Effect of Bone Marrow Aspirate with Autogenous Bone Graft for Alveolar Cleft in a New Rabbit Model

PURPOSE: Alveolar bone grafting has become an essential process in the treatment of alveolar cleft patient for stabilization of the maxillary arch, elimination of oronasal fistula, the reconstruction of the soft tissue nasal base support, and creation of bony support for tooth eruption for implant. The use of Autologous iliac cancellous bone is preferable because it enables to use adequate quantity and its high osteoinductive potential. However, even with iliac bone, insufficient osteoregeneration or absorption occurs due to several factors such as the patient's age, cleft width, functional stress, and others. In order to increase osteoregeneration where the iliac bone is placed, the present study is associated with bone marrow aspirate(BMA).The experimental study evaluated the efficacy of osteoregeneration in normal cleft rabbits when alveolar bone grafting was performed with autologous iliac corticocancellous bone. METHODS: Twenty-four New Zealand White rabbits were divided randomly into 2 groups(BMA, control). All animals underwent harvesting of corticocancellous bone graft from the right posterior iliac crest via standard surgical technique. 1mL of BMA were obtained by scraping the needle and aspirate with 10mL syringe from the contralateral iliac bone wall. The muco-periosteal flap on the palate was elevated. A mixture of Equal bone's volumes with BMA and saline as its control was inserted into the cleft. Animals were sacrificed in 2, 4, and 8 weeks and maxilla was harvested for dental peri-apical X-ray, bone matrix density (BMD), and histologic analysis. RESULTS: BMD of regenerated bone to the cleft in the rabbits was higher than that of the control rabbits. X-ray, histologic analysis showed that increased osteoregeneration and low absorption rate were observed in the BMA group. CONCLUSION: Our experimental study shows BMA enhanced the osteoregeneration and survival rate of alveolar bone grafting. BMA is easy to extract and cost-time effective. So it can be an effective enhancers for bone grafting mixtures.

Reconstruction of Lower Extremity Soft Tissue Defect using Cross-leg Free Flap

PURPOSE: To reconstruct soft tissue defect on lower extremity especially combined with osteomyelitis, free flap with enough blood supplies is required. There are some instance when patients have inadequate recipient vessels for microanastomosis. Anastomosis with harvested vein graft can solve the problem. It may be more problematic or even increase recipient site complication. Cross leg free flaps using contra-lateral vessel can be a solution. METHODS: From 2005 to 2008, 12 cases of cross leg free flap were done for 12 patients(9 male, 3 female). External fixators used in all cases. The free flaps used were laissmus dorsi muscle flap(n=5), anterolateral thigh flap(n=4), gracilis muscle flap(n=2) and medial plantar artery fasciotaneous flap(n=1). In all cases, contralateral posterior tibial artery and vein were used as recipient pedicle. RESULTS: All flaps survived without additional operative procedures. There happened no complications such as hematoma or Infection. Sometimes patients needed further therapeutic exercise for fast movement recovery. CONCLUSION: Although cross leg free flaps require long period of bed resting and rehabilitation after pedicle cutting, It can be a practical alternative for soft tissue defect on lower distal extremity with inadequate recipient vessels for free flap on affected leg.

Oncoplastic Techniques For Treatment of Inferiorly Located Breast Cancer

PURPOSE: Breast conserving surgery(BCS) for breast cancer has a common treatment protocol. Oncoplastic surgery represents a form of BCS which combines both a cosmetic mammoplasty approach and oncologic resection for the treatment of breast cancer. Depending on the tumor site, BCS can make an unsatisfactory cosmetic result, especially in inferiorly placed tumors. This study describes the use of oncoplastic techniques for inferiorly located breast tumors in immediate partial mastectomy reconstruction. METHODS: From September of 2006 to February of 2008, these techniques were used in 11 patients at the OO hospital. After BCS was preceded, breast reshaping by oncoplastic techniques were selected depending on the location and size of the tumor within the breast as well as the size of breast itself. Oncoplastic techniques after partial mastectomy included 'Wise pattern (inverted T)' reduction mammoplasty, 'vertical pattern' mammoplasty, 'J-pattern' mammoplasty. In order to improve the cosmetic outcome, repositioning of the nipple areola complex(NAC) or reshaping of the contralateral breast may be considered additionally. RESULTS: These techniques have been used in 11 patients. The mean age was 51 and the average follow- up period was 8 months. Eleven of these patients underwent the 'Wise pattern(inverted T)' reduction mammoplasty(n=6), 'vertical pattern' mammoplasty(n=3) and 'J-pattern' mammoplasty(n=2). There was one wound dehiscence during the follow-up periods. This complication was treated by conservative approach. The overall cosmetic result was evaluated in 6 months. The majority of patients were satisfied at the cosmetic result. CONCLUSION: Oncoplastic techniques in inferiorly located breast tumors could be a reasonable and safe option for breast cancer patients who desire conserving surgery with esthetical breast.

Nerve Regeneration Using a Vein Graft Conduit filled with Hyaluronic Acid in a Rat Model

PURPOSE: The vein graft was considered as a useful conduit for nerve defect. But the problem is that it might be collapsed in long vein graft state. A new experimental model using vein graft filled with hyaluronic acid was considered. METHODS: Thirty rats were used for the experimental animal. In group I, one side of the femoral nerve was exposed and a segment was removed about 15mm. The neural gap was connected with nerve graft. In group II, the nerve gap was connected with vein graft only. In group III, the nerve gap was connected with vein graft filled with hyaluronic acid. A walking track analysis was made periodically for 2 months and NCV(nerve conduction velocity) was executed at the end of the experiment. And morphologic studies were also done for all groups RESULTS: In a walking track analysis, the toe-spread was widen and the foot-length was lengthened. The recovery of the toe-spread and foot length was checked 2 weeks interval, periodically for two months. The SFI (sciatic function index) was -52.5+/-8.2 in group I, -68.1+/-4 in group II, -55.3+/-7.9 in group III. In electrophysiological study, NCV(nerve conduction velocity) was 26.71+/-3.11m/s in group I, 17.94+/-4.35 m/s in group II, 25.69+/-2.81m/s in group III. The functional recovery in group I and III was superior to that the group II statistically(p<0.05) Under electromicroscopic study, the number of the myelinated axons were 1419.1+/-240 in group I, 921.7+/-176.8 in group II, 1322.2+/-318 in group III. The number of the myelinated axons were much more in group I and III than group II statistically (p<0.05). CONCLUSION: This study suggested that the vein graft filled with hyaluronic acid is more effective than vein graft only for the conduit of the nerve gap. It was thought that the technique could be used in clinical cases with nerve defects as an alternative method to classical nerve grafts.

Nerve Regeneration Using a Vein Graft Conduit filled with Hyaluronic Acid in a Rat Model

PURPOSE: The vein graft was considered as a useful conduit for nerve defect. But the problem is that it might be collapsed in long vein graft state. A new experimental model using vein graft filled with hyaluronic acid was considered. METHODS: Thirty rats were used for the experimental animal. In group I, one side of the femoral nerve was exposed and a segment was removed about 15mm. The neural gap was connected with nerve graft. In group II, the nerve gap was connected with vein graft only. In group III, the nerve gap was connected with vein graft filled with hyaluronic acid. A walking track analysis was made periodically for 2 months and NCV(nerve conduction velocity) was executed at the end of the experiment. And morphologic studies were also done for all groups RESULTS: In a walking track analysis, the toe-spread was widen and the foot-length was lengthened. The recovery of the toe-spread and foot length was checked 2 weeks interval, periodically for two months. The SFI (sciatic function index) was -52.5+/-8.2 in group I, -68.1+/-4 in group II, -55.3+/-7.9 in group III. In electrophysiological study, NCV(nerve conduction velocity) was 26.71+/-3.11m/s in group I, 17.94+/-4.35 m/s in group II, 25.69+/-2.81m/s in group III. The functional recovery in group I and III was superior to that the group II statistically(p<0.05) Under electromicroscopic study, the number of the myelinated axons were 1419.1+/-240 in group I, 921.7+/-176.8 in group II, 1322.2+/-318 in group III. The number of the myelinated axons were much more in group I and III than group II statistically (p<0.05). CONCLUSION: This study suggested that the vein graft filled with hyaluronic acid is more effective than vein graft only for the conduit of the nerve gap. It was thought that the technique could be used in clinical cases with nerve defects as an alternative method to classical nerve grafts.

Clinical Experiences of Face Lift: A Marginal Tragal Incision and Two Point Anchor

There is one problematic part of the facialplasty procedure that has been addressed with relative infrequency in the plastic surgery literature. Hypertrophic scar, deformed tragus and "pixie ear" deformity, the problems associated with the design and closure of the periauricular incisions, are still recognized. Prevention of these undesirable results of facialplasty is the surgical challenge about which this article is concerned. In facelift, pretragal incision leaves long scar formation on preauricular area and retrotragal incision occasionally makes the unnatural tragus. Since the marginal tragal incision consists of several short segments, it can prevent tragal deformity caused by scar contracture and preserve shape of the tragus. Putting 2 anchoring key sutures on just above the ear and at the mastoid area minimizes the tension on the incision line and minimizes postoperative ear deformity. We experienced 42 face lifting procedures in patients with aging face during the last 6 years(from Dec 1999 to May. 2005). Complications were hematoma in four cases(9.5%) and focal wound dehiscence in two cases(4.8%). The patients with the complications completely recovered 3 months later.