ABSTRACT
The perfect breasts are supposed to be symmetrically balanced and proportionate to the rest of the body with softness, good-position, and mobility to respond to gravity and postural change. But saline filled implants have some disadvantages compared to silicone gel implant. Their low viscosity creates an unnatural feeling and suboptimal aesthetic result, their deflation offers the most important complication such as rippling or size reduction of breast. Therefore precise preoperative design, exact procedure and appropriate postoperative care are essential to optimal result. In past 5 years, we have performed the transaxillary subpectoral augmentation mammaplasty using saline filled implants on 183 female patients whose breasts were hypoplastic and followed up 58 months maximally. All patients were assisted with endoscopy. We employed round, textured type implant with the size ranging from 120cc to 270 cc and overinflated them 10 to 20% beyond its original volume. The overall result was satisfactory but some cases of capsular contracture, deflation, implant displacement and infection were found. On the basis of our experience, we suggest some critical points so as to obtain the best result: what conforms to the patients anatomy and satisfies her goal at the same time. First of all, preoperative design in accordance with the dimension is very important. The best dimension for each patient depends on the definition of the ideal base width of the breast. Secondly, exact subpectoral dissection using endoscopy, no-touch technique for the implant is essential to achieve excellent results. Finally, postoperative self management must not be ignored.
Subject(s)
Female , Humans , Breast , Contracture , Endoscopy , Gravitation , Mammaplasty , Postoperative Care , Self Care , Silicone Gels , ViscosityABSTRACT
A muscular calf is esthetically unappealing in Asian women. Treatment by liposuction alone has poroven to be difficult due to a small amount of fat. We established a new method of transecting half of the gastrocnemius tendon in order to improve the contour of the calf. Thirty-five patients were operated on during the past 3 years. The medial or lateral half of the gastrocnemius tendon was cut using an endoscopic-guided 3M AGEE blade through a 1cm-sized incision. The portion of the muscle above the site of the transection was elevated from the underlying soleus muscles. We checked the calf circumference and evaluated the clinical results at 6 months postoperatively. An average 10% reduction in calf circumfernce was measured, showing a significant esthetic improvement. There were no significant changes in gait analysis or in the Cybex test. There were no specific complications related to the procedure. Through our clinical experience in 35 cases, we were able to prove that tenotomy is a effective, simple and easy method without severe morbidity.
Subject(s)
Female , Humans , Asian People , Gait , Lipectomy , Muscles , Tendons , TenotomyABSTRACT
It has been well documented that dysfunction of the Eustachian tube if the main cause of middle ear disease in most cleft palate patients. The middle ear disease is refractory to medical treatment and has frequent recurrences; the final results may end up with chronic otitis media and/or hearing loss. Currently, myringotomy with placement of ventilation tube in early infant stage have been widely accepted for treatment of otitis media in cleft palate patients. We calculated the frequency of the occurrence of otitis media in cleft palate patients who have received palatoplasty in our clinic. Preoperative otoscopic examination and tympanometric test were taken in all patients. We performed tympanostomy and ventilation tube insertion at the time of palatal repair on every patients who had evidence of otitis media in the preoperative otologic examinations. Since November 1996, 79 patients received palatoplasty and among these 63 patients(79.7%) received bilateral ventilation tube insertion simultaneously. We confirmed the previously documented high prevalence of otitis media in cleft palate patients and understood the importance of preoperative otologic examinations in the managements of cleft palate.
Subject(s)
Humans , Infant , Cleft Palate , Ear, Middle , Eustachian Tube , Hearing Loss , Middle Ear Ventilation , Otitis Media , Prevalence , Recurrence , VentilationABSTRACT
To increase the survival area of the venous flap, we studied the arterialized venous flap in a rabbit ear model. The ears of 12 New Zealand white rabbits(n=24) were randomized into three groups, group A receiving arterio-venous anastomosis 14 days before the arterialized venous flap elevation; group B receiving bipedicled flap elevation 14 days before arterialized venous flap elevation; group C receiving no pretreatment before the arterialized venous flap elevation. Tc -pertechnetate scan was performed on all groups immediately after the arterialized venous flap elevation to evaluate the blood flow of the flap. The survival area of the flap was measured 14 days after the arterialized venous flap elevation. Average ratio of survival area was 92% in Group A, 88% in group B, which were comparatively higher than the 12% in group C. The entire flap was visualized in groups A and B on scan images, however, only the proximal area of the anterior and posterior marginal vein was visualized in group C. Flap survival pattern was similar to that of the scan image and the slope of time-activity curve of groups A and B was much steeper than that of group C. High survival rate of group A, which received the arterio-venous anastomosis as a pretreatment, may be due to the decrease of resistance of outflow during the 14 days. Anticipated mechanisms involved are, valve insufficiency due to high pressure arterial inflow, development of vascular collaterals in the flap, and opening of arteriovenous(A-V) shunt. Bipedicled flap elevation as a pretreatment may not effect on valves, however, may impair the sympathetic nerve and cause ischmic stimuli which in turn may develop vascular collaterals and make an opening of the A-V shunt.
Subject(s)
Ear , New Zealand , Survival Rate , VeinsABSTRACT
Tanzer introduced the auricular reconstruction using autologous rib cartilage & full thickness skin graft for congential microtia correction in 1959. After then, many surgeons adapted various modified methods for total ear reconstruction. However, there are some problems in the stage of ear elevation with the conservative technique. Due to scar contracture, the auriculocephalic angle cannot be maintained with the skin graft alone. Nagata tried to overcome this problem by inserting rib cartilage covered by temporoparietal fascia to the elevated cartilage frame. However, this technique also induced several problems. 1st, it leaves a long scar and alopecia on the temporal scalp. 2nd, Nagata method requires a lot of cartilage in order to fabricate the 3-dimensional framework, sometimes leaving no cartilages to be used for the semilunar pillow in the ear elevation procedure. 3rd, this method cannot be used if the temporoparietal fascia was already used for another reason such as cartilage framework exposure. To overcome these problems, we used the silicone block and mastoid fascia flap instead of semilunar cartilage pillow and temporoparietal fascia flap. Since silicone is not an absorbable material, it can maintain good auriculocephalic angle. Furthemore, due to the excellent blood circulation of the mastoid fascia flap, there is a strong resistance to postoperative complications such as infection and extrusion. Other advantages are that it leaves short scars and is esthetically tolerable. This method may preserve the temporoparietal fascia and therefore, may be prepared for the 2ndary operation in case of the exposure of framework. From March 1995 to July 1997, 18 patients (14 males and 4 females) who ranged in age from 9 to 23 years underwent ear elevation using the silicone block and mastoid fascia flap. These patients had previous rib cartilage graft operations at 6 months before these operations. We did not find any complications such as infection, silicone implant extrusion and decreased auriculocephalic angle. During 6 to 26 months follow-up period (average follow-up period; 12 months), there was no case of decreased auriculocephalic angle. The clinical result of this technique was excellent at the stage of ear elevation.
Subject(s)
Humans , Male , Alopecia , Blood Circulation , Cartilage , Cicatrix , Contracture , Ear , Fascia , Follow-Up Studies , Mastoid , Menisci, Tibial , Postoperative Complications , Ribs , Scalp , Silicones , Skin , TransplantsABSTRACT
Tie-over dressing is commonly used in order to immobilize the skin graft. The classic method takes too much time and effort, and various apparatuses of the other modifications are somewhat large and bulky, especially in the surgery for hands, therefore, we have developed a simplified method for tie-over dressing. We placed several key stitches with absorbable suture material, and passed silk sutures from one margin of the graft to the opposite without tying. Then after putting saline-soaked cotton balls below and above the silk sutures, we tied the silk suture together applying appropriate pressure. This method has the following advantages: 1. speed of application 2. double compression 3. easy to remove
Subject(s)
Bandages , Hand , Silk , Skin , Sutures , TransplantsABSTRACT
The purpose of this study was to determine the efficacy of the CO2-laser energy in the operation of cleft palate and pharyngeal fiap compared with the traditional scalpel surgery. This investigation involved a series of 34 patients who underwent CO2-laser assisted palatoplasty and pharyngeal flap between 1995 and 1997. The 19 males and 15 females ranged from 13 months to 36 years in age (mean age of 5.6 years) at the time of surgery. The postoperative clinical follow-up ranged from 6 to 24 months (mean 12 months). The CO??-laser provided the surgeon with bloodless operative field with reduction in blood loss giving greater visibility. It also offered an advantage in deep surgical cavity in Ro-pharynx through an operative arm, reaching areas that would otherwise have been difficult to access by traditional means. There was less bleeding during the surgery using, and therefore, complication. associated with bleeding was minimalized. There were no significant differences in their wound healing between the traditional scapel method and the laser method. The mean hospitalization in the group using the laser was approximately one day less than the group using the scapel. Preliminary findings suggest that the laser assisted palatoplasty and pharyngeal flap has a definitive advantage in providing the surgeon with bloodless operative field, reduction of blood loss, early recovery. Disadvantages of the laser surgery is a learning curve, the expenses of equipment, and safety precaution.
Subject(s)
Female , Humans , Male , Arm , Cleft Palate , Follow-Up Studies , Hemorrhage , Hospitalization , Laser Therapy , Learning Curve , Wound HealingABSTRACT
The traditional transaxillary approach for breast augmentation gained popularity among plastic surgeons for its abscence of scar on the breast, minimal loss of nipple sensation and a theoretically decreased risk of periprosthetic infections by minimizing contact with breast tissue. The shortcomings of the traditional approach are limitation of visualization and hemostasis. Blunt dissection limits surgeons ability to precisely control the inframammary fold and lowed pole of breast. This limitation may result in improper implant placement and poor aesthetic result. In order to overcome theirs disadvantages, we used endoscopic technique in transaxillary technique. With endoscopically detected transaxillary subpectoral breast augmentation, bleeding vessels are easily seen and coagulated. Visualization of the pocket allows significantly better control of the inframammary fold. We can also divide the pectoralis muscles and prepectoralis fascia under controlled visualization. From 1994 to 1996, 84 implants haute been placed in 42 patients utilizing the endoscopic assisted transaxillary subpectoral augmentation mammaplasty . We used 32 textured implants and 52 smooth type implants. Follow up ranged from 2weeks to 18 months. We did not experience any hematomas, inflections, capsular contractures or other complications. We obtained good aesthetic results and patient acceptance. With endoscopically assisted transaxillary subpectoral augmentation mammaplasty, we have precise control of inframammary crease and hemostasis. As we obtained good aesthetic results, here, we have described our surgical technique and brief clinical expediences.
Subject(s)
Female , Humans , Breast , Cicatrix , Contracture , Endoscopes , Fascia , Follow-Up Studies , Hematoma , Hemorrhage , Hemostasis , Mammaplasty , Nipples , Pectoralis Muscles , SensationABSTRACT
Habitual snoring is common among males, especially among those who are overweight, and gets worse with the age. Snoring Is related to physical obstruction of breathing during sleep. This obstruction occurs when the palatal muscles, uvula muscles, and sometimes tonsiles relax during deep sleep and acts as vibrators. We have treated, with laser assisted uvulopalatoplasty(LAUP), twenty patients who suffer from snoring. CO2 laser was used and approximately I5-30 minutes of operation time was required. There were no singnificant complications, such as bleeding and asphyxia, in the 20 patients treated with LAUP. Results observed in the short term showed that 90% of the patients treated with LAUP considered thems to be essentially improved. Two patients developed scars at the posterior pillars. LAUP is a relatively simple and safe method which is performed at the hospital on an outpatient basis under local anesthesia.
Subject(s)
Humans , Male , Anesthesia, Local , Asphyxia , Cicatrix , Hemorrhage , Lasers, Gas , Muscles , Outpatients , Overweight , Palatal Muscles , Palatine Tonsil , Respiration , Snoring , UvulaABSTRACT
No abstract available.