Orbital Reconstruction with Free Flaps after Orbital Exenteration

PURPOSE: To report the results of the orbital reconstruction with microvascular free flap following orbital exenteration in patients with orbital malignancy. METHODS: We performed microvascular free-tissue reconstruction for extensive orbital defects immediately after exenteration in 6 patients. RESULTS: The causes for exenteration were adenocystic carcinoma of the lacrimal gland (2), squamous cell carcinoma of the upper eyelid (1), the nasolacrimal duct (1), maxillary sinus (1), and the ethmoid sinus (1). The extensive orbital defects were reconstructed with the rectus abdominis flaps in 3 patients, with the radial forearm flaps in two, and with the scapular flap in one patient. There was no flap loss. There was no donor site complication. CONCLUSIONS: Microvascular free-tissue transfer allowed successful facial reconstruction in patients with extensive orbital and periorbital defects. It seemed to permit reliable, expeditious, one-stage reconstruction of the orbital defects.

Day Surgery in Pediatric Plastic Surgery: A 5-Year Hospital Experience

The popularity of elective day surgery has increased significantly over the past two decades. Potential advantages of day surgery are alleviation of parental burden on time and money, less social disruption for the child and family due to the shorter period hospitalization and the absence of overnight stay. Between January of 1996 and December of 2000, we studied 391 cases that underwent day surgery (age 1 mo.-15.0 yrs). This practice is reviewed with regard to initial assessment, preparation for surgery, postoperative complications and management, and immediate follow-up by telephone visit. Up to 28% of all pediatric plastic surgical cases were performed on day-care basis mainly in laser therapy and excision of benign soft tissue mass. The incidence of postoperative minor medical complications was 3.1 In addition, we reviewed 14 patients who underwent ambulatory surgery with syndactyly and/or polydactyly of the hand. Then we compared 3 parameters (hospital charge, postoperative complications and degree of postoperative satisfaction in parents) with those of 84 inpatient children who underwent the same surgical procedures. As results, ambulatory surgery group is more economical than inpatient surgery group with postoperative satisfaction higher than inpatients surgery group with negligible complications.And based on a 5-year experience of authors, day-surgery system in pediatric plastic surgery is safe, effective and in the best interest of a select but significant proportion of children requiring elective operation.

Comparative Effects of Retin-A and Vitamin C on Photoaging Skin

Photoaging skin occurs as a result of long-term exposure to ultraviolet radiation. In contrast to intrinsic aging, skin changes of photoaging can be reversed by the topical use of skin care products. Several skin care products have now undergone sufficient evaluation and have a well-defined role in our practice. Retin-A and alpha hydroxy acids have a significant number of data available for evaluation; data for Vitamin C and antioxidants are still emerging. We conducted clinical trial to compare the anti-photoaging effects of Rein-A and Vitamin C in 25 women volunteers. Each formulation wes applied daily to the randomly assigned hemifaces over the 8-month study period. Comparative evaluations of anti-photoaging effects were made using subject self-appraisal questionnares, plastic surgeon's assessment, ultraviolet revelations, and histologic examinations. Subject self-appraisal and plastic surgeon's assessment showed predominance of Retin-A over Vitamin C. But both Retin-A and Vitamin C provided objective and subjective improvement in photodamaged facial skin and no significant difference was found between Retin-A and Vitamin C in histologic examinations.

Treatment of a Giant Pigmented Nevus using an Alloderm: A Case Report

Because a giant pigmented nevus has the risk of malignant transformation to malignant malanoma, early surgical excision is recommended. There have been various types of surgical methods in a giant pigmented nevus, for example dermabrasion, staged excision, skin graft, local flap and tissue expander. The authors have used an alloderm combined with a very thin split thickness skin graft in the treatment of a giant pigmented nevus. Among the 3 patients we operated in 1999, we could not find a significant cosmetic difference compaired with the conventional split thickness skin graft. Our method with the use of an alloderm combined with a very thin split thickness skin graft would be considerable in the treatment of a giant pigmented nevus, because it shows less visible scars in donor site than conventional split thickness skin graft. Moreover, we could harvest skin graft from the same site twice or more times.

Correction of Facial Soft Tissue Defects Using Acellular Human Dermal Allograft

The augmentation of soft-tissue defects in the facial region is a challenging task for plastic and reconstructive surgeons. Numerous materials, both autologous and nonautologous materials including alloplastic implants, have been used for augmentation of soft-tissue defects of the face. Each has its limitations. There is no ideal material for soft-tissue augmentation. Acellular human dermal allograft (Alloderm, LifeCell Corporation, Woodlands, Texas, U.S.A.) combines the benefits of autografts and allografts. Alloderm does not appear to be resolved, it is a much more cost- effective treatment than fat injection, collagen injection, or other treatments that require multiple surgical operations or repeated application. Using Alloderm eliminates the need for creating a donor site. The authors report its use in 13 patients who have soft-tissue defects in the face. No serious complications such as rejection, absorption, dislocation, or extrusion were encountered. Alloderm appears to be an easily handled, safe material to use as an implant for permanent soft-tissue augmentation. Further long-term tudies are warranted to monitor the persistent volume maintenance of Alloderm.

Correction of facial depression using precisely-shaped silicone implants

We introduce a new silicone implanting method to correct facial depression caused by trauma or congenital anomaly. It resulted in good facial aesthetics in patients with facial depression. From August 1997 to January 1999, 5 patient (3 males and 2 females), in ages from 19 to 34 years, underwent silicone implantation for facial depression using our method. Three males were injured by traffic accident and had facial depression with or without bone defect. Two females had congenital forhead depression and requested aesthetic contouring. An impression of the face was taken with alginate backed with quick setting plaster. When set, a further stone plaster model was taken from the alginate-plaster, which was removed after fixation. Wax was then carved into the patient's stone model to fill the depression. Another stone cover was taken to cover this was-stone model. Then wax was melted away and medical implant grade room temperature vulcanized silicone adhesive was squeezed into the empty space. After cured, this precisely-shaped silicone imlant was inserted into the patient. We did not experience major complicaion such as infection, implant extrusion during 4 to 18 months' follow-up periods. All patients were satisfied with the results. The clinical result of this technique would be useful for accurate and excellent aesthetic implantation.

One-Stage Reanimation of Paralyzed Lips Using Rectus Abdominis Muscle Neurovascular Free Flap

Facial paralysis is a devastating problem, since such a patient can neither make facial expressions nor enjoy an active social relationship. If it persists for a long time, facial muscles will have irreversible changes and deformities. The goal in the treatment of facial paralysis is to achieve a normal appearance at rest and reconstruct a natural, symmetrical smile. One of the most distressing figures in a facial palsy patient is oral deformity. There have been numerous corrective methods of reanimating the paralyzed lips. Recently the one-stage muscle transplantation, innervated by the contralateral facial nerve, has been introduced to solve this distressing problem. From March 1998 to December 1998, 3 patients(2 males and 1 female), who ranged in age from 17 to 33 years, underwent one-stage reanimation surgery of paralyzed lips using rectus abdominis muscle neurovascular free flap. All patients had unilateral facial paralysis caused by tumor resection. The rectus abdominis muscle with long intercostal nerve and pedicle vessels(deep inferior epigastric vessels) was elevated and transferred to the preoperatively designed subcutaneous pocket. The upper end of the muscle was fixed to the zygoma and parotid fascia, and the lower end was fixed to the mouth corner, upper and lower lip. The intercostal nerve was repaired to the non-paralyzed buccal branch of the facial nerve through the subcutaneous tunnel of the upper lip, and the vascular pedicle of the muscle flap was anastomosed to the paralyzed side of the facial vessels. The onset of muscle function was reported in all the patients. Five months after the surgery, nerve conduction study and EMG showed compound motor action potential(CMAP) and motor unit action potential(MUAP) of the transferred muscle respectively. Nine months after the surgery, we observed volitional muscle contraction. The power of contraction increased constantly for 2 years after the surgery.

Lacrimal Gland Adenoid Cystic Carcinoma: Case Report

No abstract available.

Augmentation mammaplasty Using saline filled implant: Clinical experience in 368 cases

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.

Clinical Experience of Middle Ear Disease in Cleft Palate Patients

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.

Septal Cartilage Graft for Nasal Tip

No abstract available.

Free Flap Reconstruction in the Head and Neck Regions: A Review of 40 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With the advent of free flap reconstruction techniques, several free flaps were used for a variety of head and neck defects. The objective of this study was to review our experience during 3-year period in performing 40 microvascular free flaps for head and neck defects. Materials and Method: A review of 40 microvascular free flaps performed in 38 patients between April 1995 through August 1998 was undertaken. Patient's age, sex, stage of disease, types of free flaps, short-term postoperative outcome including the flap success rate, postoperative complications, effect of preoperative irradiation on the development of the wound complications such as fistula were evaluated. RESULTS: 36 (90%) of 40 free flaps were successful with 4 failures resulting from 3 venous thromboses and 1 infection. Emergent reexploration was done in 2 patients, none of whom were successfully salvaged. The postoperative surgical complications including donor site complications and medical complications were seen in 17 flaps (47%) and in 8 flaps (22%), with multiple complications seen in several patients. The preoperative radiotherapy did not affect the incidence of the postoperative surgical complications (p=0.273). CONCLUSION: In review of our experience, we believe that free flap reconstruction in head and neck regions has become a useful procedure with acceptable outcome and complication rates and has surpassed conventional techniques cosmetically and functionally.

Correction of deviated nose using reverse swinging door precedure

There have been so many methods described for the correction of the deviated noses but it is difficult to get satisfactory results and recurrence rate is high. There is no exact explanation why the recurrences are so high and no estabished guides for techniques according to the surgical pathology. We found the classical swinging door technique effective in cases where the caudal septum deviated from the midline. However, where the caudal septum and the tip stay in the midline, scoring or submucosal resection do not work well enough to cortet them. We used the reverse swinging door technique of our own. After elevation of mucoperichonodrium, we did sagittal section in the posterior septum and moved the septum to the midline on the pivot point of the caudal septum and. The gap created in the posterior portion of the septum were filed with bone grafts, cartilage grafts or Medopor, which were sutured to the septum, We did this technique with or without osteotmies in 56 deviated noses for last 5 years. The results were very satisfactory and there was no complication.

Sural Vessels as Recipient Vessels for Free Flap Transfer to the Single Vessel Leg

Free flaps have been widely used in lower leg reconstruction. However, in cases with extensive injury to the vessels as well as to the bone and soft tissues, and having only one intact major vessel in the lower leg(single vessel leg), careful selection of recipient vessels for the free flap transfer is mandatory for preventing further vascular compromise of the distal lower leg. The sural artery and its vena comitantes are frequently protected form externally harmful forces by the bulky surrounding gastrocnemius muscle and can be used as recipient vessles for free flaps without any detrimental influence on the vascularity of the distal lower leg. In our department, three latissimus dorsi muscle free flap were transferred with sural vessels as recipient vessels in the reconstruction of the single vessel legs. Except for one case of flap failure due to serious infection at the microvascular anastomoses site, all the other cases were successfully reconstructed without any necrosis of the gastrocnemius muscle or the distal leg. In addition, the sural vessels were easily accessed in any patient position and their caliber was similar to that of the vascular pedicles of the donor muscle flaps. In conclusion, the sural vessels can be another useful option in selecting recipient vessels for free flap transfer in the reconstruction of the single vessel leg.

Clinical Experience of 95 Cases in Transconjunctival Blepharoplasty

No abstract available.

Clinical and Histological Evaluation of Tattoos Treated with Q-Switched Alexandrite Laser

No abstract available.

Experimental study of survival of arterialized venous flap

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.

Reconstruction of wide and long skin defects using lateral thigh free flap

Plastic surgeons have frequently encountered wide and long skin defects which require flap coverage. These include defects that occur after radical tumor resection of the head and neck region, release of severe bum scar contracture, and defects with exposure of the bone or tendons in upper and lower extremities. Lateral thigh fasciocutaneous flap, first introduced by Baek in 1983, has a long and wide skin territory. By using this flap, we performed 6 cases of burn scar contractures and 2 cases of head and neck cancer defects. In the flap elevation, it is not necessary to change the patient's position, therefore, the two-team approach shortens the operating time. The donor site can be closed primarily if the width of flap is not over 8 cm. The donor scar of the thigh is easily concealed. The lateral thigh flap can also be used as a composite or sensate flap. We conclude that, due to the lateral thigh flap being a thin and pliale fasciocutaneous flap which has a long and wide skin territory, it is very useful for reconstruction of large skin defects.

The importance of the accurate repair of orbicularis oris muscle in the correction of unilateral cleft lip

No abstract available.