The Rectus Abdominis Myocutaneous Flap for the Immediate Reconstruction of Partial Vaginal Defects Following the Extended Abdominoperineal Resection of Recurrent Rectal Cancer

Extensive resection including posterior vaginal wall may be required for the advanced low rectal cancer or recurrent rectal cancer in order to achieve the tumor free circumferential margins. We describe closure of a vaginal defect with rectus abdominis musculocutaneous flap after extended abdominoperineal resection, hysterectomy and partial colpectomy in a patient with recurrent rectal cancer with the special reference to the surgical technique.

A case report: A case of fibroepithelial polyp on vulvoperineal area / 대한산부인과학회지

A case of fibroepithelial polyp on vulvoperineal area is described. Her age is 20 year old and the tumor measured 9 cm in its largest diameter and was connected to the left labium majus. This case is very unusual in that almost all reported vulvar fibroepithelial polyps are small and sessile, and should distinguish from malignant cancer. We have experienced an unusually large vulvoperineal mass that was surgically excised and histologically diagnosed as benign fibroepithelial polyp and present this case with a brief review of literature.

Regulation of RANTES and MCP Expression in Human Nasal Mucosal Fibroblasts

BACKGROUND: Fibroblast functions both as a structural element and as a vital immunoregulatory cell. Fibroblasts regulate inflammation through governing of chemokine expression. In order to elucidate the mechanisms by which the expressions of chemokines were regulated, the co-stimulatory effects of Th1 and proinflammatory cytokines were compared using nasal mucosal fibroblasts. METHODS: Human nasal mucosa was obtained from surgery for septal deviation and the growth of fibroblasts was established. Fibroblasts from 4th to 6th passage were stimulated with various combinations of cytokines. To inhibit selected signaling pathways, fibroblasts were pretreated with cyclosporin A, wortmannin, staurosporine, and dexamethasone prior to the stimulation with cytokines. The supernatants were collected and chemokines were detected with a sandwich enzyme-linked immunosorbent assay. RESULTS: TNF-alpha/IFN-gamma-induced production of RANTES was inhibited by all inhibitors used. MCP-1 was produced constitutively and TNF-alpha-induced or TNF-alpha/IFN-gamma-induced production of MCP-1 was not inhibited by cyclosporin A or wortmannin, but by stauroporine or dexamethasone. All inhibitors used in this experiment inhibited TNF-alpha/IFN-gamma-induced or IL-1beta/IFN-gamma-induced production of MCP-2 in nasal mucosal fibroblasts. Although staurosporine or dexamethasone showed strong inhibitory effects, cyclosporin A or wortmannin did not inhibit the production of MCP-3 by IL-1beta/IFN-gamma treatment. CONCLUSION: Chemokines were strongly induced by stimulation of cytokines in combination and showed different pattern of inhibition by the inhibitors. Therefore, it was assumed that cytokines acted on multiple pathways or on unknown pathways which converged to gene-specific transcription factors

Reconstruction of the Soft Tissue Defect Using Thoracodorsal Artery Perforator Skin Flap

In the case of a soft tissue defect which requires thin & pliable tissues, the choice of donor site is limited due to flap bulkiness and donor site morbidity. To overcome these problems, a variety of perforator-based flaps such as paraspinous and parasacral perforator flap, deep inferior epigastric perforator flap, gluteal perforator flap, and thoracodorsal artery perforator flap have recently been introduced. We experienced 8 cases of soft tissue defects from December 1996 to March 1999 using the thoracodorsal artery perforator flap for reconstruction. We could elevate the cutaneous flap with preservation of the latissimus dorsi muscle flap only when it was based on one cutaneous perforator. Defatting procedure was possible for further thinning of skin flap. In one case, axillary defect after release of postburn scar contracture was repaired with island perforator flap and the other seven cases were repaired with free flap. The results were satisfactory. We believe the thoracodorsal artery perforator flap is useful for reconstruction of soft tissue defects which are large or under conditions requiring thin flap.

Postracheostomy Scar Revision

The tracheostomy is increasingly being performed. In most cases, the tracheostomy sites are left to heal by secondary intention, so it leaves a depressed and wide scar that is cosmetically disfigured. Another problem os that the scar is also attached directly to the trachea itself and will move vertically with the trachea during the act of swallowing. Even though the tracheostomy scar is cosmetically acceptable, the mobility and retraction of the scar is a continual nuisance to the patient. We performed a retrospective study on 9 patients who had undergone revision of the depressed thracheostomy scar by the Renner Method from June, 1997 to February, 1999. The method includes transverse fusiform incision of the original scar and excision of the depressed portion of the scar to the level of the trachea itself. To prevent attachment of the skin and trachea, a bilateral subcutaneous flap and muscle flap were simply advanced to the midline and overlapped. Then the rest of scar that was not depressed was deepithelized and flipped to augment the soft tissue volume in the central depressed area. Satisfactory results were achieved in all patients without hematoma, infection, hypertrophic scar, and keloid formation. We believe this simple Renner method is one of the best ways of performing posttracheostomy scar revision.

A Study of The Relationship Between The Degree of Patient's Satisfaction with the Results of Aesthetic Operantion and Psychological Factors

No abstract available.

Clinical cases of deep inferior epigastric artery free skin flap

Since the use of the rectus abdominis myocutaneous flap was first reported by Mathes and Bostwick in 1977, its clinical utility both as an pedicled flap and a free flap has broadened reconstructive surgery. But there is a risk of postoperative abdominal hernia formation and bulkiness due to the volume of the rectus muscle and subcutaneous fatty tissue, it is pointed out as a disadvantage in the recipient site where a thin flap is required. To overcome these problems, Koshima (1989), and Itoth (1993) described the modification of this flap which contained little or no muscle or fascia. In our department , we performed deep inferior epigastric artery free skin flap in soft tissue reconstruction in three patients: we dissected one or two muscle perforator from the rectus muscle, removed the deep fatty layer, so we could elevate a thin flap. The results were good, so we are willing to describe the operative technique and its usefulness.