Ear Elevation using the Superficial Temporal Fascia Harvested Through Minimal Incision

The superficial temporal fascia is a thin, pliable, well- vascularized flap that is useful in elevation of the reconstructed ear of the microtia. However, the elevation of the superficial temporal fascial flap by conventional T or zigzag incisions in temporal region frequently leaves a conspicuous scar, hair thinning and alopecia. To overcome these problems, we harvested the superficial temporal fascia as a random pattern flap using only a retroauricular skin incision line for the ear elevation. Thereafter, the cartilage framework was elevated including superficial temporal fascia and superficial mastoid fascia underneath: dissection plane was continuous with the superficial temporal fascial flap harvest and dissection was performed just beneath the superficial mastoid fascia under the framework. A carved costal cartilage block was grafted at the posterior wall of the concha and covered with the harvested superficial temporal fascial flap, followed by a full-thickness skin graft. From June 2001 to December 2001, 9 patients (male 8 and female 1), who ranged from 9 to 26 years in age, underwent ear elevation using this method. The skin grafts was successful and the appropriate auriculocephalic angle was preserved in all cases. We did not find any complications such as infection, graft loss or cartilage extrusion in the 3 to 9 months follow-up period and the patients were satisfied with their cosmetic results. This method was easy to perform and did not leave any other scar in the temporal hear-bearing area and the results have been favorable.

Psychological Characteristics and Changes after the Tattoo Removal

Tattooing has been practised since pre-Christian times, as an object of both fascination and revulsion. In the Present day, body tattoo has been a flourishing and contemporary teen issue. Adolescents have discovered tattoos as a means of self-expression. Due to the external characteristics of the tattoo however, a lot of researchers have shown their interest and done various researches. The examination of the psychological characteristics of the tattooed people revealed that a lot of people have psychological problems, the tattoos revealing the person's deviated image. As a result, several attempts have been made to try and correlate tattoos with the psychiatric diagnoses such as schizophrenia or personality disorder, or with adverse social circumstances such as poverty. The subject of tattoo removal is as old as the history of tattooing itself. Plastic surgeons have witnessed numerous tragic instances where a tattoo has caused hardship, including diminished employment prospects, even loss of love and affection from family and friends and, very commonly, loss of self-esteem. For this reason, the bearers of tattoo often consider the inevitable scarring left by tattoo removal as a preferable alternative. Past techniques of removing tattoos, using corrosive agents or skin graft, have been universally unsuccessful, or certainly less than satisfactory. But, currently laser therapy has been introduced into the market to remove tattoos. As a result, a lot of people have visited hospitals to get tattoos removed. In addition, many of those who had tried to hide the fact that they had tattoos, have been given the opportunity to express their feelings, and rate their psychological statements. This research enables to find the best approach to the person's psychiatric point of view, by objectively observing the person's psychological characteristics and psychological changes after the tattoo removal.

Preoperative Nasal Molding and Unilateral Cleft Lip Repair By Mohler'S Technique

Various techniques of unilateral cleft lip repair are being developed. Nowadays, rotation-advancement flap technique is most widely used for the repair of unilateral cleft lip. This procedure places a premium on the conservation of tissue and preservation of natural landmarks. Millard's technique however occasionally can produce a scar that crosses the philtrum obliquely in the upper third of the philtral unit. In Mohler's technique, the marking of the medial segment has been altered in uppermost portion by utilizing tissue from the columellar base. That is to say, cutback on columellar tissue is utilized at approximately 90 degrees. After full-thickness release of the medial lip segment, the C flap is advanced into donor defect of the columellar base and is also used to lengthen the shortened columella. This results in the placement of a scar that will simulate the mirror image of the non-involved phitral column. And another advantage of this technique is the possibility of primary nasal correction including wide dissection of alar cartilage through cutback incision on columellar base without need of additional incision for nasal dissection. In addition, preoperative nasal molding was performed with a special NAM(nasoalveolar molding) appliance by orthodontist during preoperative period. The authors performed 27 cases of the correction of the unilateral cleft lip using this technique between July 2000 and December 2001. All the patients showed satisfactory results by achieving enough rotation of medial lip segment without scar that crosses the philtral column and satisfactory correction of primary nasal deformity.

Experimental Analysis of Skin Regeneration after Ablation of Ultrapulse and Clearpulse Laser

Lasers are used increasingly in the surgical field. As far as plastic surgery is concerned, CO2 lasers are the most frequently used lasers especially in removing superficial skin lesions. But the traditional continuous mode CO2 lasers causes thermal injury in the surrounding tissues by heat diffusion, thus preventing the widespread clinical use. However, CO2 lasers of the continuous mode are being replaced by pulsed type, which emit high-energy pulse in a short period of time. Keeping the pulse length below the thermal relaxation time, these pulsed CO2 lasers vaporize tissues with less thermal injuries in the surrounding tissues. We irradiated Clearpulse and Ultrapulse lasers on the back of two swine models, Seven spots with 3 mm diameter were measured. We observed the histological changes of injuries and regeneration, and analyzed the depth of the thermal injury and the thickness of the regenerating epidermis quantitatively with image analyzer according to the time sequence(immediate, 1 day, 3 days, 1 week, 2 weeks, 3 weeks, 4weeks). In Clearpulse group, there was epidermolysis and the depth of thermal injury was 432 +/- 12.7micrometer, whereas in Ultrapulse group, the epidermis showed just coagulation necrosis and the depth of thermal injury was measured as 217 +/- 8.7micrometer. Clearpulse group showed the healing pattem of dermis, while Ultrapulse group showed the healing pattern of epidermis. That means Ultrapulse group is superior to Clearpulse group considering healing time. But all specimens obtained the complete healing of skin around 4th week after ablation.

Ear elevation using mastoid fascia flap and silicone block

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.

Simple method of tie-over dressing

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