Hidradenitis Suppurativa

Hidradenitis suppurativa is a chronic inflammatory condition that affects apocrine gland-rich areas such as the axilla and groin. It causes painful nodules, abscesses, sinus tracts, and scarring, significantly impairing quality of life.

Conventional treatments, including antibiotics, steroids, and minor excisions, often provide incomplete control and are associated with high recurrence rates. At Asan Medical Center, we are aware of the limitations of these approaches.

That is why we adopt a definitive surgical approach:

• Complete excision of all inflamed and potentially pre-affected tissue
• Reconstruction with local flaps or skin grafts to ensure durable healing

Our proactive and comprehensive surgical management is designed not only to eliminate visible lesions but also to prevent future recurrences, helping patients regain dignity and daily comfort.

Giant Congenital Melanocytic Nevus

Giant congenital nevi require staged surgical excision to reduce cosmetic burden and lower the potential risk of malignancy. These cases frequently involve pediatric patients, for whom safety is the highest priority, not only during surgery but throughout the perioperative course and long-term follow-up.

At Asan Medical Center, we offer pediatric-specialized surgical care supported by:

• Dedicated pediatric anesthesiologists with expertise in airway management and sedation safety for infants and children
• Plastic surgeons highly experienced in pediatric tissue handling, wound healing physiology, and scar modulation
• Postoperative negative-pressure wound therapy (NPWT) to stabilize wound edges, reduce tension and dehiscence, and promote optimal healing

Surgical Strategy

The surgical plan is carefully tailored to the size, location, and thickness of the nevus, as well as the patient’s age and skin elasticity.

• Staged Excision : The nevus is removed through multiple surgeries over time. Each stage removes a portion of the lesion while allowing the surrounding skin to gradually stretch and adapt.
• Skin Expansion or Serial Excision : In some cases, natural skin laxity or tissue expansion techniques are used between stages to achieve closure without the need for grafting.
• Avoidance of Skin Grafts : Whenever possible, we aim to achieve complete excision using only adjacent skin for closure, thereby enhancing the final cosmetic outcome.
• Aesthetic Planning : Incision lines are carefully aligned with relaxed skin tension lines and natural creases, especially in visible areas such as the face and extremities.

This stepwise protocol minimizes surgical trauma and maximizes both aesthetic and oncologic safety, ensuring that each child receives individualized, age-appropriate, and safest-possible care.

Burn Scar Contracture

Burn scar contracture is a common consequence of deep partial- or full-thickness burns, particularly when healing occurs via secondary intention or following split-thickness skin grafting. The scar tissue gradually matures, becoming fibrotic and inelastic, which can cause skin tightening and joint immobility, especially in areas such as the neck, axilla, elbow, knee, and fingers.

Such contractures can significantly impair range of motion (ROM), hinder normal development in children, and diminish overall quality of life by affecting daily activities, posture, and, when located near the face or thorax, even breathing or vision.

Surgical Principles at Asan Medical Center

At Asan Medical Center, we provide advanced surgical solutions that extend beyond basic contracture release, focusing on both functional restoration and long-term recurrence prevention

• Comprehensive Contracture Release

  • All fibrotic bands are meticulously excised, often down to subcutaneous or fascial levels, to fully free the affected joint or area.
  • In complex or recurrent cases, Z-plasty or local tissue rearrangement may be used as an adjunct to maximize release.

• Reconstruction Tailored to Location and Function

  • Split-thickness skin grafts are used when the would bed has good vascularity and limited shear stress.
  • Thin, pliable free flaps, such as SCIP, ALT, or MSAP flaps, are selected for high-mobility or weight-bearing areas where durability, contour, and a gliding surface are critical.
  • All flaps are preoperatively designed using ultrasonographic vascular mapping to optimize outcomes at both the donor and recipient sites.

• Functional and Aesthetic Optimization

  • Reconstruction materials are chosen not only for coverage but also for their ability to preserve elasticity and support dynamic movement.
  • Incision lines are strategically placed to minimize future tension and improve scar camouflage.

• Pediatric Consideration

  • In growing children, special attention is given to preserving growth potential and preventing joint deformity. We employ techniques that accommodate ongoing skeletal development.

Postoperative Rehabilitation and Prevention

Our care extends beyond the operating room. A dedicated postoperative rehabilitation protocol is implemented to:

• Begin early joint mobilization through physical therapy
• Apply custom pressure garments or silicone sheeting for scar modulation
• Use splints or dynamic orthoses to maintain joint position
• Conduct long-term monitoring for recurrence and provide secondary interventions if necessary

When appropriate, adjunctive therapies such as fractional CO₂ laser, intralesional corticosteroid injection, or fat grafting are applied to improve scar quality and mobility.

Why Choose Asan Medical Center?

• Extensive experience in microsurgical and supermicrosurgical reconstruction
• Expertise in harvesting ultrathin perforator flaps for delicate areas such as the eyelids, hands, and neck
• Integrated burn rehabilitation team including physiatrists, therapists, and wound care specialists
• Multidisciplinary approach to managing post-burn sequelae in both adults and children