Approach for naso-orbito-ethmoidal fracture

The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be treated through the transconjunctival approach easily. However, in more severe cases, for example, fracture extending to the medial orbital wall or zygomatico-frontal suture line, only transconjunctival incision is insufficient to secure good surgical field. And, it also has risk of tearing the conjunctiva, which could injure the lacrimal duct. Also, in most complex types of facial fracture such as NOE fracture or panfacial fracture, destruction of the structure often occurs, for example, trap-door deformity; a fracture of orbital floor where the inferiorly displaced blowout facture recoils to its original position, or vertical folding deformity; fractured fragments are displaced under the other fragments, causing multiple-packed layers of bone.

Acquired Dermal Melanocytosis of the Dorsum in a Middle-Aged Asian Woman

No abstract available.

Utility of Toe-brachial Index for Diagnosis of Peripheral Artery Disease

BACKGROUND: The ankle brachial pressure index (ABI) is a simple, useful method for diagnosing peripheral artery disease (PAD). Although the ABI is an objective diagnostic method, it has limited reliability in certain scenarios. The aim of the present study was to determine the accuracy and reliability of the toe brachial index (TBI) as a diagnostic tool for detecting stenosis in PAD, associated with normal or low ABI values. METHODS: ABI and TBI values were measured in 15 patients with diabetic gangrene who were suspected of having lower extremity arterial insufficiency. The ABI and TBI values were measured using a device that allowed the simultaneous measurement of systolic blood pressure in the upper and lower extremities. In addition, the ABI and TBI values were compared pre- and post-angiography. RESULTS: Patients with an ABI of 0.9-1.3 showed almost no difference between the 2 measurements. The patients with TBI >0.6 had no arterial insufficiency. The patients with TBI <0.6 required vascular intervention with ballooning. After the angiography, the gangrenous wounds decreased in size more rapidly than they did prior to the intervention. CONCLUSIONS: Our findings suggest that TBI is the method of choice for evaluating lower limb perfusion disorders. This result requires further studies of TBI in a larger number of patients. Future long-term studies should therefore evaluate the utility of TBI as a means of screening for PAD and the present findings should be regarded as preliminary outcomes.

A Case of Secondary Augmentation Rhinoplasty with Dermofat Graft for Immediate Rhinoplasty Who Had a Fractured Nasal Bone

Augmentation rhinoplasty is one of the most common aesthetic procedures in Asian countries. For this procedure, a variety of implants are used. Nasal bone fracture is one of the common facial bone fracture, and patients who have nasal bone fracture often need secondary rhinoplasty because of certain complications such as nasal deviation and depression. Unfortunately, the management protocol has not yet been established. Depending on whether the previous implant is removed or not, therefore, this may lead to partial decompression of the nasal bone, mobility of the implant, or reposition of the implant. For these reasons, we corrected fractured nasal bone, removed silicon implants and capsules, and employed immediate secondary rhinoplasty with dermofat graft for the patient who had had rhinoplasty. The height and appearance of the patient's nose were maintained as before surgery. The patient appealed a little depression of the nasal dorsum, but was very satisfied with its natural appearance. There were no complications such as nasal tip deformity, chronic inflammation, or partial depression deformity. We report herein the usefulness of this procedure; doing non-invasive closed reduction, removing silicon implants, and employing immediate secondary rhinoplasty with dermofat graft of the patients who had rhinoplasty previously.

Treatment of Accessory Axillary Breast Tissue Using Ultrasound-assisted Liposuction with Pull-out Method

Treatment of accessory breasts with simple excision, diamond-shaped excision, or Y-V technique provides insufficient aesthetic results. Therefore, we hereby present an effective surgical method to provide aesthetic and satisfactory results. Fifteen women between the ages of 18 and 48 years were treated with the method. Incision was made within the natural wrinkle line in the axillary fold, and ultrasound assisted liposuction was performed through the incision. For natural lining of axilla, accessory breast tissues were removed with pull-out method. Average follow up period for the patients was 8 months. All patients (total 15 patients, 25 accessory breasts) who underwent the operation with ultrasound assisted liposuction and breast tissue excision by pull-out method did not show any major complications such as skin necrosis, hematoma or scar contracture. The method could minimize scar and reduce contour problem after the operation. The patient's satisfaction was high, as they stayed in hospital for only 3 days and returned to full activities in a week. This can be an excellent method to treat accessory breast tissue and parenchyme.

Reconstruction of the Soft Tissue Defect of the Lower Leg by Distally Based Superficial Sural Artery Fasciocutaneous Island Flap Using Supercharged Vein

PURPOSE: Distally based superficial sural artery island flap has some disadvantages such as postoperative flap edema, congestion, and partial necrosis of the flap margin. Venous congestion is an area of considerable concern in distally based superficial sural artery fasciocutaneous flap and is one of the main reasons for failure, particularly when a large flap is needed. However, we could decrease these disadvantages by means of venous superdrainage. METHODS: From June of 2006 to June of 2007, a total of two patients with soft tissue defects of lower one third of the leg underwent venous supercharging distally based superficial sural artery island flap transfer. The distal pivot point of this flap was designed at septocutaneous perforator from the peroneal artery of the posterolateral septum, which was 5cm above the tip of the lateral malleolus. Briefly, this technique is performed by anastomosing the proximal end of the lesser saphenous vein and collateral vein to any vein in the area of the recipient defect site. RESULTS: No venous congestion was noted in any of the two cases. No other recipient or donor-site complications were observed, except for minor wound dehiscence in one case. In 3 to 6 months follow-up, patients had minor complaints about lack of sensation in the lateral dorsal foot. CONCLUSION: The peroneal artery perforator is predictable and reliable for the design of a distally based superficial sural artery island flap. Elevation of the venous supercharging flap is safe, easy, and less time consuming. In conclusion, the venous supercharging distally based superficial sural artery island flap offers an alterative to free tissue transfer for reconstruction of the lower extremity.

Reconstruction of Fingertip Amputation by Using Digital Artery Perforator Flap

PURPOSE: Fingertip injuries are the most common hand injuries and may lead to significant disability. Knowledge of fingertip anatomy is mandatory to treat these injuries effectively. All surgical techniques used for coverage of fingertip injuries must be based on the nature of the injury and the patient's age. Many authors have studied the method of fingertip reconstruction because goals of these treatments should include maintaining length, sensibility, motions, and appearance. The purpose of this study is to evaluate the effect of digital artery perforator flap for fingertip reconstruction without aesthetic and functional problems. METHODS: From November 2006 to March 2007, the authors performed fingertip reconstruction on 3 fingers of 3 patients, aged between 41 to 54 years (average age, 47 years) using digital artery perforator flap. RESULTS: All fingers recovered successfully and there were no necrosis of the flap. We followed up 3 cases more than 5 months. Light touch and temperature sensation could be detected in all flaps and the static two-point discrimination test was 8 mm. CONCLUSION: This flap is an alternative choice for coverage of fingertip defects. This method also takes short time to procedure and to recovery. The digital artery perforator flap has never been reported in Korea, however it is considered as a useful method for treatment of fingertip injury.

Submasseteric Abscess

PURPOSE: The masserteric space is an important tissue compartment of the face, but a disease in it is difficult to diagnose and treat. The submasseteric abscess is located between the masseter muscle and mandibular ramus with different appearances such as sepsis, infection, or tumor. Especially the common misdiagnosis of submasseteric abscess is acute or chronic parotitis. The purpose of this report is to pay special attention to the possible diagnosis of submasseteric abscess for the symptoms of unilateral cheek swelling and tenderness that accompany marked trismus. METHODS: A 11-year-old boy came to our hospital because of facial swelling, tenderness, and trismus in a history of left cheek swelling and toothache. We diagnosed his case as submasseteric abscess by CT scan and surgical intervention was performed. Under general anesthesia, the abscess was opened by the intraoral incision and considerably massive pus was drained. RESULTS: Swelling, tenderness, and trismus became to subside during postoperative 10 days and general condition and vital signs became stable. After 6 months, CT scan showed that both masseteric muscles were symmetric and there was no periosteal reaction of the mandible. CONCLUSION: In conclusion, submasseteric abscess is a rare infection with the symptoms of cheek tenderness and marked trismus. A detailed medical history and clinical examination of a patient as well as computed tomography(CT) are important tools in the accurate diagnosis and efficient treatment of the submasseteric abscess. Adequate drainage, removal of cause, and antibiotic infusion are the management of choice.