Surgical Correction of Cleft Lip and Nose Deformity Associated with Augmentation Rhinoplasty Using Silicone Implant

The correction of secondary cleft lip and nose deformity often presents an extremely difficult plastic surgical problem. The deformity is a complex, three dimensional alteration in nasal anatomy with defects in all tissue layers : skin, cartilage, vestibular lining and bone. The patient who has these kinds of deformities undergoes the aggravation of deformities, as the patient grows older. And the decreased length of maxilla is accompanied by the deficiency of posterior development. As a result, the depression of nose and midface is usually developed and especially the depression of nose is severely noted in an oriental. To correct this secondary cleft lip nose deformity in Oriental patients, alar cartilge mobilization and suspension techniques have been developed. But, these techniques have critical limitations in the suspension vector and power. Oriental people usually have thin alar cartilages and thick skin. So, the suspended, deformed alar cartilage may relapse and pull the normal alar cartilage to the deformed side. To overcome these limitations, we have carried out the augmentation rhinoplasty using a silicone implant with Tajima's inverted U incision and interdomal suturing at the same time, which is inexpensive and easily handled, to twelve patients of secondary cleft lip and nose deformity for recent 2 years. The results were considerably satisfactory, so we report this paper and then can ascertain the further aesthetic benefits, such as the postoperative augmentation of a nose, finer nasal tip and the symmetry of both nostrils.

Reconstruction of Ischial Pressure Sore by Using Posterior Thigh Transposition Flap

The area overlying the ischium is a frequent site for the development and recurrence of pressure sores because they directly overlie the points of maximum pressure on the sitting surface. Furthermore, they are frequently complicated by abnormal lesional bursae, or by extension, fistula toward the perineum or peritoneal cavity. In all cases of the ischial pressure sores, total en bloc excision of the ulceration, underlying bony prominence with immediate closure, and healthy, well-vascularized soft tissue is required to obtain the satisfactory result. It is well known that the choice of the treatment of the ischial pressure sore is the gluteal or posterior thigh flap. There have been many reports on the reconstruction of the ischial pressure sores such as cases involving the fasciocutaneous flap, muscle and musculocutaneous flaps, V-Y advancement flaps, rotation flaps, and long random flaps. In spite of these varieties, the recurrence of the ischial pressure sore after treatment still remains about seventy-five percent according to Conway and Griffith.9 Consequently, any surgical plane for ischial pressure sores must provide a stable, durable soft tissue cover that can be reused in the event of recurrence. From February to December 2002, we have performed the reconstruction of the ischial pressure sores on the posterior thigh's transposition flap in order to get following advantages: simplicity of the operation, sufficiency of padding with skin flap, preservation of the adjacent normal tissues and the capability of recycling this same flap in case of recurrences. Its design is somewhat different from and more extended widely than that of the gluteal or posterior thigh flap. This flap was elevated above the deep fascia to be cutaneous with appropriate backcut incision; some perforators from the inferior gluteal artery were also preserved. We present some cases of ischial pressure sores treated with a laterally based posterior thigh transposition flap herein. Therefore, the need to perform repetitive surgery in the future must be considered so that the maximum number of reconstructive options can be preserved. Although the follow-up period has not always been satisfactory, we have not had any serious complications in these patients until recently.

Surgical Correction of Scalp Defect after Tumor Removal by Tissue Expansion Technique

Since the introduction of expansion technique by Neuman(1957), the use of it has been repeatedly adjusted to the breast reconstruction, head and neck reconstruction and treatment of male pattern baldness, and so on, by the improvement of expansion devices and advancement of expansion techniques. We also used this technique in 5 patients who have scalp tumor, either benign or malignant, for 3 years(from 2000 to 2003) and specific complications were not found except wide scars. This technique has shown more excellent result than any other techniques already used and has made it possible to cover the scalp defect without the loss of hair in donor site, so we report this paper and then can ascertain the further benefits, such as the effective coverage of scalp defect by hair bearing normal scalp.

Localization of Cyclooxygenase Isozymes in Dermal Wound Healing in Mouse

Cyclooxygenase(COX)-1 and COX-2 expression in dermal wound healing of mouse was detected by immunohistochemistry and Western blot analysis. In order to gain more information on the functional importance of COX-1 and COX-2 in dermal wound healing, we analysed COX-1 and COX-2 protein levels using the Western blotting technique. In addition, we used immunohistochemistry to determine the cellular localization of the protein products. The collected skins were rapidly frozen and kept at -70degrees Cuntil assayed. Each frozen skin was lysed with 0.5 ml of ice-cold solution. Large tissue debris and nuclear fragments were removed by two low-speed centrifugations and the resulting supernatant fraction was used for blots. The skin extracts were stored below -20degrees Cfor further experiments. By Western blotting, compared to the activity of COX-2 in normal skin, its activity was increased at days 1, 4, 8, and 12 and was maximal at 1 day after incisional wound of mouse skin whereas COX-1 was barely detectable. In normal skin, COX-1 immunostaining was observed among the basal cells of epidermis whereas COX-2 immunostaining was detected in the more differentiated, suprabasal keratinocytes. At post-incision 1-4 days, COX-2 staining was particularly prominent in the inflammatory cells, and at day 8, many macrophage-like cells were stained positively. COX-2 immunoreactive fibroblast, macrophage-like cells, and newly formed vascular endothelial cells were increased in number at 12 days after incision. These data suggest that COX-2 is constitutively expressed, just as is COX-1, in epidermis and is associated with keratinocyte differentiation. In addition, these findings support the well-established role for COX-2, the prostaglandins that they generate, as mediators of inflammatory response.