ABSTRACT
We experienced satisfactory outcomes by synchronously transplanting an artery and vein using an anterolateral thigh flap pedicle between the vascular pedicle and recipient vessel of a flap for scalp reconstruction. A 45-year-old man developed a subdural hemorrhage due to a fall injury. In this patient, the right temporal cranium was missing and the patient had 4x3 cm and 6x5 cm scalp defects. We planned a scalp reconstruction using a latissimus dorsi free flap. Intraoperatively, there was a severe injury to the right superficial temporal vessel because of previous neurosurgical operations. A 15 cm long pedicle defect was needed to reach the recipient facial vessels. For the vascular graft, the descending branch of the lateral circumflex femoral artery and two venae comitantes were harvested. The flap survived well and the skin graft was successful with no notable complications. When an interposition graft is needed in the reconstruction of the head and neck region for which mobility is mandatory to a greater extent, a sufficient length of graft from an anterolateral flap pedicle could easily be harvested. Thus, this could contribute to not only resolving the disadvantages of a venous graft but also to successfully performing a vascular anastomosis.
Subject(s)
Humans , Middle Aged , Arteries , Femoral Artery , Free Tissue Flaps , Glycosaminoglycans , Head , Hematoma, Subdural , Neck , Scalp , Skin , Skull , Thigh , Transplants , Vascular Grafting , VeinsABSTRACT
Nowadays, nonincisional double eyelid operation is preferred by lots of patients and surgeons. There are a variety of suture methods but all the suture procedures-including continuous buried suture methods-in the literatures penetrate the conjunctivas. So due to the pain, surgeons had to infiltrate local analgesics into the conjunctiva. This horrifies the patients, gives pain, makes the eyelids and conjunctivas swollen, and sometimes interrupts the movements of the eyelids by affecting the levator palpabrae muscles. This condition could make the eyelid folds asymmetric. Authors changed the procedure by using a chalazion forcep with a small slit which allows the suture materials to get out and we could successfully perform the suture without penetrating the conjunctiva. So we could make double folds maintaining the patient's dynamic and static conditions very well since no direct local analgesics were needed for the conjunctivas, and the results were pretty satisfactory.
Subject(s)
Humans , Analgesics , Chalazion , Conjunctiva , Eyelids , Muscles , Surgical Instruments , SuturesABSTRACT
The callotasis is widely used in lengthening of bones without bone graft. We thought that the accompanying vessels is critical in the viability of distal tissue to the lengthened area and has an important effect on the bone-lenthening itself. So we made an assumption that the accompanying vessels is adapted to the lengthening via neogenesis more than simple physical stretching. At this, we placed a pair of small external fixator in the left tibiae of ten Spraugue-Dawley rats and made an osteotomies. At two weeks after 25% lengthening, vessels of both lengthened and unlengthened side was harvested and five sections from each vessels were stained with BrdU immunohistochemical staining. We investigated the DNA synthesis counting the number of BrdU labeled cells. The number of BrdU labeled cells is significantly increased in the lenthened side arteries(p<0.0001). The synthesis of DNA was significantly increased in the center rather than the ends (p<0.0001). And there was no difference between the number of the BrdU labeled cells of proximal part and that of distal parts(p=0.316). It means that the accompanying vessles in the distraction-lengthening are adapted to the lengthening not only by just physical stretching but also by neogenesis of vascular cells.
Subject(s)
Animals , Rats , Bromodeoxyuridine , DNA , External Fixators , Immunohistochemistry , Osteogenesis, Distraction , Osteotomy , Rats, Sprague-Dawley , Tibia , TransplantsABSTRACT
Along with aural atresia, abnormalities of the middle ear and external ear canal can impede the audition of the developing infant. In cases of bilateral atresia when bone-conduction aids fail to adequately restore impaired hearing, unilateral canal reconstruction may be required at a very early age to enable proper speech and language development. We are often confronted by cases in which canaloplasty has previously been performed by ENT surgeons, leaving auricular canals of various locations and sizes in addition to scars. In such cases, it can be difficult to prepare a skin flap sufficient in size to cover the cartilagenous framework for auricular reconstruction. Scar tissues with relatively poor vascularity induced by a prior incision and elevation of the soft tissue may compromise the ultimate result of auricular reconstruction. To obtain the sufficient, thin, pliable and well vascularized skin, we used tissue expansion at the first stage of the auricle reconstruction in microtia patients who previously received canaloplaty. From December, 1988 to February, 1999, we attempted tissue expansion using volume 35cc, cresent- type inflatable silicone expanders(SebbinR) in 12 patients who previously received canaloplasty. Ear frameworks were prepared using autologous rib cartilage. The expanded skin provided sufficient, thin, pliable, and well vascularized skin for easy draping and better contouring. The reconstructed auricle was satisfactory in both color and texture and had nearly normal sensation. No resorption of the inserted rib cartilage has been observed from 7 months to 9 years and 9 months after the operation.
Subject(s)
Humans , Infant , Cartilage , Cicatrix , Ear , Ear Canal , Ear, Middle , Hearing , Language Development , Ribs , Sensation , Silicones , Skin , Tissue Expansion , Tissue Expansion Devices , TransplantsABSTRACT
Secondary bone grafting of the maxilla in the mixed transitional dentition stage has become a well accepted procedure in the surgical protocol for rehabilitation of patients with residual alveolar clefts. In our retrospective study we documented the excellent long term results obtained with iliac bone graft. For closure of alveolar cleft authors used combined corticocancellous bone of ilium with fibrin sealant on 54 children patients since 1994. The mean age of bone grafted patients was 6 years old. All patients were followed up from 6 to 48 months. Following exact assessment of the amount of bony defect was carried out through clinical and radiologic study including 3 demensional CT, sufficient amount of corticocancellous iliac bone onlay graft along the piriform aperture in addition to cancellous component inlay graft was carried out. Tooth eruption rate obtained from our method was 100%. In our studies, we experienced excellent results in terms of cleft closure, tooth eruption, bone incorporation and external nasal appearance.
Subject(s)
Child , Humans , Bone Transplantation , Dentition, Mixed , Fibrin Tissue Adhesive , Fibrin , Ilium , Inlays , Maxilla , Rehabilitation , Retrospective Studies , Tooth Eruption , TransplantsABSTRACT
Extensive clinical research has demonstrated that the 585-nm pulsed dye laser(PDL) is effective in eradicating port-wine stains(PWS) and telangiectasia with an extremely low incidence of scarring. The successful treatment of laser therapy is based on selective photothermolysis of blood vessels without damaging the normal overlying epidermis. Unfortunately, the native epidermal melanin acts as an optical shield that absorbs the laser light and reduces the heat generated in blood vessels. When melanin absorbs laser light, the resultant temperature increase can induce epidermal blistering. In these patients, the laser treatment dosages must be kept low, often subtherapeutic, to avoid damage to the epidermis and to prevent the possibility of scarring. Cryogen spray cooling of skin may be an effective method for minimizing epidermal thermal injury. The objective of this study is to determine histologically the effectiveness of the cryogen cooling by spraying the skin with a brief spurt of cryogen prior to the laser pulse, so as to reduce epidermal damage (hypo/hyperpigmentation) caused by this laser. We present a histologic study of the thermal response of the skin of the Sprague-Dawley rats to spray cooling in conjunction with 585-nm pulsed dye laser irradiation with 6J/cm. Both treatment sites with and without the use of the cryogen spray were compared. Under light microscope, the epidermal and dermal histologic changes were compared. A significant reduction in epidermal damage was found in study groups using the cryogen cooling without changing the efficacy of the laser treatment statistically. And a significant reduction in healing periods was observed in study groups using the cryogen cooling prior to the laser pulse. This study suggests that cryogen cooling can reduce epidermal damage during PWS treatment with the 585-nm PDL without reducing treatment efficacy. The absence of epidermal damage suggests that precooling with the cryogen may allow the use of higher laser input to expedite clearance without inducing epidermal change.
Subject(s)
Humans , Blister , Blood Vessels , Cicatrix , Epidermis , Hot Temperature , Incidence , Laser Therapy , Lasers, Dye , Melanins , Port-Wine Stain , Rats, Sprague-Dawley , Skin , Telangiectasis , Treatment OutcomeABSTRACT
Furlow's palatoplasty has been used as the primary treatment for cleft palate. From 1991 to 1999, 24 submucous cleft palate patients underwent Furlow's palatoplasty. The follow-up period was 3 months to 8 years (mean 24 months). Patients were selected after a thorough study for velopharyngeal insufficiency including intraoral examinatioin, speech assessment, digital subtraction radiography (DSR). Postoperatively velopharyngeal function was reevaluated with speech assessment and digital subtraction radiography in the 7 cooperative patients. Speech parameters including hypernasality, nasal emission, and Allison scale were improved after surgery. Digital subtraction radiography provided the value of velopharyngeal gap and the degree of the motion of lateral pharyngeal wall, both of which were improved after surgery. Furlows palatoplasty has advantage such as no impairment of nasopharyngeal physiology, no hannful effect on the hard palate and the realignment of the levator muscle which plays important role on the movement of the soft palate. The results show that a Furlow's palatoplasty can satisfactorily correct velopharyngeal insufficiency in carefully selected submucous cleft palate patients.
Subject(s)
Humans , Cleft Palate , Follow-Up Studies , Palate, Hard , Palate, Soft , Physiology , Radiography , Velopharyngeal InsufficiencyABSTRACT
A notching deformity of the vermilion is one of the most common secondary lip deformities following unilateral cleft lip repair. It is due to inadequate approximation of the orbicularis marginalis muscle, vertical scar contracture, and inappropriate adjustment and suturing of the vermilion. During the primary repair, symmetric construction of vermilion is difficult. This is because the thickness and shape of the vermilion is different on both sides of the cleft. To prevent notching deformity of the vermilion, authors designed the incision line such as Tongue-in-Groove on the vermilion and has been utilizing this technique for the last several years and obtained quite satisfactory results. Hereby we present the technique and result.
Subject(s)
Cicatrix , Cleft Lip , Congenital Abnormalities , Contracture , LipABSTRACT
Many operative techniques for the repair of cleft lip nasal deformities have been reported. However, the situation with regard to nasal deformity is less satisfactorily understood than lip deformity, in which we have experienced significant improvement led by enhanced understanding of the total anatomic deformity of the primary cleft lip and the consequent refinement of surgical techniques. Our purposes in tip plasty are the restoration of nasal tip symmetry and correction of the obtuse angle of the cleft side nostril. Additionally, an inconspicuous scar is one of the merits of our method. The alar cartilage war exposed through both the alar rim and transcolumella incision, and then interalar loose connective tissue based superiorly was dissected and elevated. Cleft side alar cartilage was cross-hatched(Lipsett technique) on the deformed dome and relocated superomedially by a 4-0 vicryl fixation suture. The elevated intera1ar loose areolar tissue was used for augmentation of the alar dome. Conchal cartilage graft on cleft side dome and septoplasty were carried out in cases of specific necessity. We have performed this procedure in 19 patients, aged between 15 to 19. Average follow-up period was one year. Results have been rated good to excellent by patients and surgeons. There has been no recurrence of this deformity.
Subject(s)
Humans , Cartilage , Cicatrix , Cleft Lip , Congenital Abnormalities , Connective Tissue , Follow-Up Studies , Lip , Polyglactin 910 , Recurrence , Sutures , TransplantsABSTRACT
During the last 10 years, we have experienced 169 cases of congenital melanocytic nevi of the face at Seoul National University Children's Hospital. In these patients, various modalities of treatment have been used, including excision, staged excision, skin graft, local flap, and composite graft. Dermabrasion, electrocoagulation, and laser therapy were excluded because these were not definitive treatments. We reviewed over 169 cases based on the involved on the aesthetic units of the face and the length of the defect perpendicular to wrinkle lines. We have attempted to create a stadard for the selection of the appropriate treatment modality. Cases which involved orbital unit(38 cases), cheek(30 cases), and parotid-masseteric unit(18 cases) were analysed statistically. To avoid the statistical error, units of sufficient number of cases and involving only one unit were included. In each unit, we used Receiver Operator Characteristic Method to identify the turning points of the length of the defect perpendicular RSTL which decided the treatment modality. And we used t-test to show the statistical difference between the lengths of the defect perpendicular to RTSL in each modality. The turning point were 0.9-1.0 cm between excision/staged excision, 2.0 cm between staged excision/FTSG, in orbital unit, 1.3 cm between excision/staged excision in cheek unit, 1.6-1.9 cm between excision/staged excision in parotid-masseteric unit. And it was identified by ANOVA test and t-test that the above groups were statistically different. Till now, the treatment modality of the congenital melanocytic nevus was based on the experiences of the surgeon. But now, we have presented the stadard of the treatment according to the size in each aesthetic unit. Therefore we can choose the approproate treatment modality among the severals in accordance with the standards.
Subject(s)
Child , Humans , Cheek , Dermabrasion , Electrocoagulation , Laser Therapy , Nevus, Pigmented , Orbit , Seoul , Skin , TransplantsABSTRACT
Skin graft has been widely used for facial skin reconstruction. Inguinal area is the common donor site for full-thickness skin graft of various area. Especially for facial skin graft, retroauricular area or upper eyelid skin has been used as a donor site. But these donor sites have some limitations as perfect ones in terms of size, color and texture when applied onto facial area. Even retroauricular skin shows color and texture differences from normal facial skin after it is grafted. Authors performed expansion of the skin of preauricular area or forehead where minimal scars would come out after final operation. We harvested this expanded skin and performed skin graft following excision of nevus, poor scar, or hemangioma in face.We achieved satisfactory results in terms of color and texture by applying this method in 11 clinical cases; 4 cases of hemangioma, 4 nevus, and 3 cases of traumatic scar. Donor site scars were clinically inspicuous in all these 11 cases.
Subject(s)
Humans , Cicatrix , Eyelids , Forehead , Hemangioma , Nevus , Skin , Tissue Donors , TransplantsABSTRACT
BACKGROUND: The Central nervous system(CNS) plays a essential role in mediating~stress responses. However, the enact mechanism of the CNS in mediating stress responses has not been clarified sufficiently as yet. Stress may cause brain dysfunction including cognitive dysfunction which was most commonly found in Alzheimer's dementia. Amyloid precursor protein(APP) is a large, ubiquitously distributed and evolutionarily conserved molecule whose function remains unknown. Although the precise function of APP following injury to the CNS such as stab and kainic acid lesion. However, there have not been reports on the effects of stress on the expression of amyloid precursor protein in the brain. This study was undertaken to elucidate the effects of stress on the expression of APP in the mouse brain. METHODS: The several brain region was isolated from the mouse that was in the immoblization stress for 30 min, 1 hour, and 2 hours. The mouse brain was divided into 5 regions, cerebral cortex, cerebellum hippocampus, midbrain and thalamus, corpus striatum and brain stem. The change of mRNA was examined in the several brain regions using Northern blot hybridization. RESULTS: The amounts of APP mRNA in the cerebral cortex, hippocampus and brain stem were found to be significantly increased after stress for 30 minutes and to 1.each a maximum after stress for 1 hour and to normal range at stress for 2 hours. On the contray, the contents of APP mRNA in midbrain and thalamus were decreased after stress for 30 minutes and sustained after stress for 2 hours. CONCLUSION: These findings suggest that APP may not be static but functional protein reactive to stress and stress may increase the levels of APP mRNA especially in Alzheimer disease associated sites such as cerebral cortex and hippocampus, which may contriute to the pathogenesis of Alzheimer disease.
Subject(s)
Animals , Mice , Alzheimer Disease , Amyloid , Blotting, Northern , Brain Stem , Brain , Cerebellum , Cerebral Cortex , Corpus Striatum , Dementia , Hippocampus , Immobilization , Kainic Acid , Mesencephalon , Negotiating , Reference Values , RNA, Messenger , ThalamusABSTRACT
It Is generally accepted that autografts of bone are superior to any other types of bone graft. But this technique may be hampered by the size of the bone defect and requires additional surgical procedure, therefore results in increased risk of infection and morbidity. Recently, there is increasing interest in autogenous bone substitute and biomaterials which being extensively investigated: coral, ceramic implants and xenograft can be used as bone substitutes. Some authors have reported successful results using bovine cancellous bone graft in experimental and clinical studies. Authors experienced 15 cases augmentation of cleft lip nose deformity of hypoplastic pyriform rim and maxillary alveolus by using Lubboc(R)(purified bovine cancellous bone matrix) including 3 failure cases of autogenous bone graft. The patient's follow-up period ranged from 4 months to 30 months. In our series, we found no adverse immune reaction and experienced favorable aesthetic results in augmentation of alar base with maintenence of considerable volume and stability. Through long term follow-up, this new purified bovine cancellous bone can be a reliable bone substitute in the treatment of minor bone defect.