018–May 2023), unilateral BCRL patients who underwent both ICG L and LS were included. ICG L was performed at 1, 2, and 3 hours after web space injections, and time to axilla was categorized as ≤1 h, ≤2 h, ≤3 h, and >3 h/not reached (T grades 1–4). Outcomes were associations of T grade with MDACC stage, LS stage, and maximal circumference difference (MCD). Ordinal trends were tested by Jonckheere–Terpstra. Results: Eighty nine women were analyzed. T grades: 1 (n=37), 2 (n=7), 3 (n=6), 4 (n=39). MCD increased across T grades (medians 2.5, 2.3, 3.9, and 3.5 cm; P = 0.009). MDACC stage distribution shifted rightward with higher T grade (median 3.00 at T1 to 4.00 at T4; P < 0.001). LS stage also trended higher with T grade (medians 3.00, 5.00, 5.00, and 4.00; P = 0.003). Conclusions: A simple, categorical ICG time to axilla measure correlates with both MDACC morphology and LS severity and tracks clinical limb size difference. Time to axilla may complement qualitative ICG L patterns and LS findings by providing an objective transport capacity signal for BCRL stratification.

Tracheal defects that occur after resection can be reconstructed in various ways. Depending on the depth of the tumor invasion or the circumference of the trachea defect, options such as local flaps, free flaps, or primary closure can be used. We report a case of reconstruction using a sternocleidomastoid myoperiosteal flap for partial tracheal defect following tumor resection. A 77-year-old woman was diagnosed with papillary thyroid cancer with tracheal invasion. The patient underwent total thyroidectomy and partial tracheal resection. The resulting partial tracheal defect was reconstructed with a sternocleidomastoid myoperiosteal flap. The flap was elevated including the periosteum of the sternal head and the clavicular head of the sternocleidomastoid, and was inset into the tracheal defect. No complications were observed. At 3 months after operation, the patient reported no discomfort, laryngoscope and neck computed tomography examinations revealed no abnormal findings.

Scar endometriosis, which is characterized by ectopic endometrial-like glands and stroma surrounding scar tissue, is rare and presents diagnostic challenges due to its inconsistent presentation. We report a case of a 40-year-old woman who had previously undergone two cesarean sections and a hysterectomy, in whom a mass in the subcutaneous layer of the lower abdomen was incidentally discovered by computed tomography (CT). A physical examination revealed a linear cesarean scar with a palpable, pigmented mass. An enhanced abdominal CT scan revealed an approximately 3.5-cm ill-defined soft tissue mass infiltrating the rectus abdominis muscle. A desmoid tumor was suspected based on the radiological findings, and endometriosis was also considered in light of the patient’s medical history. Wide mass excision was performed, ensuring 5-mm margins. The mass was completely excised, and a histopathological examination revealed endometriosis. Due to its rarity, scar endometriosis in the abdominal area can be easily misdiagnosed. Therefore, a heightened suspicion of scar endometriosis should be maintained in female patients with a history of abdominal or pelvic surgery presenting with an abdominal mass. Although imaging modalities can play a supportive role in the diagnosis, an extensive medical history assessment and comprehensive physical examination remain crucial.

Recurrent parotid sialocele is rare and challenging to treat. Treatment options are limited for cases of parotid sialocele that recur despite ductal ligation. This case study presents a patient who underwent wide excision of the right buccal mucosa due to squamous cell carcinoma. During the wide excision, a segment of the parotid duct was excised, and ductal ligation was performed to prevent the occurrence of a sialocele, followed by reconstruction using a folded anterolateral thigh free flap. Twenty-two days after surgery, parotid sialocele occurred despite the initial ductal ligation and subsequent ductal ligation was performed; however, the sialocele recurred. As an alternative therapeutic option, a transdermal scopolamine patch was applied for 3 weeks, with one patch used every 3 days. The results were encouraging, with complete resolution of the sialocele. A transdermal scopolamine offers a noninvasive, convenient method of treating parotid sialocele with minimal side effects. The successful outcome of this case suggests that a transdermal scopolamine can be an effective therapeutic option for recurrent parotid sialocele in conjunction with surgical treatment.

Background: Wide excision of malignant melanoma on the foot usually results in an extensive function-destroying defect, and the reconstruction of foot defects remains challenging for reconstructive surgeons. We propose using anterolateral thigh perforator (ALT) free flaps for the reconstruction of widespread defects caused by malignant melanoma in the sole. Methods: This retrospective study included 34 patients who underwent reconstruction of sole defects caused by malignant melanoma resection with 35 ALT perforator free flaps between August 2005 and July 2021. Results: In total, 18 male patients and 16 female patients were included (mean age at surgery, 65.4 years). The mean size of the flaps was 100.4 cm². Thirty-three of the 35 flaps survived. Hematoma, seroma, and chronic ulceration were not identified in any cases. All patients achieved independent ambulation within the follow-up period, except 1 patient with gait discomfort. The 5-year overall and disease-free survival rates of patients were 64.4% and 56.6%, respectively. Conclusions: The ALT flap is a versatile surgical option that should be considered for reconstruction of the sole after malignant melanoma resection, considering its various surgical advantages and the functional aspects of independent ambulation, the aesthetic aspects of wearing conventional footwear, and the anatomical aspects of the sole.

Morbihan disease (MD) is a very rare condition characterized by rosaceous or erythematous lymphedema on the upper twothirds of the face. A definitive management strategy for MD is lacking, and treatment is challenging. Herein, we present a case of persistent bilateral eyelid edema treated by lymphaticovenular anastomosis (LVA) and lymph node-vein bypass surgery. The patient experienced persistent bilateral eyelid edema. Indocyanine green lymphography was performed, and the diagnosis of bilateral facial lymphedema was confirmed. On the right side, a preauricular lymphatic vessel was anastomosed to a vein. On the left side, lymphostomy on the preauricular lymph node was done, with anastomosis to the transected proximal end of the concomitant vein of the transverse facial artery. Furthermore, a preauricular lymphatic vessel was anastomosed to a vein. Eyelid edema decreased and progressively improved on both sides. The outcome of this case suggests that LVA and lymph node-vein bypass surgery are appropriate for treating persistent eyelid edema related to MD.

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.

This study aimed to compare and analyze the prognosis after lipectomy with respect to the difference in time required for indocyanine green (ICG) to reach the axilla in patients with advanced unilateral upper extremity lymphedema. The study population was divided into 2 groups, according to the time required by ICG to reach the axilla after injection, that is, P = .847) and 1 month (P = .336), 3 months (P = .630), and 6 months after surgery (P = .124) between the excess volume ratio values of the < 1 hour and > 1 hour groups. A statistically significant difference was confirmed 12 months after surgery (P = .034). The difference in the time when ICG reached the axilla in patients with lymphedema was associated with prognosis after lipectomy. The difference in time could possibly be used as a variable to classify the progress of lymphedema in the future.