Case Report of Rib Bone Graft for Correction of Bifid Nose of Median Facial Cleft

Craniofacial cleft is a rare congenital anomaly with a wide range of clinical manifestation and severity of deformity. In 1976, Tessier announced classification system on the basis of anatomical observation derived from clinical finding or operative dissection. Nowadays, this system is in common use because it is in accordance with terminology and observational finding and clinical manifestation is accordant with operative finding. Median facial cleft(No. 0-14 facial cleft) has a wide range of congenital malformation from a midline cleft upper lip to orbital hypertelorism, among which the bifid nose is frequently associated with hypertelorism. The manifestation of a bifid nose is variable from a simple central groove at the nasal tip to a complete clefting of the osteocartilaginous framework. In consequence, the planning of correction of the bifid nose must be individualized. We contrived correction of bifid nose using rib bone graft containing small amount of costal cartilage with maneuver of 2mm incision on nasal root skin together with fixation with 9mm miniscrew through an open approach in two No. 0-14 facial cleft patients with mild hypertelorism and bifid nose. With this method we could obtain satisfactory results in the standpoint of function as well as aesthetics. We think that this method is appropriate for correction of bifid nose of mild median facial cleft.

Clinical Cases of Composite Graft for Reconstruction of Fingertip Amputations using Combination Procedure of Tie-over Dressing and Drain

The treatment of fingertip amputation is difficult and controversial. Although the microsurgery has been accepted as a procedure of choice, in distal location, however, both reattachment of amputated portion as a composite graft and microvascular anastomosis are prone to failure. The fact that microscopic reconstruction of vessels is safer means of replacing amputated digits, makes considerably smaller the need to use the technique of composite graft nowadays. Nevertheless, there still remains a group of distal digital amputations which cannot be replaced by microsurgical procedure and the composite grafting is the only way of achieving a full length digit with a normal nail complex. Nowadays, it is generally accepted that replacement should be made as early as possible for the prevention of bacterial and proteolytic activity. However, if the replacement is made so quickly that bleeding doesn't stop, there is a layer of clot blocking adhesion between the two surfaces, and the union will not be achieved. We report a new strategy: the tie-over dressing ensures not only fixation, but also hemostasis, and the drainage application is used to drain retained blood, so composite graft doesn't need to be delayed until the bleeding stops. We achieved good results by using this new technique.

Correction of Constricted Ear

The constricted ear was suggested by Tanzer for the purpose of obviating the confusion involving lop ear, cup ear and prominent ear as defect whose helix turns down, and scapha and fossa triangularis are narrowed. The constricted ear has a spectrum of severity and therefore, requires a graded surgical approach. Tanzer has described the degree of deformities of the constricted ear as falling into three groups. For the correction of constricted ear, there are numerous techniques but we have had difficulties in adopting these techniques in various type. We also describe the various constricted ear as the Tanzer's classification and adopted three methods to each type, banner flap(group I), concha cartilage graft (group II) and rib cartilage graft(group III) for reducing postoperative deformity and confusion in correcting the ear deformities. Constricted ear repairs must be individualized to accomodate each specific deformity. We corrected 22 cases of constricted ear in 20 patients using each optimal method described above according to the degree of deformities. Mild deformities need only reshaping and adjusting of existing tissues, moderate deformities need additional skin and severe deformities require a cartilage graft. For correction of constricted ear, accurate identification of the severity of deformity is essential. The results were satisfactory and we report our experience with relative literatures.

Forehead Augmentation with Methylmethacrylate

No abstract available.

Reconstruction of the Cheek using Various Methods

The reconstruction of the cheek area is a complex problem because the cheek is the most broad area of the face and is close to the aesthetically important region such as eyelids, nose, and mouth. The ultimate purpose of the cheek reconstruction is the restoration of the original shape and function, and establishment of the harmony with the adjacent structure in terms of color, nature and thickness. Various procedures such as skin graft, local flap, free flap, and local flap using skin expansion have been performed for cheek reconstruction. However, no golden principal or indication has been clarified to be imperative. Analyzing our clinical experiences of the cheek reconstruction, we intend to present a general guide of the cheek reconstruction and to assess the advantages and/or disadvantages of the operative methods. Between march of 1989 and August of 1999, we have experienced 154 cases of the cheek reconstruction. There were 52 males and 73 females, and their ages ranged from 3 to 89 years (mean 28.1 years). Preoperative diagnosis were post-burn deformity(n=74), Romberg disease (n=9), post-traumatic deformity(n=7), hemangioma(n=7), nevus(n=7), neurofibroma(n=5), hemifacial microsomia (n=3), lymphangioma(n=3), cancer(n=6), post-hemimandibulectomy(n=1), radical maxillectomy(n=1). The procedures were one stage cervicofacial flap(49 cases), cervicofacial flap following skin expansion(42 cases), local cheek flap (14 cases), deltocervicopectoral flap(2 cases), skin graft(29 cases), free flap(18 cases). Follow up period ranged from 3 to 72 months(mean 11.8 months). Advantages and disadvantages of each procedures were explained. The satisfaction rate was higher in one stage cervicofacial flap and free flap when assessed by both patients and surgeon. There were 3 cases of the ectropion of lower eylids, 4 cases of partial flap necrosis, and 1 case of exposure of tissue expander. The local flap is always the preferred method for the cheek reconstruction and the free flap is the treatment of choice for the cheek contour reconstruction. Selection of the most suitable flap is mandatory depending on the location and size of the defects.

Complication of Non-Incision Oriental Blepharoplasty: Is Disappearance of the Lid Crease a Fearful Complication ?

The Non-incision "double eyelid" operation reported by Mikamoto of Japan in 1896 has the advantage of shorter operating time, less morbidity and minimal scarring thus more natural final appearance. Incidence complications of this procedure such as disappearance of the fold, asymmetry, and inclusion cyst has been reported to be higher than the incision method and there has been reports of complication rates of up to 30%. The surgeon and the patient are most worried about the complete disappearance of the surgical palpebral fold. The complications of Non-Incision ""double eyelid"" operation was evaluated in 190 patients who were available for follow up of more than 1 year. Classification of the complications which required revision surgery was classified and evaluated. There were no major complications such as blindness, retrobulbar hematoma, and blepharoptosis. Total number of complications requiring reoperation: 24(100%). The most common reoperation procedure that we experienced was asymmetry which occurred in 10(42%) patients followed by lowering of the fold line and disappearance of the fold with 6(25%) cases each. All these patients were taken back to surgery and were corrected by Non-incision method with favorable results. Conclusively, 24 complications of Non-incision double eyelid procedure experienced in 190 patients. Disappearance of the palpebral fold was seen in 6 patients who were corrected by another Non-incision technique with excellent results. The complete disappearance of the fold was experienced in very few patients and correction of this complication was satisfactory. Thus, disappearance of the fold after Non-incision double eyelid procedure should not be termed by the patient or the surgeon with full under- standing of the procedure.

Effect of Vitamin C on the Random Flap Survival in the Rat

Vitamin C acts as a antioxidants and as free radical scavengers in biological systems. The objective of this study was to examine whether the administration of vitamin C could improve the skin flap survival. Sprague-Dawley rats (n = 40) were divided into 4 groups (n = 10); normal saline, vitamin C 200 mg/day, vitamin C 500 mg/day, vitamin C 1000 mg/day were injected subcutaneously to each group (n = 10). A classic caudally based random flap (2 X 7 cm) was elevated on the dorsum of rats and then sutured to its normal position. On the 3rd, 7th, 14th days postoperatively each animal was evaluated for percentage area of flap survival by paper template technique, thereafter rats were sacrificed and we obtained tissue from the distal ends of the flap. Following is our results. 1) The experimental group treated with vitamin C revealed an increased rate of random pattern skin flap survival compared with the control group (p < 0.005). 2) There was correlation of vitamin C dosage with flap survival rate (Spearman's correlation coefficient = 0.971). 3) The biopsy of the control group showed extensive atrophy and necrosis. However, New capillary proliferation and collagen deposition were noted in the vitamin C 200 mg and 500mg treated group. In the vitamin 1000 mg group, microscopic findings were very alike compared with normal rat skin texture. Finally, we concluded that the Vitamin C supplement increases survival rate of random pattern flap in rat skin flap model, and flap survival is correlated with vitamin C dosage.