A Quilting Suture Technique for the Correction of Prominent Ears

A great number of operative techniques has been described about the correction of the prominent ears. The most primary deformity of the prominent ears comes from an underdeveloped or unfolded antihelix, which results in widening of the conchoscaphal angle and/or flattening of the superior crus, and which, in severe forms, involves antihelical body and inferior crus. Most authors manage the prominent ear deformity by excising, suturing, scoring, or sculpturing the auricular cartilage. We carried out a modified quilting suture technique in order to produce an antihelix. This technique provides several advantages; 1) it prevents the bowstring of the suture material during the formation of the helix; 2) the procedure is easy and time-saving; 3) the reconstructed ear shows reliable results in firmness and stability against external force or trauma; 4) the recurrence rate is not more than that of the conventional methods.

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.

Case Report of Osteomyelitis after Monobloc Advancement for the Treatment of a Crouzon's Syndrome

In 1912, Crouzon described a syndrome compromising the triad of cranial deformity, facial deformity, and exorbitism. Crouzon's syndrome occurs in 1 in 25,000 live births and follows an autosomal dominant mode of transmission. However 30 to 60% of cases are sporadic and represent fresh mutations. The 27-year-old female patient we report here has family history of two cases of Crouzon's syndrome. The patient had mild nasal obstruction and rhinorrhea, which didn't make the surgery absolutely contraindicated. The Monobloc advancement-Le Fort III osteotomy for midfacial advancement and the lamellar split osteotomy of supraobital bandeau for orbitofrontal advancement- were performed. After 8~12 weeks of patient follow up, CSF rhinorrhea was observed and infection was suspected. The primary focus of infection was supposed to be preexisting sinusitis of the patient. The infection didn't spread intracranially, which was contributed by intact inner table of cranium owing to the lamellar split osteotomy. In conclusion, 1) The importance of irradication of preexisting nasal / perinasal infection such as sinusitis cannot be emphasized too much, 2) How to obliterate the dead space between the inner and outer table, and 3) In terms of infection, at least, lamellar split osteotomy can be regarded superior to classical osteotomy, since inner table serves as a barrier of ascending infection.

Immediate Breast Reconstruction after a Mastectomy for Breast Cancer

PURPOSE: Immediate breast reconstruction following ablative surgery for breast cancer is gaining more acceptance in terms of safety, reliability, and advantages nowadays. The purpose of this article is to address the major benefits of immediate breast reconstruction following a mastectomy, to introduce our team management protocol for breast cancer, and finally to improve the quality of life for this unfortunate group of cancer patients. METHODS: Fifteen consecutive patients underwent a mastectomy with immediate breast reconstruction by general surgeons and plastic surgeons at Seoul National University Hospital between 1995 and 1999. RESULTS: The mean age of these patients was 39.3 years, and the majority of patients had infiltrating ductal cancer and received a mastectomy or breast-conserving surgery. The operative methods for the breast reconstructions were a breast implant in one case, a tissue expander in 6, and a free transverse rectus abdominis myocutaneous (TRAM) flap in 8. A bilateral free TRAM flap was used in one case among the eight. Despite some minor complications, such as hematomas, fat necrosis and partial necrosis of the TRAM flap, the general outcomes were satisfactory. Close association of the two kinds surgeons allowed selection of candidates, surgical planning for the mastectomy and a decision on the reconstructive method to be used. CONCLUSION: Immediate breast reconstruction allowed the patients to undergo the proper oncologic treatment, to avoid the stress of breast loss, and to be satisfied with the aesthetic result of the reconstruction.

Study on Abdominal Sequelae after Free TRAM Flap or Rectus Abdominis Muscular Free Flap Operation

The TRAM flap provides the safe creation of a durable, soft, natural-appearing breast mound and has thus become the most popular method of breast reconstruction. On the other hand, the rectus muscle can be used as a good donor site for a flap reconstruction in trauma or osteomyelitis cases on the lower extremity. The abdominal sequelae, including abdominal wall dysfunction after free rectus muscle transfer, was evaluated. Thirty-seven patients underwent free TRAM (n=29) or rectus abdominis muscular free flap(n = 8) operations between 1994 and 1997. In harvesting of the TRAM flap, a muscle-splitting technique was used and thus one-quarter of the muscle was preserved. In rectus muscular free flap, the entire width of the rectus abdominis muscle was harvested. Among the 37 patients, 26 patients (20 free TRAM flap and 6 rectus muscular free flap) were studied, for they were followed up postoperatively for at least 6 months and had provided preoperative data of abdominal strength. Cosmetic results of the abdomem were appraised by four independent judges on photographs taken of 26 patients. The global appearance of the abdomen was rated as "natural" in 75%. The scar on the umbilicus and lower abdomen was rated as acceptable or not visible in 65%. The replies to questionnaires were analyzed Patient self-assessment showed general satisfaction. In 24 of 26 answers, they said they would recommend the operation to others, and 70% of the patients found their abdominal strength and sports ability the same or improved. Thirty percent of the patients complained that back pain developed or became aggravated after surgery. Abdominal muscular strength was tested both preoperatively and 6 months to 1 year period after surgery according to Lacote. The abdominal wall function was impaired, especially in the upper rectus and external oblique muscle. In conclusion even though the abdominal sequelae after free TRAM or rectus muscular free flap reconstruction should not be urderestimated, no problem of clinical significance was encountered, and patients showed a high degree of satisfaction with the operation

Scar Tissue Expansion for the Treatment of Scar Contracture

The treatment of scar contracture has a relatively long history in the department of plastic surgery. Flap surgery, including Z-plasty and skin graft has been a common surgical modality for the treatment of scar contracture. However, the 'deficiency' of the tissue is basically responsible for the limitations of this treatment. The concept of tissue expansion has contributed to the solution of tissue deficiency and thus tissue expansion is currently widely used for various purposes in plastic and reconstructive surgery. Nevertheless, tissue expansion has not yet clearly solved the problems in cases of seven deficiency of surrounding normal tissues, or in cases of multiple and diffuse scar contracture. We have tried to 'expand the scar tissue' to overcome these limitations. The authors 'several decades of experience in tissue expansion has taught us to find the usefulness of incidentally expanded scar tissues. Thirty-one patients with scar contracture urderwent expansion of surrounding normal and/or scar tissues, including 5 cases of pure scar tissue expansion. The postoperative results were satisfactory with a minimal complication rate. In conclusion, scar tissue expansion was usefully applicable for the scar contracture with no surrounding normal tissues. Scar tissue could be expanded safely and sufficiently, designed to various flaps, and the flap survival was reasonable. The functional and aesthetic quality of the scar tissue seems to improve following tissue expansion. In addition, meticulous planning is essential from the initial operation, including the area of expander insertion, flap design considering the aesthetic unit and functional aspect.

The inhibition of wound contraction and biologic attachment of acellular dermal matrix on full-thickness skin defect in rat

Although wound healing is a natural biologic process by which the homeostasis is preserved, the resultant hypertrophic scar or scar contracture may produce undesirable morphologic and functional sequelae. To overcome these problems, a number of attempts to produce skin substitute have been made in recent years, but none have proved to be entirely satisfactory. We compared the wound healing of full-thickness dorsal skin defects between ADM(acelluar dermal matrix)-applied wound and ADM non-applied wound group in 20 adult female Sprague-Dawley rats. The wound area was serially evaluated at 1,2,3 weeks and the difference in the mean area ratios between the two groups was then statistically analyzed using Wilcoxon rank sums test. We also performed histological evaluation of the wounds at 1,2,3 weeks. Results were as follows: 1. Experimentally produced ADM was easy to handle. Histologic findings showed no epithelium, no appendages, no cells dermal and subcutaneous layer and pure bundles of collagen. 2. The wound area ratio of ADM applied wound group was statistically larger than that of ADM non-applied(control) wound group. That is, ADM was able to inhibit the wound contraction compared with the ADM non-applied wound group. 3. In the ADM-applied group, we observed low grade exudates, no infection, fine take-up of ADM on full-thickness skin defect, gross and histologic findings of neovascularization, and progressive epithelization on ADM. These findings of biologic attachment implies the function of the ADM as a dermal substitute. These can be basis of the study on the development of artificial skin.

Facial skin graft using preauricular and forehead expansion

Skin graft has been widely used for facial skin reconstruction. Inguinal area is the common donor site for full-thickness skin graft of various area. Especially for facial skin graft, retroauricular area or upper eyelid skin has been used as a donor site. But these donor sites have some limitations as perfect ones in terms of size, color and texture when applied onto facial area. Even retroauricular skin shows color and texture differences from normal facial skin after it is grafted. Authors performed expansion of the skin of preauricular area or forehead where minimal scars would come out after final operation. We harvested this expanded skin and performed skin graft following excision of nevus, poor scar, or hemangioma in face.We achieved satisfactory results in terms of color and texture by applying this method in 11 clinical cases; 4 cases of hemangioma, 4 nevus, and 3 cases of traumatic scar. Donor site scars were clinically inspicuous in all these 11 cases.

THE EFFECTS OF A THIN SHEET OF TYPE I COLLAGEN ON WOUND HEALING OF FULL THICKNESS SKIN DEFECTS

No abstract available.