Treatment of Blow-out Fractures Using Both Titanium Mesh Plate and Porous Polyethylene (Medpor(R))

PURPOSE: The goals of a blow-out fracture reconstruction are to restore the osseous continuity, provide support for the orbital contents and prevent functional and anatomic defects. Over the past several years, a range of autogenous and synthetic implants have been used extensively in orbital reconstructions. None of these implants have any absolute indications or contraindications in certain clinical settings. However, in extensive blow-out fractures, it is difficult to restore support of the orbital contents, which can cause more complications, such as enophthalmos. This study examined the clinical outcomes of extensive or comminuted blow-out fractures that were reconstructed by the simultaneous use of a titanium mesh plate and Medpor(R). METHODS: Eighty six patients with extensive orbital fractures, who were admitted between March 1999 and February 2007, were reviewed retrospectively. The patients' chart and CT were inspected for review. Twenty three patients were operated on with both a titanium mesh plate (Matrix MIDFACE pre-formed orbital plate, Synthes, USA) and Medpor(R) (Porex, GA, USA). The patients underwent pre-operative CT scans to evaluate the fracture site and measure the area of the fracture. A transconjunctival approach was used, and titanium mesh plates were inserted subperiosteally with screw fixation. Medpor(R) was inserted above the titanium mesh plate. The patients were evaluated post-operatively for enophthalmos, diplopia, sensory disturbances and eyeball movement for a period of at least 6 months. RESULTS: No implant-related complications were encountered during the follow-up period. Enophthalmos occurred in 1 patient, 1 patient had permanent sensory disturbance, and 3 patients complained of ocular pain and fatigue, which recovered without treatment. Although there were no significance differences between groups, the use of 2 implants had fewer complications. Therefore, it can be an alternative method for treating blow out fractures. CONCLUSION: The use of both a titanium mesh plate and Medpor(R) simultaneously may be a safe and acceptable technique in the reconstruction of extensive blow-out fractures.

Two Portal Approach(Endoscopic Transnasal and Subciliary) in Medial Orbital Wall Fracture

PURPOSE: As the use of computed tomographic scanning spread, the diagnosis of blow-out fractures of the medial orbital wall increased. Conventionally, the surgery of blow-out fractures in medial orbital wall was performed by various approaches with external incision or endoscopic approach. Although the field of orbital surgery has progressed significantly during the last decade, accurate realignment and replacement of component is difficult due to lack of visualization of the fracture site, blind dissection of the orbital wall, and difficulty in insertion of implant. In order to overcome these shortcomings, we explored the use of endoscopic transnasal approach together with subciliary approach. METHODS: The entrapped periorbital tissues in the ethmoid sinus were completely reduced endoscopically, and the bone defect of medial orbital wall was reconstructed with Medpor(R) insertion via subciliary approach. This technique was applied to 13 patients who had medial orbital wall fracture. RESULTS: The patients were followed-up for 3 to 24 months with an average of 9 months. The postoperative courses were satisfactory in all cases. CONCLUSION: The conjunction of endoscopic transnasal and subciliary approach technique seems to produce good results in medial orbital wall fracture.

The Effects the Composite Differences of the Transferred Vascular Tissues and the Surgical Delay on the Vascularization of the Prefabricated Cutaneous Flap

This study was designed to investigate the effect of the surgical delay in the prefabricated cutaneous flap. Abdominal skin flaps (n=40), 4.5x6.0cm in size, were created by the subcutaneous implantation of a saphenous vascular tissue in the male Sprague-Dawley rats. In the groups 1 and 2, the pedicle was skeletonized. In the groups 3 and 4, perivascular muscle cuff or gracilis fascia was retained, respectively. Six weeks later, each flap was elevated as an island flap and reposed in place. All flaps of the group 2 had a 72-hours of delay period. Five days after the flap repositioning, estimation of flap viability, microangiographies, and histological evaluation of vessel development were performed. The groups 2 and 3 showed higher viability in flap survival. The dilated choke vessels and fully developed vascular network were observed in the flap of the group 2, but not typically seen in the other groups. New vessels around the implanted pedicle were more developed in the group 2. Amount of the vessels in the mid-portion of the flap was significantly increased in the groups 2 and 4. In conclusion, the delay procedure enhanced the viability, and its effect was dependent on the new vessel formation around the implanted pedicle.

Variable Effect of Estrogen on Fibroblast Proliferation and Collagen Synthesis by Gender and Age

It was assumed that the effect of estrogen on wound healing would be variable according to patient's gender and age since estrogen is a sex steroid. This study was designed to determine the variability of the effect of estrogen on proliferation of human dermal fibroblasts and collagen synthesis which are most important in wound healing considering patient's gender and age. Fibroblasts were isolated from the dermis of female patients in premenstrual, menstrual, or postmenopausal age group and that of male patients. The isolated fibroblasts were cultivated in the presence of estrogen(1.0microgram/ml). The cells were seeded at 5.0x103cell/ well in Dulbecco's Modified Eagle's Medium/Ham's F-12 nutrient including 5% fetal bovine serum in 96-well plates. The cells were incubated for 3 days. For fibroblast proliferation MTT assay method was used. To measure the production of collagen, the collagen type I carboxy- terminal propeptide enzyme immunoassay was carried out. Estrogen stimulated the proliferation of fibroblasts in female patients, but not in male patients. The greatest cell proliferation and collagen synthesis was seen at women in menstrual and postmenopausal age. These results demonstrated that effects of estrogen on dermal fibroblast proliferation and collagen synthesis were variable with gender and age.

A Survey of Korean College Students' Cognition of Cosmetic Operation

Throughout the ages, mankind has always been in pursuit of enhanced personal beauty. Thanks to the power of mass media, interest in one's own personal appearance and the ability to make enhancements through cosmetic operation has skyrocketed. The purpose of this study is to examine the cognition that Korean college students have of cosmetic operation and how it relates to their own personal appearance. From December, 2002 through February, 2003, a total of 402 college students attending school on campuses in Seoul, South Korea were surveyed. The survey population consisted of 218 men and 184 women. Eighteen questions were included in the survey, falling into 5 basic categories; their personal concept of appearance, the need for cosmetic operation, the operative regions they are most concerned with, the means be which they gather information about aesthetic surgery, and their understanding of board certification. Wilcoxon rank sum test(SPSS version 10.1 for window) was used to analyze the data and show the statistical results. The survey revealed that both male and female students consider appearance as important as intelligence. 93% of all respondents feel that they will need some kind of cosmetic operation at some point in their future. Of the desired operative regions, men as well as women gave higher priority to skin surgery than to rhinoplasty, eye surgery, and facial bone contouring surgery. When asked why they might hesitate to undergo an operative procedure, the fear of side effects ranked highest. The results also showed that these students get most of their information on cosmetic operation from the Internet. When asked about their understanding of board certification, only 24% of the respondents could distinguish between board certified plastic surgeons and general physicians. The results of our survey highlight the high amount of interest Korean college students have in maintaining their personal appearance and the positive understanding they have of cosmetic operation. Even though many of the respondents expressed a desire to have cosmetic operation, most of them were apprehensive of the possible side effects. The results also showed that most of the students were unable to correctly identify board certified plastic surgeons. Therefore, the results of this study suggest that the general public is in need of more information on specialized cosmetic operation and board certification.

Effect of Estrogen on Fibroblast Proliferation and Collagen Synthesis

Estrogen is a sex steroid hormone which is known to be helpful in preventing aging process in various ways. It is frequently used in hormone replacement therapy (HRT). Basically wound healing is likely to have same process on the view of cell proliferation and extracellular matrix formation. However, it is not determined yet whether estrogen up-regulates or down-regulates wound healing. This study was designed to determine the effect of estrogen on proliferation of human dermal fibroblasts and collagen synthesis in vitro which are most important in wound healing. Fibroblasts were isolated from the dermis of adults and cultivated in the presence of either one of 5 concentrations of estrogen(0, 0.01, 0.1, 1.0, 10microgram/ml). The fibroblasts were seeded at 5.0x103cell/well in Dulbecco's Modified Eagle's Medium/Ham's F-12 nutrient including 10% fetal bovine serum with either one of 5 different concentration of estrogen in 96-well plates. The cells were incubated for 3 days. For fibroblast proliferation MTT assay method was used. To measure the production of collagen, the collagen type I carboxy- terminal propeptide enzyme immunoassay was carried out. All concentrations of estrogen stimulated the proliferation of fibroblasts. The best proliferation and maximum stimulation of collagen synthesis was seen at supplementation of 1.0microgram/ml of estrogen. The collagen synthesis per cell was also maximal at concentration of 1.0microgram/ml estrogen. These results demonstrate that estrogen influences human dermal fibroblast proliferation and the estrogen concentration is critically important factor in vitro.