Web Uni-Limb Z-Plasty for Correction of Alar Web Deformity in Unilateral Cleft Lip Nasal Deformities: Photogrammetric Analysis

PURPOSE: In the treatment of the unilateral cleft lip nasal deformities, the correction of the low-nostril height and short-columella are very difficult problems. We report the treatment outcomes of web uni-limb Z-plasty used for correction of unilateral cleft lip nasal deformities by using photographic analysis. METHODS: A total of 36 patients with unilateral cleft lip nasal deformities were enrolled in this study, who underwent web uni-limb Z-plasty and were followed up for at least 6 months. First, a triangular flap was made on the medial side of alar-columella web. The nostril apex of cleft side was corrected to a higher point compared to noncleft side by 2 mm. The flap was transposed into the defect of the vestibule. To reduce the bulging of the flap, horizontal cinching sutures were added. Postoperative outcomes were evaluated by using photographic analysis. 2 indices and 1 angle were measured on their photographs taken before and after the surgery. Symmetry was also evaluated by means of the noncleft side to cleft side index. For anthropologic assessment, observers described postoperative outcomes, using Ordinary Scale Method. RESULTS: The postoperative values obtained in photographic analysis improved compared to preoperative ones. More improving anthropologic assessment was shown in post-than pre-operative. CONCLUSION: Although, further long term follow up is needed, we found this technique to be an effective procedure to the symmetry of nostril apex level and the lengthening of columella in the unilateral cleft lip nasal deformities.

Characteristics of Fat Tissue According to the Anatomical Regions of the Body: Computed Tomographic and Histological Findings

PURPOSE: The subcutaneous fat tissue is separated into 2 layers by the subcutaneous fascia: the superficial and deep fat layers. The two fat layers have different structures according to the body regions. The purpose of this study is to evaluate the distribution and pattern of the two fat layers in the human body by computed tomography (CT) and histological analysis according to age, sex, anatomical region, and body mass index (BMI). METHODS: This study included 200 males and 200 females who underwent 64-channel dynamic CT in our hospital. The patients were divided into 5 groups according to 10 years of their ages separately in either male or female gender. The thickness of the superficial and deep fat layers was measured in the abdominal, pelvic, and femoral regions, and we analyzed the values. Statistical analyses were performed using SPSS software. The 3 x 3-cm whole fat layers were harvested from the same sites of 3 cadavers for histological examination, and one cadaver was dissected for gross evaluation. RESULTS: The total thickness of subcutaneous fat tissue was greater in females than in males, and the ratio of the superficial fat layer to the whole fat layer was higher in females. The superficial fat layer became thinner with increasing age in males. As BMI increased, the total fat layer became thicker, and the superficial fat layer became thicker than the deep fat layer. On histological examination, the superficial fat layer had small adipose lobules and showed a densely distributed pattern in the abdominal region, whereas in the femoral region, it had large adipose lobules and showed a sparsely distributed pattern. There were no significant differences in the histological findings of the deep fat layer between the 3 body regions. CONCLUSION: Significant differences in histological findings of the two fat layers were found in relation to age, sex, anatomical region, and BMI. The superficial fat layer became thinner with increasing age in males, but it was constant in females. As BMI increased, the total thickness of subcutaneous fat tissue became greater, and the superficial fat layer became thicker than the deep fat layer. Our measurements can be used to understand the characteristics of the fat layers in relation to age, sex, anatomical region, and BMI.

Abdominal Dermolipectomy Using Bicycle Handlebar Incision

Abdominal Dermolipectomy using bicycle handle bar incision was anounced to be effective incision method for hiding the postoperative scar by Baroudi in 1989. The authors experienced 8 cases by Baroudi's incision method; 7 women and 1 man of the correction of abdominal deformities from 1998 to 2002. The abdominal deformities ranged from Grade III to IV by Matarasso's classification. Baroudi's bicycle handlebar incision was used. Suction assisted lipoplasty in 7 cases and ultra-sound assisted liposuction in 1 case were used with abdominal dermolipectomy. Changes of body contour were found in all cases and postoperative scars were minimal. But in 3 cases, reverse T-shaped scar was developed and in 1 case, which performed ultra-sound assisted liposuction simultaneously, skin necrosis was developed. In conclusion, dermolipectomy using Baroudi's bicycle handlebar incision was an effective technique for covering the postoperative scar even though they wear the V-shaped underwear.