Correction of Minor-Form and Microform Cleft Lip Using Modified Muscle Overlapping with a Minimal Skin Incision

BACKGROUND: In treating minor-form or microform cleft lip, obtaining an optimal result is a challenge because of the visible scarring caused by traditional surgery. We present a refined method using muscle overlapping with a minimal skin incision in patients younger than 3 years, a group characterized by thin muscle. METHODS: The surgical technique involves restoration of the notched vermillion using Z-plasty, formation of the philtral column using overlapping of an orbicularis oris muscle flap through an intraoral incision, and correction of the cleft lip nasal deformity using a reverse-U incision and V-Y plasty. A single radiologist evaluated ultrasonographic images of the upper lip. RESULTS: Sixty patients were treated between September 2008 and June 2014. The age at the time of operation ranged from 6 to 36 months (mean, 26 months). The follow-up period ranged from 8 to 38 months (mean, 20 months) in minor-form cases and from 14 to 64 months (mean, 37 months) in microform cases. A notched cupid's bow was corrected in 10 minor-form cases and 50 microform cases. Ultrasonographic images were obtained from 3 patients with minor-form cleft lip and 9 patients with microform cleft lip 12 months after surgery. The average muscle thickness was 4.5 mm on the affected side and 4.1 mm on the unaffected side. CONCLUSIONS: The advantages of the proposed procedure include the creation of an anatomically natural philtrum with minimal scarring. This method also preserves the continuity and function of the muscle and provides sufficient augmentation of the philtral column and nostril sill.

Comparison between Z-plasty and V-Y Advancement for the Surgical Correction of Cryptotia

BACKGROUND: Cryptotia correction by V-Y advancement of a temporal triangular flap was introduced in 2005. However, despite the several advantages of V-Y advancement, visible scars at the donor site are problematic. As a result, a Z-plasty technique was considered for skin deficiency in mild cases. Therefore, we introduce a new surgical scheme for cryptotia correction based on considerations of techniques and complications that arose in our clinic. METHODS: Between 2000 and 2013, 26 patients (35 cases) of cryptotia were treated. Seventeen patients had unilateral cryptotia and nine had bilateral cryptotia. Two corrective methods were used, Z-plasty or V-Y advancement, based on the severity. In mild cases, Z-plasty was used for correction and in severe cases, V-Y flap advancement was used for more skin supplement. RESULTS: Follow-up periods ranged from 6 months to 1.5 years. The results obtained were relatively favorable. Nine cases of mild deformity were corrected by Z-plasty, and the other 26 cases with mild or severe deformities were corrected by V-Y advancement. In Z-plasty cases, there was one hypertrophic scar and in V-Y advancement cases, seven resulted in visible scarring and three in skin sloughing. CONCLUSION: The main advantage of Z-plasty is a lower likelihood of visible scarring at the donor site. In mild cases, Z-plasty may be a good alternative, but in severe cases, V-Y advancement is probably the best option for more skin supplement.

Our Experiences in Nipple Reconstruction Using the Hammond flap

BACKGROUND: Nipple reconstruction following breast mound reconstruction is the final step in breast reconstruction. Although nipple reconstruction is a simple surgery, the psychological aspects of nipple reconstruction are thought to be important. Nipple projection is a key factor in determining patient satisfaction with the surgery. In the present study, the Hammond flap technique was introduced for nipple reconstruction. METHODS: Twenty-six patients who had undergone breast reconstruction from February 2008 to March 2012 were enrolled in this prospective study. All patients were evaluated based on preoperative photos, and their nipple diameters and heights were measured. Postoperative evaluation was conducted 3, 6, 9, and 12 months following nipple reconstruction. A questionnaire on patient satisfaction with the nipple reconstruction was administered 12 months after nipple reconstruction. Moreover, the same plastic surgeon scored nipple projection and overall cosmetic result of the new nipple. RESULTS: The mean projection was 4.4 mm (range, 3-6 mm), and it well matched the contralateral nipple. Twelve months following nipple reconstruction, the mean reduction rate in the nipple projection was 43.6%. Patients were satisfied or very satisfied with the nipple projection and the overall cosmetic result in 80.7% cases. CONCLUSIONS: In the present study, compared with other techniques, the use of the Hammond flap technique in nipple reconstruction showed competitive results with regard to nipple projection and patient satisfaction.

Vaginal Reconstruction with Laparoscopic-perineal Rectosigmoid Colpopoiesis in Mayer-Rokitansky-Kuster-Hauser Syndrome: A Case Report

PURPOSE: Various operations have been proposed to compensate for congenital absence of the vagina using ileal or colonic interposition. These methods involve laparotomy, which shows postoperative complications such as long scar and delayed recovery. One case of neovagina reconstruction with laparoscopic rectosigmoid colpopoiesis in Mayer-Rokitansky-Kuster-Hauser syndrome is presented to avoid laparotomic complications. METHODS: Laparoscopic surgery was performed in a 27-year-old MRKH syndrome patient. After a cruciate incision, blunt dissection through two-finger wide space was created between the bladder and the rectum. A 14-cm rectosigmoid segment vascularized by a branch of sigmoid artery was isolated by laparoscopy. The distal end was sutured with vaginal vestibule mucosa. A continuity of intestine was restored by circular end-to-end proximate curved intraluminal stapler CDH29(R) through perineal opening. RESULTS: Total operation time was 4 hr 15 min. Normal walking and ingestion were possible within 3 days and 4 days after surgery. The hospital stay was 7 days and the patient was followed up for 6 months. The neovaginal introitus was wide enough for inserting two fingers, and there has been no narrowing of the neovagina on palpation as confirmed by vaginogram. The patient had functional self-lubricating neovagina without excessive mucous production or the need for routine dilation or unnoticeable scar. CONCLUSION: The successful result of this laparoscopic vaginal reconstruction technique with rectosigmoid segment suggests that this technique can be considered for the option of vaginal reconstruction in girls with the MRKH syndrome.

Effect of Bone Marrow Aspirate with Autogenous Bone Graft for Alveolar Cleft in a New Rabbit Model

PURPOSE: Alveolar bone grafting has become an essential process in the treatment of alveolar cleft patient for stabilization of the maxillary arch, elimination of oronasal fistula, the reconstruction of the soft tissue nasal base support, and creation of bony support for tooth eruption for implant. The use of Autologous iliac cancellous bone is preferable because it enables to use adequate quantity and its high osteoinductive potential. However, even with iliac bone, insufficient osteoregeneration or absorption occurs due to several factors such as the patient's age, cleft width, functional stress, and others. In order to increase osteoregeneration where the iliac bone is placed, the present study is associated with bone marrow aspirate(BMA).The experimental study evaluated the efficacy of osteoregeneration in normal cleft rabbits when alveolar bone grafting was performed with autologous iliac corticocancellous bone. METHODS: Twenty-four New Zealand White rabbits were divided randomly into 2 groups(BMA, control). All animals underwent harvesting of corticocancellous bone graft from the right posterior iliac crest via standard surgical technique. 1mL of BMA were obtained by scraping the needle and aspirate with 10mL syringe from the contralateral iliac bone wall. The muco-periosteal flap on the palate was elevated. A mixture of Equal bone's volumes with BMA and saline as its control was inserted into the cleft. Animals were sacrificed in 2, 4, and 8 weeks and maxilla was harvested for dental peri-apical X-ray, bone matrix density (BMD), and histologic analysis. RESULTS: BMD of regenerated bone to the cleft in the rabbits was higher than that of the control rabbits. X-ray, histologic analysis showed that increased osteoregeneration and low absorption rate were observed in the BMA group. CONCLUSION: Our experimental study shows BMA enhanced the osteoregeneration and survival rate of alveolar bone grafting. BMA is easy to extract and cost-time effective. So it can be an effective enhancers for bone grafting mixtures.

Oncoplastic Techniques For Treatment of Inferiorly Located Breast Cancer

PURPOSE: Breast conserving surgery(BCS) for breast cancer has a common treatment protocol. Oncoplastic surgery represents a form of BCS which combines both a cosmetic mammoplasty approach and oncologic resection for the treatment of breast cancer. Depending on the tumor site, BCS can make an unsatisfactory cosmetic result, especially in inferiorly placed tumors. This study describes the use of oncoplastic techniques for inferiorly located breast tumors in immediate partial mastectomy reconstruction. METHODS: From September of 2006 to February of 2008, these techniques were used in 11 patients at the OO hospital. After BCS was preceded, breast reshaping by oncoplastic techniques were selected depending on the location and size of the tumor within the breast as well as the size of breast itself. Oncoplastic techniques after partial mastectomy included 'Wise pattern (inverted T)' reduction mammoplasty, 'vertical pattern' mammoplasty, 'J-pattern' mammoplasty. In order to improve the cosmetic outcome, repositioning of the nipple areola complex(NAC) or reshaping of the contralateral breast may be considered additionally. RESULTS: These techniques have been used in 11 patients. The mean age was 51 and the average follow- up period was 8 months. Eleven of these patients underwent the 'Wise pattern(inverted T)' reduction mammoplasty(n=6), 'vertical pattern' mammoplasty(n=3) and 'J-pattern' mammoplasty(n=2). There was one wound dehiscence during the follow-up periods. This complication was treated by conservative approach. The overall cosmetic result was evaluated in 6 months. The majority of patients were satisfied at the cosmetic result. CONCLUSION: Oncoplastic techniques in inferiorly located breast tumors could be a reasonable and safe option for breast cancer patients who desire conserving surgery with esthetical breast.