Delayed intestinal perforation and vertebral osteomyelitis after high-intensity focused ultrasound treatment for uterine leiomyoma

High-intensity focused ultrasound (HIFU) is a non-invasive uterine fibroid treatment option for patients who want to preserve fertility. However, according to several reports regarding ablation of solid tumors by HIFU, there are rare complications in patients with uterine leiomyomas, and overall data are still insufficient. Here, we report rare and major complications of HIFU, such as delayed intestinal perforation, uterine perforation with recto-uterine fistula, and osteomyelitis 29 days after the HIFU procedure to treat multiple myomas. Thus, we present a very serious case resulting from HIFU treatment of uterine fibroids and a review of the literature.

Treatment of Congenital Muscular Torticollis with Unipolar Release

PURPOSE: The congenital muscular torticollis is a neck deformity involving shortening of the sternocleidomastoid muscle, which is detected at birth or shortly after birth. This childhood disease is the third most common congenital musculoskeletal anomaly. The indication for surgery is a persistent head tilt with dificit of passive rotation and lateral bending of the neck and a tight band or tumor in the sternocleidomastoid muscle even after physical therapy. The purpose of this article is to report surgical outcomes with patients who had no or little response to physical therapy. METHODS: Surgery was performed on 29 patients and their average age was 4.1 years(from 6 months to 20.1 years). The unipolar open release and partial myectomy were done in 28 cases and the muscle lengthening was done in 1 case. Physical therapy was started from postoperative seventh day. Follow-up period was ranged from 2 months to 5.4 years(mean follow-up, 20.4 months). Result: There were neither rotation nor lateral bending deficit after surgical treatment. Mild head tilt was noticed in 3 cases and residual bend was observed in 4 cases. The subjective assessments of surgical results by parents were excellent. CONCLUSION: Our surgical outcome encourages the surgical treatment of congenital muscular torticollis for patients who failed to respond to physical therapy.

The Anatomical Study of Internal Mammary Perforators

PURPOSE: As a recipient vessel, internal mammary vessels have many advantages for microvascular reconstruction of the breast. But the approach is time consuming and results in large morbidities. However, the perforating branches of the internal mammary vessels can be used to minimize such demerits. The purpose of this cadaver study is to clarify the location and diameter of the perforating branches of internal mammary vessels and to prove that they are safe and reliable recipient vessels. METHODS: We studied 11 formalin-fixed cadavers and dissected their anterior chests bilaterally. The chests were exposed using midline presternal incisions. We dissected and found all perforators at subfascial planes under loupe magnification. The number, external diameter, and the distance from the midline were measured. Result: The mean external diameter of the arterial perforators was 1.32mm and the mean external diameter of the venous perforators was 1.48mm. The largest arterial and venous perforators were most frequently found in the second intercostal space. The mean distance from the midline to the perforator was evaluated; the artery averaged 1.95cm and the vein averaged 2.08cm. CONCLUSION: This study will be helpful when using the internal mammary perforating vessels as a recipient vessel during breast reconstruction.

The Regional Anatomy of Perforating artery and Pedicle for the Anterolateral Thigh Free Flap in the Korean

PURPOSE: The anterolateral thigh flap has many advantages over other conventional free flaps. But the anterolateral thigh flap has yet to enter widespread use because perforating arteries exhibit a wide range of anatomic variations and are difficult to dissect when small. The aim of this study is to identify the vascular variability of perforating arteries and pedicle in the anterolateral thigh free flap. METHODS: We studied 12 cadavers and dissected 23 thighs. An anterolateral thigh flap (12x12cm) was designed and centered at the midpoint of the line drawn from anterior superior iliac spine to the superolateral border of the patella. After we identifed the perforating arteries we dissected up to their origin from lateral circumflex femoral artery along descending branch of lateral circumflex femoral artery. We then investigated the number and the position of perforating arteries, length and diameter of vascular pedicle and pattern of lateral circumflex femoral arterial system. RESULTS: On average 2.3+/-1.1 perforating arteries per thigh were identified. The musculocutaneous perforators were 63.1%. In those perforators five perforators were arose from transverse branch of lateral circumflex femoral artery and two were arose from rectus femoral artery. Most of the perforators were near the intermuscular septum between rectus femoris muscle and vastus lateralis muscle. The length and diameter of pedicle were 11.9+/-3.5cm and 3.1+/-0.8mm on average. CONCLUSION: This study will be helpful for the success in anterolateral thigh free flap.

A Case of Congenital Palatal Teratoma Associated with Cleft Palate

PURPOSE: The oral teratoma is found approximately in live birth at the rate from 1:35,000 to 1:200,000. In a review of literature 16 cases of midline teratoma with cleft palate were reported. We report a case of congenital palatal teratoma with cleft palate in a 1-year-old girl. METHODS: A 1-year-old girl was admitted our institution for the closure of cleft palate. On the intraoperative findings there was 4x1x0.5cm sized hairy soft mass at the midline and complete cleft palate. We did incisional biopsy intraoperatively and its pathology revealed heterotopic brain tissue. The excision of remaining mass and palatoplasty with Sommerlad's method were performed. The final pathology of the mass was mature cystic teratoma. RESULTS: After the operation there were neither recurrence nor oronasal regurgitation. CONCLUSION: We report for one patient with congenital palatal teratoma associated with cleft palate and obtained an excellent result.

Treatment of Post-traumatic Scapho-lunate Dissociation / 대한정형외과학회잡지

We have analyzed 27 cases(38.8%) of scapho-lunate(SL) dissociation which were the most com- mon type of total 72 cases of post-traumatic wrist instabilities since 1985. As a result, SL dissociations associated with wrist fracture were 23 cases, more common than simple dynamic SL dissociation(4 cases). Early diagnosis and treatment influenced on their prognosis, and both wrist PA roentgenograms were useful for the confirmative diagnosis of SL dissociation. In 16 cases with early diagnosis, closed reduction, 2 or 3 K-wires fixation under C-arm image and short arm cast for 8 weeks were effective. But in 11 cases with neglected diagnosis and with wrist fractures showed poor results. Excessive wrist ligamentous reconstruction in chronic cases should be avoided because of osteoporosis and wrist stiffness. Conclusively, clinical wrist symptoms are more important than radiological changes in wrist insta- bilites. So if the symptoms are not so severe, we must consider the patient's age, occupation and their social activities etc. to decide the proper way of treatment.