Clinical Experience of Cryptopenis

PURPOSE: By virtue of good nourishment, obese boys are increasing in Korea, which may result in prevalence of cryptopenis. As milieu of economy, culture, and society changes, increased attention to the external genitalia in children should encourage surgeon to do assertive treatment for cryptopenis. But various operative methods have been devised yet to need sophistication and revision. The author performed suprapubic lipectomy and operation according to the modification of the Johnston's principle. METHODS: The patient was 5 years old, 32kg, and 122cm. He had no pain or tenderness. The operation was done under general anesthesia. It was done with excision of suprapubic fat, cutting of retracted dartos fascia instead of removing the fascia around penile base, and anchoring of dermis and the cutting margin of the fascia to the underlying fascia such as Buck's fascia, tunica albuginea and rectus fascia at penile base. And then circumcision was performed. RESULTS:Postoperative complication was not observed. The clinical result of the operation was satisfactory to both surgeon and parents of the patient. CONCLUSION: Suprapubic lipectomy and anchoring of dermis and retracted cutting dartos fascia margin to the underlying fascia in all directions at the penile base through a single suprapubic incision provide this patient with complacency.

The Treatment of the Large Palatal Fistula Using the Tongue Flap

INTRODUCTION: Most of the palatal fistulas develop along the suture line in a small size, so they can be corrected easily by re-palatoplasty or various flap surgery using the local mucoperiosteum. But it is very difficult to repair if the fistula is very large or located anterior to the hard palate. Buccal mucosal or vestibular mucosal flaps may settle the problems but there are many limitations on the size and location. And other extraoral distant flaps need not only many surgical steps but also cause inconvenience. But tongue flap proffers as an excellent method for the repair of large anterior palatal fistula because of highly mobility and rich blood supply and low donor site morbidity. MATERIALS & METHODS: We treated the six cases of large palatal fistulas using the distally based tongue flap. We dissected under the submucosa layer around fistula site preserving the mucoperiosteum and the elevated flap was rotated to nasal side and sutured with 4-0 Vicryl(R) for the repair of the nasal side. And then we elevated the tongue flap on the distal portion of the tongue. The elevated tongue flap was placed on the defect area and sutured with 4-0 Chromic(R). After 2 or 3 weeks, we detached the tongue flap which was placed on the fistula site. Donor site was closed with 4-0 Chromic(R). RESULTS: The mean size of palatal fistula was 7.2 cm. All of patients complained the discomforts in masticating and speaking before flap detaching operation. A wound dehiscence was observed on tongue flap sutured to defect site. But it was healed by revisionary suture. There was no donor site complication. CONCLUSION: The authors propose that the distally based tongue flap is an excellent method for the repair of large palatal fistula because of its highly mobility, rich blood supply, and few of donor site morbidit

Clinical Considerations of the Surgical Treatments of the Pressure Sore

PURPOSE: The number of sore patients are increasing steadily, especially in old ages, chronic disease and paralytic patients. Most of patients need to surgical treatment. The aim of this paper is to assess clinical analysis of surgical treatment and to consider operative methods, complications, and recurrences. METHODS: We reviewed the data from 82 consecutive patients with 101 pressure sores from March 2003 to May 2006 to discuss the occurrence rate and recurrence rate according to the site on the basis of the presence or absence of paraplegic and its etiology-the patients were categorized into three diagnostic groups: traumatic paraplegics(TP), nontraumatic paraplegics (NTP), and nontraumatic nonparaplegics(NTNP). We examined the sites and sizes of each lesions, patient's state, primary causes of pressure sore, operative methods as each sites and groups, occurrence of complications and recurrences on each groups. RESULTS: In 82 patients, 52 patients were male, 30 patients were female. The male to female ratio was 1.7 :1. Mean age was 55.8 years. 27 patients were in TP group, 35 in NTP group, and 20 in NTNP group, respectively. The common site of sore were sacral area (50.5%), greater trochanteric area(15.8%) and ischial area(13.9%). In each group, incidence rate of recurrence and complication were 11.1%, 40.7% in TP, 5.7%, 5.7% in NTP and 15%, 45% in NTNP. CONCLUSION: Surgeons must consider the general condition of the patient and possibility of recurrence and returning of daily life. We propose that cutaneous flap, fasciocutaneous flap or skin graft as well as musculocutaneous flap be useful to repair of sore site as each patient's state.

The Effectiveness of Progressive Tension Suture at Latissimus Dorsi Muscle Harvest

PURPOSE: The latissimus dorsi muscle flap is a versatile flap used in a variety of reconstructive procedures. The most common complication of LD muscle flap is donor site seroma, reported to occur in 20 to 79 percent of cases. The formation of dead space under the flap is intimately associated with seroma formation. The authors think that the use of progressive tension suture at closing donor site can decrease the formation of dead space and ultimately reduce the incidence of donor site seroma. METHODS: A retrospective review was performed with 38 patients who underwent latissimus dorsi muscle harvest for breast reconstruction from March 2003 to September 2004. Progressive tension sutures were used during donor site closure in 22 patients. This group was compared with controls group(16 patients) who underwent latissimus dorsi muscle harvest without using this technique. Operation time, length of hospital stay, period of drainage, complication, and satisfaction about postoperative scar of donor site were examined. RESULTS: The average length of hospital stay was 10.2 days and 12.7 days, and the mean duration of drainage were 7.3 days and 11.7 days in each progressive suture group and control group. These results were statistically significant (p<0.05). In the 22 patients who underwent progressive tension suture, none had seroma, hematoma or skin necrosis. In control group(16 patients), there happened one seroma formation and one partial skin necrosis. These complications were healed by aspiration of seroma and wound revision. The patients' satisfaction was not statistically significant, but the higher points were given by the patients who underwent progressive tension suture. CONCLUSION: This technique, progressive tension suture, is an effective method to reduce or eliminate donor site seroma, which is the most common complication associated with latissimus dorsi muscle harvest.

A Case Report of Schwannoma on Nasal Tip

Neurilemoma(schwannoma, neurinoma, Schwann's cell tumor) is a relatively uncommon, slowly growing lesion that usually has been present for a considerable time before diagnosis and treatment are requested. The site of origin is believed to be the ectodermal Schwann cells of the nerve sheath. An interesting variant, known as the ancient neurilemoma, has been reported by Eversole and others. They suggest that the histologic feature that typify this tumor result from degenerative changes which occur as a classic neurilemoma ages. We have experienced a case of schwannoma arising on the nasal tip of a 27 years old man and discussed with brief current literatures review.