Analysis of Cleft Lip Nose Deformities Correction in Adults: Detailed Techniques and Comprehensive Review

PURPOSE: Correction of cleft lip nose deformity(CLND) in adulthood is different from one in childhood. Usually correction of CLND is final surgery for adult patient who has cleft lip, so many things have to be considered for correction. Of course, it is different from common rhinoplasty, either. The adult patients can be corrected by complete rhinoplasty with various techniques. To recognize how rhinoplasty techniques was used for correction of CLND, authors analyzed detailed techniques which were selected in the adult patients for 10 years and reviewed comprehensive operation. METHODS: A retrospective review was conducted involving 64 patients with CLND who underwent surgery and aged after 14 years at operation between 2001 and 2010. Detailed techniques were investigated by medical record review and classified according to incision, septoplasty, osteotomies, correction of vault, tip plasty and etc. RESULTS: Except one, all patients were performed open rhinoplasty. 49 patients were performed septoplasty. 33 patients were performed complete rhinoplasty with osteotomies. Hump nose correction was performed for 10 patients. Dorsal augmentation was performed for 8 patients. And all patients were performed tip plasty. Tip plasty using suture technique was performed for 58 patients and graft was performed for 48 patients. CONCLUSION: Correction of CLND in adult is one of the most challenging and varied operation of plastic surgery. In this study, the majority of patients were performed complicated and delicated procedures. It seems to be because patient's demand level has been elevated and rhinoplasty procedures have been advanced. This study may help to planning of CLND correction.

A Retrospective Analysis of Six Cases of Angiosarcoma

PURPOSE: Angiosarcoma is a rare and aggressive malignant soft tissue tumor. Due to a lack of the established optimal treatment modalities, however, an extensive resection followed by an early detection has been reported to be the best treatment of choice. We analyzed the clinical course of six patients, hence attempted to contribute to making a treatment plan for patients with angiosarcoma. METHODS: Six patients who have been surgically treated between 2005 and 2010 are included. Through a retrospective analysis of the medical records, we evaluated the pattern of disease detection, a past history, time span between the detection and the primary surgery, surgical treatment modalities, time span between the primary surgery and the recurrence/metastasis, the sites of metastasis and the secondary treatment modalities. RESULTS: The mean age of patients was 70.5 years; all male; and the sites were the scalp. Four patients underwent the reconstruction using a local flap with a skin graft and two patients using a free flap. The mean period elapsed until the primary operation since the identification was 7.3 months and until a recurrence or a metastasis occurred following the primary operation was 12 months. Four patients had pulmonary metastasis. As a secondary therapy, four patients underwent the radiotherapy and one was treated with the chemotherapy. At the present, five patients died and one undergoes a monitoring of the clinical course. CONCLUSION: It would be mandatory to shorten the length of hospital stay and to return patients to their daily lives as the earliest as possible using relatively simpler surgical methods, thus attempting to give them opportunity to resume their previous normal life.

The Result and Attentiveness of Reconstructive Surgery by Anterolateral Thigh Perforator Free Flap

PURPOSE: Anterolateral thigh(ALT) perforator free flap is commonly used because of its various benefits. The author reports important factors of preoperative and perioperative ALT perforator free flap and causes of failure. METHODS: 84 patients who were treated with ALT perforator free flap from December 2004 to 2008, and February 2010 to April 2010 were studied. 61 patients were male and 23 were female. The mean age of patients was 51.1. The main cause was neoplasm and the main reconstructive areas were head and neck area. The size of flap was various from 3 x 4 to 12 x 18cm. 6 patients received split thickness skin graft at donor site. Preoperative angiography was checked to all patients. RESULTS: Among the 84 patients, partial necrosis of flaps occurred in 4 patients because of atherosclerosis, varicose vein, or inattention of patient, etc. And total flap necrosis in 5 patients because of abnormal vessels of recipient area or delay of operation, etc. One case of serous cyst was found as the complication of donor area. Two cases of skin graft on donor site were done because of suspected muscle compartment syndrome, 4 cases of that because of large flap. Septocutaneous perforators were found in 7 cases. The author couldn't find reliable perforator in 3 cases, ipsilateral anteromedial thigh perforator and contralateral ALT perforator and latissimus dorsi musculocutaneous free flap were done instead of ALT. There was no case which needed reoperation because of the impairment of blood supply, and 3 cases were revised by leech because of the burn injury by a lamp or venous congestion. CONCLUSION: Although ALT perforator free flap is widely used with its various merits, many factors such as preoperative condition of donor or recipient area, morphology of defect and operating time need to consider to prevent flap necrosis. And operators should need careful technique because septocutaneous perforator is uncommon, and musculocutaneous perforator is common but difficult to dissect.

The Effect of Sphingosine-1-Phosphate in Survival of Grafted Fat Tissues

PURPOSE: Autologous fat grafting is a popular procedure for the correction of the soft tissue depression and deformity. But there are several issues required to be carefully considered in relation to this procedure, mainly about the unpredictability and the low survival rate of the grafted fat due to absorption and partial necrosis. Sphingosine-1-phosphate (S1P) is a lysophospholipid mediator that has been proposed to promote angiogenesis and to regulate the differentiation of adipose derived stromal cells (ASCs). In this study, we analyzed the viability of the grafted fat tissue mixed with S1P into each 12 nude mice (cann.cg-fox1nu/crlori) compared to the group of mice grafted fat tissue only. METHODS: Human aspirated fat was grafted subcutaneously into the backs of 8-week-old nude mice with or without S1P. Eight weeks later, the grafted fat was harvested and the weight and volume were checked. The fat was stained with hematoxylin-eosin and 4',6-diamidino-2-phenylindole. RESULTS: S1P group weighed significantly more than the control group (p=0.009), and the volume from the S1P group was considerably larger than that of the control group (p=0.004) either. In histological features, the surviving layer of the S1P group was thicker than the control group and microvasculature appeared to be prominent in the S1P group, especially in the outer layers. CONCLUSION: These findings suggest that S1P plays a vital role in the soft tissue augmentation, potentially providing a novel point of the control in adipose tissue for microfat graft.

Correction of Gynecomastia by Subcutaneous Mastectomy through "Zigzag" Wavy-Line Periareolar Incision with Liposuction

Nowadays, several surgical options are available for correction of gynecomastia. The present authors combined subcutaneous mastectomy with liposuction and analyzed the postoperative results to find out an effective surgical method with few complications and good cosmetic result. From January, 2000 to October, 2008, 22 patients(41 breasts) underwent subcutaneous mastectomy through "Zigzag" wavy-line periareolar incision, and liposuction was done on peripheral region through the same approach site. The results were evaluated in terms of postoperative complications, character of the scar on periareolar region and subjective satisfaction of patients. Three patients(7.3%) experienced complicated with hematoma, however, all of them were healed by simple removal and compressive dressing without leaving any problem. Most of the patients were tolerable with operative scar on periareolar region, however, hypertrophic scar developed in 1 patient(2.4%) and regular follow-up with intralesional triamcinolone injection is now in progress. On the period of over 6 months, all of the patients were satisfied with postoperative contour of their breasts. By subcutaneous mastectomy with peripheral liposuction through "Zigzag" wavy-line periareolar incision for correction of gynecomastia, it was possible to excise sufficient volume of breast tissue with minimum postoperative scar and complications.

Correction of High Fold without Skin Excision

PURPOSE: Double-eyelid operation is one of the most common cosmetic operations among Korean patients. In such operations, however, the complexity of and individual differences in the patients' anatomical structures may cause various complications, such as asymmetry, retraction of the eyelid, and the occurrence of a high fold. A high fold occurs frequently, and its correction is not very simple. Many methods have been developed to correct it, and among these, the operation involving the excision of the skin between the previous double-eyelid line and the new double-eyelid line is usually selected by plastic surgeons. In many cases, however, patients have insufficient eyelid skins for this operation. In this study, the authors introduce an operation procedure for high-fold correction that does not involve skin excision METHODS: From June 2005 to June 2009, 246 cases were treated with this procedure. After the incision of the new double-eyelid line, dissection was done between the previous scar tissue and the levator aponeurosis. Then the orbital septum, orbital fat or the retro-orbicularis oculi fat was slid down and sutured with a tarsal plate. Such sutures were repeated at four to five points, including the lateral and medial limbus, to prevent the reattachment of the previous scar and to create a new double-eyelid line at the end of the orbital septum. RESULTS: Most of the high-fold patients were satisfied with the procedure described above. Their previous scar was hidden under the new double-eyelid line after the operation. In the six cases, the scar was visible in the patients who had a very high and deep inner line. As such, scar revision was undertaken three months after the operation. It is known that scar revision is also required after an operation involving skin excision in the case of a very high inner-eyelid line. CONCLUSION: This method is an appropriate procedure for high-fold correction for patients who have insufficient upper-eyelid skin.

The Correction of Clinodactyly on Thumb by Bone Graft from Deformed Metacarpal Region-Previous Correction of Polydactyly: Case Report

Clinodactyly is defined as an angulation of a digit in the radio-ulnar plane. This anomaly can be congenital, dominantly inherited, or acquired due to trauma or inflammation. Although the deformity usually causes little functional impairment, correction is made because of cosmetic problems. Male subject, with polydactyly on thumb(Wassel's type VII) received first surgery at the age of one. And at the age of six, abnormal growth on the radial side of the first metacarpal bone and ulnar deviation of the distal phalanx of the thumb at the interphalangeal joint had developed. The authors used the growing bony segment from the first metacarpal bone as a bone graft for the correction of clinodactyly on thumb. Z-plasty incision was made on the concave(ulnar) side of thumb and a wedge osteotomy was made on the distal phalanx. The bone graft was inserted into the gap of the distal phalanx of the thumb and fixed it with K-wires. Deformity of the metacarpal bone and clinodactyly on thumb was corrected effectively without donor site morbidity with noticible growth of the grafted metacarpal bone 12 months after surgery.

Simultaneous Reduction Mammoplasty with Excision of Benign Tumor

The purpose of study was to retrospectively assess the possibility of simultaneous breast reduction and tumor excision in women with benign tumor and mammary hyperplasia. Performance status of the patient, appropriate operation technique and postoperative results were analyzed. Evaluation was made regarding four patients who underwent simultaneous breast reduction and tumor excision with more than 6 months follow up. The types and locations of the tumor, corresponding operation technique, postoperative complication such as flap necrosis, subjective alteration in sensorium around the nipple-areolar complex and esthetic satisfaction were assessed. Preoperative radiologic examinations, histologic findings of the fine needle aspiration, and postoperative biopsy were equivalent. The histologic types revealed were tubular adenoma, leiomyoma and lipoma(2 cases). The tumor was each located in lower lateral quadrant, subpectoral, inframammary fold, and upper lateral quadrant of breast, respectively. Regarding the location of tumor and status of mammary hyperplasia, each breast reduction was done with superior, inferior and medial pedicle(2 cases). There were no postoperative complications and esthetic satisfaction rate was high in all patients. When accurate diagnosis based on preoperative radiologic and histologic evaluation and appropriate selection of operative technique were done, simultaneous breast reduction with excision of benign tumor showed satisfying outcome without postoperative complication even along with esthetic satisfaction.

Reconstructive Considerations in Webster's Modification of Bernard Operation after Wide Excision of Squamous Cell Carcinoma on Lower Lip

Reconstruction of the lower lip requires consideration of several factors. There should be retained sensation, maintenance of oral sphincter function, and a large enough opening for the mouth. In addition, it is important to achieve an aesthetically acceptable appearance. Webster's modification of Bernard operation is one of good methods which satisfy above mentioned goals. The purpose of this article is to present the results and review the perioperative problems after reconstruction of the lower lip by this operation. We reviewed seven patients after surgical reconstruction by the same method between January of 1996 and December of 2003. Five patients were male and two were female. The mean follow-up period was 15 months. We obtained functionally and cosmetically acceptable appearance after reconstruction. Most of the reconstructed lower lips were large enough for full mouth opening, but one patient required additional commissuroplasty, and one other patient was treated with wound revision for dehiscence resulting from protrusion of mandibular lateral incisor tooth. All other patients accepted their facial appearance. In conclusion, careful planning and consideration for dental problems and proper closure tension may ensure satisfactory outcome & lower lip competence, when using this modified operative method for lower lip reconstruction.

A Clinical Analysis of the Anatomy of the Superficial Temporal Vessels

The anatomy and distribution of the superficial temporal vessels are known to follow regular patterns, with few exceptions in previous studies. But these previous studies of the anatomy and distribution of the superficial temporal vessels were based, only on the cadaver studies. Authors evaluated the anatomy of these vessels in the operative field of the living body from December 1997 to June 2001, The superficial temporal vessels were surgically exposed from the zygomatic arch extending to the superior temporal line through a preauricular incision in 18 patients(20 cases), who underwent reconstructive surgery using these vessels in the operative field. The authors measured and analyzed; the distribution, branching and diameters of the superficial temporal vessels. The results were obtained as follows; 1.In 19 cases, STV(superficial temporal vein) runs posterior to STA(superficial temporal artery) at the upper border of the zygomatic arch. 2.There was no frontal or parietal branches in 2 cases and vena comitante existed along with STA in one case. 3.The external diameter of STA and STV was measured at the lower border of the zygomatic arch. The external diameter of STA ranged from 1.5mm to 3.0 mm(average 2.1mm) and those of STV ranged from 1.3mm to 3.5mm (average 2.0mm). This study can be helpful in the reconstructive surgery using the superficial temporal vessels, for the results of our study are based on the true anatomy of the living body.