BellaGel breast implant: 6-Year results of a prospective cohort study

Background@#This is the first clinical study conducted among Asian women using breast implants manufactured by an Asian company. Four-year data regarding the safety and efficacy of BellaGel breast implants have already been published, and we now report 6-year data. @*Methods@#This study was designed to take place over 10 years. It included 103 patients who underwent breast reconstruction or augmentation using BellaGel breast implants. The rates of implant rupture and capsular contracture were measured and analyzed to evaluate the effectiveness of the breast implant. @*Results@#At patients’ 6-year postoperative visits, the implant rupture and capsular contracture rates were 1.15% and 2.30%, respectively. The implant rupture rate was 3.77% among reconstruction cases and 0% among augmentation cases. The capsular contracture rate was 5.66% among reconstruction cases and 0.83% among augmentation cases. @*Conclusions@#The 6-year data from this planned 10-year study suggest that the BellaGel cohesive silicone gel-filled breast implant is an effective and safe medical device that can be used in breast reconstruction and augmentation.

The first documentation of Li-Fraumeni syndrome in Korea

Li-Fraumeni syndrome(LFS) is an autosomal dominant disorder that predisposes individuals to multiple forms of cancer including breast cancer, soft tissue sarcoma, brain tumor, osteosarcoma, leukemia, and adrenocortical carcinoma. Recently, germ-line mutation of the p53 tumor suppressor gene has been implicated in this familial disorder. We report a case of a 25-year old woman who presented with bilateral breast cancer and uterine leiomyoma. Her mother had died of early-onset bilateral breast cancer. And her younger sister had breast carcinoma as well, which was identified at the age of 22, indicating her strong familial history. To test for the presence of the p53 germ-line mutation, we analyzed the genomic DNA from the peripheral blood of the proband and her sister by PCR-SSCP analysis of exon 5 through exon 8 of the p53 gene. As a result, a p53 mutation in exon 7 was detected in an allele, and it was shared with her sister as the same pattern. Sequencing analysis determined the altered nucleotide at codon 248(CGG < TGG) which is one of the most frequent mutation sites related to LFS. Therefore, this patient has the most consistent characteristic features of LFS phenotype and it is believed that this case is the first report of a family with Li-Fraumeni syndrome carrying the p53 germ-line mutation in Korea.

Free Gracilis Muscle Transplantation in Severe Volkmann's Contracture & Brachial Plexus Injury / 대한정형외과학회잡지

Two patients with flexor paralysis of the elbow due to brachial plexus injury and three patients with flexor paralysis of the wrist and fingers due to Volkmann's contracture were treated by transplantation of the gracilis muscle which was detached at both ends and transferred to replace the biceps and long finger flexors, preserving its long and lax neurovascular pedicle. At eleven to fifteen months after operation, the strength and flexion of the elbow were satisfactory and the additional cosmetic effect was obtained. This method should be performed only after a complete study of the patient's general functional needs and the condition of the affected arm, forearm and hand.

Heel Pad Reconstruction using Doresalis Pedis Free Flap or Rotation Flap / 대한정형외과학회잡지

Eleventh heel pad reconstruction with neurovascularized dorsalis pedis free flap or rotation flap have performed during recent three years in department of Orthopedic Surgery, Kyung Hee University Hospital. Neurovascularized dorsalis pedis free flaps were seven and neurovascularized dorsalis pedis rotation flaps were four. All patients had complained of painful limping and ulceration in grafted heel. In 5 months to 34 months follow up study, the following results were obtained. The success rate of dorsalis pedis flap was 100% except one partial peripheral necrosis. The weight bearing function and tactile protective sensation on reconstructed heel pads were excellent. Neurovascularized dorsalis pedis free flap or rotation flap is recommended to satisfactory methods in heel pad reconstruction. Neurovascularized dorsalis pedis rotation flap easier and safer technique than neurovascularized dorsalis free flap.

Replantation of Hand Amputated Through the Palmar Arch Level / 대한정형외과학회잡지

The value of replantation of parts of the upper limb is well established and replantation of a digit has now be come a standard procedure. However, there are few reports of replantation of hand amputated through the palmar arch level. We have reviewed 14 cases of 14 patients replantation of hand amputated through the arterial palmar arch level from Mar. 1976 through Mar. 1982. The success rate in our series is 64 percent. This is slightly lower than the other levels due to its anatomical complexity. According to the anatomical complexity and distribution of nerves and vessels, it is divided to three levels. In level A, the superficial palmar arch and/or the deep palmar arch should be repaired. In level B, the princeps pollicis artery should be repaired after anastomosis of the superficial and deep palmar arch. In level C, each common palmar digital artery should be repaired but if it is impossible to repair of all fingers, replantation of thumb and index should be performed as possible. Meticulous microsurgical technique and precise anatomical knowledge is mandatory for replantation of the palmar arch level.

The Rate of Bone Union in Replanted Limbs / 대한정형외과학회잡지

In view of the problems with infection, traditional orthopedic teaching has held that the use of metalic fixation in open fractures is contraindicated. But the bone shortening and internal fixation of amputated limb is a principle for replantation. The authors experienced 23 patients of replanted limbs including femur, tibia, humerus, radius and ulnar among total 142 replantations and also analysed them in the respect of the relationship among soft tissue injury, fixatives, bone union and infection rate from February, 1975 to July, 1981 in this department. The rate of delayed union, nonunion and infection were 22.6%, 6.5% and 25.8% respectively. It seems that the union process of bone in replanted limbs is similar to that of the open fracture and also rigid internal fixation is the most useful for bony union.

Free Vascularized Fibular Graft Using Microsurgical Technique / 대한정형외과학회잡지

It is notoriously difficult to obtain a sound bony union of large segmental bone defects secondary to trauma or following tumor resection, infected nonunion, congenital pseudarthrosis of the tibia, and avascular necrosis of the femoral head with conventional methods. Recent advances in microsurgery have made it possible to provide a continuing circulation of blood in bone grafts so as to ensure viability. With the nutrient blood supply preserved, healing of the graft to the recipient bone is facilitated without the usual replacement of the graft by creeping substitution. Thus, the grafted bone is achieved more rapid stabilization of bone fragments separated by a large defect without sacrificing viability. Thirty nine cases of the free vascularized fibular graft had been performed in the Department of Orthopedic Surgery, Kyung Hee University Hospital during the period of 3 years from October 1978 to December 1981. Of these, ll cases were congenital pseudarthrosis of the tibia, 4 cases were tuberculous spondylitis, 4 cases were infected nonunion, 7 cases were large segmental bone defects secondary to trauma, 9 cases were avascular necrosis of the femoral head and the other was one case. The results were obtained as follows: 1. The advantages of free vascularized living fibular graft are one stage procedure, resistance of torsion and angular stress, union with rapid hypertrophy of the graft, a shorter immobilization period and more rapid incorporation of the graft into the recipient area. 2. Free vascularized fibular graft can be widely used in the field of Orthopedic surgery. 3. The fibula is the bone best suited for reconstruction of a defect in a long bone. 4. In children, distal tibiofibular synostosis must be performed. 5. For prevention of clawing toe, the muscles around the bone is meticulously dissected, 6. Evaluation by selective arteriography and isotopic scanning both before and after operation may be used to assess the viability of the fibula graft.

Treatment of the Congenital A-V Fistula by Utilizing the Microsurgical Technique / 대한정형외과학회잡지

An arteriovenous fistula may be defined as a vascular abnormality in which there are one or more direct or indirect communication between an artery and a vein without any intervening capillary bed. Largely, such fistulas are divided into two groups-acquired (traumatic) or congenital in origin. There is a general agreement that congenital A-V fistula results from a failure in differentiation of the common embryonic anlage into true artery and vein. The authors have experienced a case of congenital A-V fistula formed in the 4th finger of the left hand. Such fistula is very difficult to excise completely with the conventional method. But we have obtained the excellent result by utilizing advanced meticulous microsurgical technique in excision.

Histological Changes Induced by Neurolysis: An Experimental Study on Rabbit Sciatic Nerve / 대한정형외과학회잡지

Several attempts have been made to assess the relative importance of the vasa nervorum and the intrinsic longitudinal vascular plexuses of nerve in maintaining the blood supply of a segment of nerve trunk, but the effect of mobilization on the ability of an injuried or repaired nerve to regenerate and regain function has been less certain and is the subject of these investigations. Thirty-two Korean rabbits of both sexes were used for these studies and we concluded that it is increased fibrosis with adhesion to surrounded tissues, loss of glistening and milk-like discoloration of never grossly, and increased degeneration and milk-like discoloration of nerve grossly, and increased degeneration of axons and demyelization progressively and early proliferated Schwann cells with increasing length of neurolysis. And there was no recovery of damage in nerve tissue induced by above 7 cm of neurolysis. (1:35)

An Experimental Microvascular Grafting on Rabbits Using the Microsurgical Technique / 대한정형외과학회잡지

The vascular graft used for the reconstruction of certain types of vascular occlusive diseases and traumatic damages of the vessel, is very important, especially for the reconstruction of microvascular damages as occuring in hand injuries. Until recently microvascular graft done by microsurgical techniques was rare compared to the many- numbered large vessel grafts. But their biologic fate is currently uncertain. We studied the histologic changes occuring in the microvesseles of 1.5cm in length and 2mm in diameter, which were grafted to the femoral artery of rabbits by recently developed microsurgical techniques. Histologic changes were observed between different donor materials with different time intervals. For 60 rabbits which were used as experimental material, 15 cases received autogenous venous graft (group I). 15 cases autogenous arterial graft (group II) and 15 cases homogenous arterial graft (group I). The observd post-operative dates were 3,7,14.60 and 90 days for each respective group. The results were summerized as follows: 1. The patency rate of grafted vessels using microsurgical technique was 91.2%. 2. The histological changes observed were: a. On the 3rd and 7th day post-operatively, mainly inflammation, formation of thrombus, increased population of endothelium and formation of suture granuloma around the suture site were observed. b. On the 14th day, decreased numbers of inflammatory cells, progressed organization of thrombus, disorganization of the medial muscle layer of the grafted vessels and degeneration of endothelium were observed. c. On the 60th day, inflammatory cells and previously formed thrombi were no longer found and increased amount of fibrosis was prominent instead. 3. The autogenous venous graft group showed less histological changes in every aspect compared to the other two groups. 4. The autogenous arterial graft group showed considerable histological changes, but endothelial lining cells were well preserved. 5. In the homogenous arterial graft group, good patency rate of grafted vessel were observed despite of severe inflammatory change initially. 6. It can be concluded from the above observation that the micrcvascular graft thought to be most useful in recstablishing circulation of injured vessels was the autcgenous venous graft. Homogenous vessel graft and autogenous graft artery were also found to be applicable when autogenous vencous graft is not available.

Free Second Toe-to-Index Transplantation for Index Reconstruction / 대한정형외과학회잡지

The development of a safe method of transfer of the greater toe for thumb reconstruction, using dorsalis pedis artery and the great saphenous vein, suggested the possibility of one stage microvascular transfer of the second toe for reconstruction of surgery. Based upon our part experience with microsurgical experiments, limb transplantation and toe-to-thumb transplantation since 1975, we accomplished the second toe-to-index transplantation done in Korea on October 24, 1979, and succeeded in one stage second toe-to-index transplantation in two cases. Following results were obtained. I. Free second toe-to index transplantation on making a index is the most excellent method of index reconstruction with results in minimum functional and cosmetic impairment. 2. Technically, skin incision, isolation of blood vessels and flexor tendon in preparation for transplantation of second toe is more difficult than that of greater toe. 3. The specialized microsurgical training with skillful technique is essential for success.

Malignant Fibrous Histiocytoma: Treated with Free Vascularized Fibular Graft after Radical Resection / 대한정형외과학회잡지

Malignant fibrous histiocytoma of the bone is relatively rare than that affecting the soft tissue. The authors have first experienced a case of malignant fibrous histiocytoma affecting the distal tibia of thirty-two years old woman in Korea. We obtained good results from free vascularized fibular graft after radical resection in stead of amputation. A case of malignant fibrous histiocytoma of the bone is reported with brief review of literature.

Congenital Pseudarthrosisof the Tibia: Treated with Free Vascularized Fibular Graft / 대한정형외과학회잡지

It is notoriously difficult to obtain a sound bony union of congenital paeudarthrosis of tbe tibia with conventional methods. This paper is the results of using the free vascularized fibular graft for congenital pseudarthorsis of the tibia in 7 patients since 1978 in this hospital, which is the first attempt in Korea. During the follow-up periods from 9 months to 32 months, 5/7 patients(71%) had good or excellent bony union, 2 patients had bone resorption at tbe distal site of grafted bone and required a second supplementary cancellous bone graft with electrode insertion. So it is thought that the free vascularized fibular graft is one of good methods of treatment for congenital pseudarthrosis of the tibia.

Vascularized Fibular Bone Graft for Tuberculous Spondylitis: Case Report / 대한정형외과학회잡지

The tuberculous infection of the skeletal system especially, tuberculous spondylitis is frequently encountered with orthopedic fields. Up to date, Various methods of the treatment are present but each method has problems. Recently, as a development of the microsurgical instrumentation and surgical technique, we had been tried to the two patients of tuberculous spondylitis by vascularized fibular bone graft and anterior fusion. The advantages were as follows; 1. Shortened the bony union times by this operative method. 2. Earlier returning to the social activities compared to the ordinary method. 3. The children involved tuberculous spondylitis with severe kyphosis, who can be corrected the severe kyphosis by this operative method. 4. We can be obtained the rigid graft bone fixation with adequate length of bone by this operative method.

Treatment of Chronic Osteomyelitis by Transplantation of Autogenous Omentum with Microvascular Anastomosis / 대한정형외과학회잡지

Omentum has the characteristic that it readily develops vascular anastomosis with adjacent tissues. It is suitable for eliminating a dead space regardless of the size, shape or site in the treatment of chronic osteomyelitis by use of technique of microvascular anastomoses. We report a case of chronic osteomyelitis treated by transplantation of autogenous omentum with microvascular anastomsis.

Neurovascular Free Flap Transfer by Microsurgery / 대한정형외과학회잡지

Sixteen microvasular free flap transfers have performed during recent two years in this department, which was first attempt in Korea. Neurovascular free flap was nine and vascular free flap was seven. The donor flaps were thirteen dorsalis pedls falps, two groin flaps and one latissimus dorsi flap respectively. The recipient sites were heel pad loss, vital organ exposure and scar contracture lesions in extremity. Their main cause of soft tissue defect was traumatic in all. All patients have experienced more than two times of split thickness skin graft before free flap transfer. The success rate of vascular free flap transfer was 94%. The only one failure case was due to venous thrombosis, but secondary split thickness skin graft performed with satisfactory result. The follow up period was from 5 months to 20 months. Sweating in transferred free flap was found at all neurovascular free flap within postoperative 4 months. Adequate 2-point discrimination was obtained at six patients of nine neurovascular free flaps and protective sensation seems to progressively improve in remained three patients. Two point discrimination was shortened at hand after neurovascular dorsalis pedis flap transfer in two cases. The weight bearing function at heel pad region and tactile sensation at hand have satisfactorily recovered after free flap transfer. Free flap transfer have many advantages compare to conventional skin graft, such as shorter therapeutic time, lesser physical and economic burdens, primary covering to vital organs and protective sensation of neurovascular free flap transfer. The most important factors are meticulous microvascular operation technique and anatomic knowledge.

Replantation of Amputed Limbs and Digits: Surgical technique, and result; in 106 patients with 117 replantation / 대한정형외과학회잡지

36 consecutive cases of major limbs replantation and 81 consecutive cases of finger replantation performed at Kyung Hee University Medical Center from Oct. 1975 through Sept. 1979 were reviewed. In 19 cases, amputation had occurred in wirst or palm. In 11 cases, amputation had occurred between forearm and shoulder. In 4 cases, amputation had occurred in thigh and leg. In 26 cases, amputation had occurred in thumb, and in 47 cases in index. The youngest was 4, the oldest was 52 in limb amputation, but from 5 through 38 in finger amputation. All amputed parts were cooled while awaiting replantation. Ischemic period was from 4 hours and 30 minutes to 29 hours and 35 minutes in limb amputation. And circulation was reestablished from 4 hours and 30 minutes to 29 hours and 35 minutes in limb replantation, and from 4 hours and 40 minutes to 15 hours and 10 minutes in finger replantation. In all cases bone was shortened from 2 to 5 cm in limb replantation, and from 0.3 to 0.8 cm in finger replantation and stabillzed by means of skeletal fixation. Dicision regarding primany repair of nerves and tendons depended upon the level and extent of local injury, but most cases performed primary repair. The success rate were 80.6% (29/36) in limb replantation, and 88.9% (72/81) in finger replantation respectively. Main cases of failure were thrombosis at anastomosed vessel, tissue crushing at distal part, and too long ischemic period. Surgical technique, type and level of amputation, number of artery and vein anastomosis, and ischemic period had direct relationship to success rate. But degree of amputation, patients age, infection in amputed part, and systemic heparinization had no relationship to success rate. In limb replantation, 25 cases were achieved follow up study from 6 months to 43 months. All cases except two were satisfied wlth replanted Iimbs, and were fully independent carrying out activities of daily living. All cases show cold intolerance. In finger replantation, 59 cases were achieved follow up study from 6 months to 47 months. All cases were satisfied wlth replanted digits, and used their replanted digits for grip, pinch, and hook. 46 cases (80%) had return of two polnt discrimination of less than 10 mm and useful finger Joint motion. Early and aggressive rehabilitation can be achieved good functional result in replanted limb and digit.

Treatment of the Huge Skeletal Hemangioma by Using the Microsurgical Technique / 대한정형외과학회잡지

Hemangioma are not rare tumor, they are found in almost all the vascular structures of the body. They are fairly common in the akeletal muscles. There Is no unanimity of opinion concerning the etlology and pathogenesis of hemangioma. It Is most llkely, however, that hemangioma are congenital in origin. The authors have experienced unusual huge skeletal hemangioma occurred in forearm and hand in infant. These huge hemangioma in infant ls very difficult to excise completely with the conventional methods. But we have obtained the excellent result by using recently advanced meticulous microsurgical technique.

A Study of Lumbar Spinal Canal Using Computerized Axial Tomogram in Korean Adults / 대한정형외과학회잡지

Appreciation of the normal variation of anterior and posterior diameter of the lumbar spinal canal under computerized axial tomogram may throw very important value on the diagnosis and treatment in lumbar spinal problems. The authers have measured the diameter of the lumbar spinal canal using EMI scanner CT 5005. The data was first based on the study of two cadaver lumbar spine and then the study of 268 normal Korean adults male 185, and female 83. The results were summerized as follows. 1. The diameter of the osseous segment was more narrow than articular segment in normal lumbar spinal canal, 2. The shape of lumbar spinal canal was oval in upper lumbar. but became triangular going down to the lower lumbar. There was no difference of diameter in sex. 4. The average diameter of anterior and posterior spinal canal was; L1 16.53± 0.18, L2 16.23± 0.215, L3 15.42± 0.26, L4 15.57± 0.43 and l% 17.7± 1.63mm respectively. 5. The average diameter of transverse spinal canal was; L1 23.31± 0.18, L2 23.76± 0.28, L3 24.78± 0.345, L4 26.07± 0.605 and L5 29.31± 1.19mm respectively. 6. It was more accurate to check out the pathology of the lumbar spinal canal using coinputerized axial tomogram than other method previously used.

Operative treatment of supracondylar-Condylar Fractures of the Femur / 대한정형외과학회잡지

The previous reports about Supracondylar-Condylar Fracture of the femur which extends to articular surfaces revealed poor results in general, regardless of the methods of treatment. But those results are thought to be much alleviated if they are treated according to the principles of ASIF. Fifteen cases of Supracondylar-condylar fractures of the femur from 13 patients were treated by open reduction and rigid internal fixation during last 3 years at Department of Orthopedic Surgery, Early mobilization of knee joint was permissible in most of the cases without loss of fixation or other complications during convalescence Subsequently, greatifying results were obtained as observed in varying period of follow up days.