A Case of Primary Mucinous Eccrine Carcinoma in the Lower Eyelid Skin

Primary mucinous eccrine carcinoma(MEC) of the skin, one of sweat gland tumor, is a rare. These tumors usually occur in one's fifties and seventies, and are characterized by the secretion of mucin that usually forms the pools surrounding the clusters of tumor cells. The common sites are the eyelids and medial canthus. Pathologically it is difficult to distinguish between primary mucionus carcinoma and metastatic cancers from breast, rectum, colon, bronchus, kidney, ovary, stomach, lacrimal glands, salivary glands, and paranasal sinuses. Therefore study for primary focus is needed. A 62-year-old mand has had a mass on left lower eyelid skin without palpable neck lymph nodes for about five years. In a fine needle aspiration, there were tumor cells floating in a mucin pool. The authors examined several tests including complete blood cell count, liver function test, renal function test, urinalysis, electrocardiography, VDRL, TPHA-S, chest X-ray, chest computed tomography(CT), neck CT, abdominopelvic CT, etc. All the tests showed the origin was the skin. It is diagnosed to primary MEC on skin. The tumor was treated by wide excision with 0.5cm in safe margin and full thickness skin graft was done. There has been no recurrence 10 months after operation.

The Comparative Study between PLGA and Chitosan Scaffolds for Cartilage Tissue Engineering

Clinical application of the cartilage formed by tissue engineering is of no practical use due to the failure of long-term structural integrity maintenance. One of the important factors for integrity maintenance is the biomaterial for a scaffold. The purpose of this study is to evaluate the difference between polylactic-co-glycolic acids (PLGA) and chitosan as scaffolds. Human auricular chondrocytes were isolated, cultured, and seeded on the scaffolds, which were implanted in the back of nude mice. Eight animals were sacrificed at 4, 8, 12, 16, and 24 weeks after implantation respectively. In gross examination and histological findings, the volume of chondrocyte-PLGA complexes was decreased rapidly. The volume of chondrocyte-chitosan complexes was well maintained with a slow decrease rate. The expression of type II collagen protein detected by immunohistochemistry and western blots became weaker with time in the chondrocyte-PLGA complexes. However, the expression in the chondrocyte-chitosan complexes was strong for the whole period. Collagen type II gene expressions using RT-PCR showed a similar pattern. In conclusion, these results suggest that chitosan is a superior scaffold in cartilage tissue engineering in terms of structural integrity maintenance. It is expected that chitosan scaffold may become one of the most useful scaffolds for cartilage tissue engineering.

The Bone Regenerative Effect of Calcium Sulfate- chitosan Complex Powder and Chitosan Microsphere Encapsulating Growth Hormone on Bone Formation in Bone Defect of Rabbits

This study was carried out on 32 New Zealand white rabbits, each weighing 3-3.5kg. Eight rabbits were allocated into each of four groups. The groups were a control group(I), hyaluronic acid group(II), chitosan microsphere encapsulating growth hormone group(III), calcium sulfate-chitosan powder group(IV). After a 1cm sized ostectomy was made on the tibial body with the periosteum preserved, artificial bone substitutes were implanted. Except group I, 1ml of hyaluronic acid were implanted in group II, 1ml of chitosan microsphere encapsulating growth hormone in group III, 1ml of manufactured calcium sulfate-chitosan complex powder in group IV. Results were evaluated using radiographic study every week, bone mineral density test and histologic examination at 2, 4, 6 weeks and three point bending test at 6 weeks after implantation. In the radiographic study, the formation and corticalization of callus were seen similarly in group III, IV and much more and earlier than group I, II. In the bone mineral density test and three point bending test to contralateral normal tibia in 6 weeks, the values in groups III and IV were statistically significantly higher than in group I and II(p<0.05). In histologic examination, group III and IV have more abundant and faster new boner formation than group I and II. In conclusion, calcium sulfate-chitosan complex powder and chitosan microsphere encapsulating growth hormone facilitates the formation of new bone. They will be used effectively as a bone substitute on defected bone in clinical situations.

Usefulness of Omental Flap for Various Soft Tissue Reconstruction

Extensive and complicated defects on the body call for an omnipotent tool for a perfect reconstruction. Flaps derived from the omentum has many advantages over the conventional flaps. From 1999 to 2004, Omental flaps were applied for various soft tissue reconstructions. Among total 20 total 7 cases were for immediate reconstruction, 2 cases for chronic infection, 3 cases for simultaneous reconstruction of two defects, 4 cases for functional joint reconstruction and 4 cases were for flow- through revascularization. Among these cases, 3 cases were operated with minimal incision harvest technique. There were no complete flap failures, partial necrosis of the distal parts were noted on three cases. The omental flap is indicated on a large contaminated defect reconstruction due to its large size, well-vascularized, and malleable properties. The omental flap provides several additional advantages over other flaps, which are; the availability of the one staged simultaneous reconstruction of two defects with one flap, providing gliding function for the joint motion, and a flow-through characteristics with long vascular pedicle. But there are some serious shortcomings, including a long abdominal scar and intraabdominal problems. However, these are rare and can be minimized with our minimal incision technique. Due to its unique characteristics. the omentum is one of the ideal tissues for the reconstruction of the complicated soft tissue defects due to its unique characteristics.

Speech Analysis in Patients with Velopharyngeal Incompetence Following Surgical Correction

A total of 35 patients with velopharyngeal incompetence were treated by surgical correction from 1995 to 2001. Twenty-six patients underwent lateral port control superior based pharyngeal flap and 9 patients underwent sphincteric pharyngoplasty. Speech analysis and fluorolaryngo-graphy was performed preoperatively and postoperatively. The nasality of open vowel, round vowel and sentence and articulation accuracy in 26 patients who underwent the pharyngeal flap improved from 37.7+/-10.71%, 49.1+/-9.54%, 50.1+/-9.03% and 68.9+/-10.11% preoperatively to 20.4+/-9.77%, 25.4+/-10.11%, 38.5+/-9.34% and 80.1+/-6.47% postoperatively, and hypernasality and articulation accuracy improved significantly (p<0.05). In case of 9 patients who underwent sphincteric pharyngoplasty, results were from 41.2+/-11.27%, 42.4+/-17.04%, 53.8+/-7.63% and 72.3+/-10.87% preoperatively to 20.7+/-8.27%, 20.8+/-14.34%, 29.7+/- 11.47% and 80.7+/-12.47% postoperatively, and hypernasality improved significantly (p<0.05). As far as postoperative fluorolaryngography is concerned, the velopharyngeal space was closed in patients with postoperative normal range of nasality. In conclusion, these results suggest that patients with velopharyngeal incompetence will improve speech dysfunction effectively if is chosen appropriately either superior based pharyngeal flap or sphincteric pharyngoplasty.

Comparison of Wound Healing Effect of Different Forms of Chitosan

This study is to compare the effect of wound healing using three different types of chitin, which include the shapes of sponge, velvet, thick non-woven fabrics, and thin non-woven fabrics. The sponge type had more capacity to absorb the first discharge of a wound than the velvet type and the two non-woven fabrics types. Instead of absorbing the discharge effectively, the velvet type showed a difficulty to take off the dressing stuff from a wound since it was solidly stuck to the wound. The sponge type showed less infiltration of inflammatory cells, producing angiogenesis and fibroblast faster than any other types. Next, the thick non-woven fabrics type was a little more effective than the thin non-woven fabrics type: However, there was no difference between two types. The velvet type sustained the infiltration of inflammatory cells for the longest duration, producing slower angiogenesis and fibroblast. In wound contraction and wound healing, the sponge type was most effective with statistical significance than any other types(p0.05). In conclusion, the sponge type showed the best effectiveness to absorb the early discharge, facilitating the progress of inflammatory phase to increase the healing rate. It induced an early healing of wound caused by wound contraction rather than by wound epithelization.

Effect of Injectable Chitosan Bead Encapsulating Calcium Sulfate on Bony Consolidation in Distraction Osteogenesis

The purpose of this project was to study the effect of injectable chitosan bead encapsulating calcium sulfate, which makes sustained release of chitosan and calcium sulfate after implantation, on early bony consolidation in distraction osteogenesis of a dog model. Forty five dogs were used for this study. An external distraction device was applied to the mandibular body after vertical osteotomy and the mandibular distraction was started five days after the operation at a rate of 1mm per day up to a 10mm distraction. The experimental group was divided into a control group(I), hyaluronic acid group(II), chitosan group(III), calcium sulfate group(IV), and injectable chitosan bead encapsulating calcium sulfate group(V). Normal saline was injected in the group I. In the group II, a 1-ml volume of hyaluronic acid solution was injected into the distracted area. In the group III, a 1-ml of injectable solution of chitosan mixed with hyaluronic acid was implanted. In the group IV, a 1-ml of injectable solution of calcium sulfate mixed with hyaluronic acid was implanted. In the group V, injectable form of powders of chitosan bead encapsulating calcium sulfate mixed with a 1-ml volume of hyaluronic acid was implanted. Bone mineral density was measured in each group at third and sixth week. The mean three point failure load was measured in each group. In histological findings, new bone was generated in all groups. In the group IV and V, the formation of active woven bone was observed throughout the distracted area at sixth week. The amount of new bone formation in the distracted zone was in the order of the group IV and V, group III and group II, and control group. In conclusion, these findings suggest that injectable chitosan bead encapsulating calcium sulfate appears to be effective in early bony consolidation in distraction osteogenesis.

Expression of TGF-beta Induced Protein, betaig-h3, in Chronic Wound and It's Effect on Wound Healing

betaig-h3 is highly induced in A549 cells(human lung adenocarcinoma) after growth arrest by transforming growth factor-beta1. Although some reports describe variable functions of betaig-h3, it's function is in part controversial. betaig-h3 is a TGF-beta inducible cell adhesion molecule and some authors contend that recombinant betaig-h3 supports attachment and spreading of dermal fibroblast. Thus, it is expected that betaig-h3 plays a good role in wound healing. In order to investigate the effect of betaig-h3 in wound healing, The expression of TGF-beta and betaig-h3 in normal skin tissues and chronic wounds were examined by immunohistochemistry stain. In addition, 5 types of recombinant betaig-h3 were made, and among them, betaig-h3 b and betaig-h3 e were used for the experiment. Sprague- Dawley white rats served as the experimental models. Four round full-thickness skin defects of 2cm diameter were made on the back of each rat. The experiment was divided into 4 groups according to the content of ointment; group A: Topical application of ointment base only, group B: Topical application of ointment containing fibronectin 100microgram/ml, group C: Topical application of ointment containing betaig-h3 b 100 microgram/ml, group D: Topical application of ointment containing betaig-h3 e 100microgram/ml. In immunohistochemical study on normal human skin, the expression of TGF-beta was located in the upper dermal part, stratum basale, stratum spinosum and stratum granulosum in epidermis. The expression of betaig-h3 in normal dermis was similar with that of TGF-beta, but increased staining was observed in only stratum basale of normal epidermis. In chronic wounds, TGF-beta and betaig-h3 were highly expressed beneath the bottom and margin of wound and there were some cells showing positive staining within the nucleus. In animal models applied ointment, the reduction of wound size was more marked in group B, C, D than in group A. More rapid reepithelialization, less fibroplasia, less infiltration of inflammatory cells, more capillary formation in early period and more rapid collagen formation were seen in betaig-h3 treated wounds. In conclusion, betaig-h3 plays an important role in wound healing, and it is expected that recombinant betaig-h3 will become potent material for the treatment of chronic wound.

The Effects of bFGF, VEGF and Micromass Culture on Proliferation and Differentiation of Human Chondrocytes

The acquisition of human chondrocytes for transplantation and cartilage coverage presents a major problem as these cells dedifferentiate rapidly during expansion in monolayer culture. Dedifferentiated chondrocytes change their shapes, metabolic states, and programs of matrix biosynthesis. We initiated this study on the basis of the hypothesis that bFGF, VEGF, and micromass culture can influence both the proliferation and their ability to express COL2A1 gene as a chondrogenic marker and Cbfa1 gene as an osteogenic marker. Chondrocytes in monolayer and micromass culture with or without bFGF and VEGF in vitro were collected and analyzed. In results, bFGF stimulated the proliferation of chondrocytes in monolayer culture. VEGF also stimulated the proliferation, but was less effective. The phenotype of chondrocytes was gradually changed in monolayer culture. Chondrocytes expanded in the presence of bFGF became dedifferentiated. However, dedifferentiated chondrocytes fully maintained their potential for redifferentiation in response to environmental changes. After transferring in micromass culture, chondrocytes which expanded with bFGF demonstrated high COL2A1 expression that was biochemically comparable to primary chondrocytes. Chondrocytes which expanded with VEGF demonstrated high Cbfa1 expression in both monolayer and micromass culture with passage times. This study provides that bFGF is needed to expand chondrocytes during tissue cultivation and additional three-dimensional environment is needed to maintain their differentiated phenotype. VEGF initiates the osteogenic potential during the chondrocyte expansion especially in micromass culture.

Effect of Calcium Sulfate-Chitosan Composite Pellet on Bone Formation in Bone Defect of Rabbits

This study was carried out on 80 New Zealand white rabbits, each weighing 3-3.5kg. Twenty rabbits were allocated into each of the four groups. After a 1cm sized ostectomy was made on the tibial body with the periosteum preserved, artificial bone substitutes were implanted. Except for control group(I), manufactured chitosan pellets were implanted in group II, Osteoset(R)(calcium sulfate) in group III and manufactured calcium sulfate-chitosan composite pellets in group IV. Results were evaluated using radiographic study, bone mineral density test and histologic examination in 2, 4, 6 weeks and three point bending test in 6 weeks after implantation. In the radiographic study, the formation and corticalization of callus were similar in groups III, IV and this was much earlier than in groups I, II. In the bone mineral density test and three point bending test to contralateral normal tibia in 6 weeks, the values in groups III and IV were statistically significantly higher than in groups I and II(p<0.05). In histologic examination, groups III and IV have more abundant and faster new bone formation than groups I and II. In conclusion, the synergistic effect between calcium sulfate and chitosan in group IV is considered to facilitate new bone formation as effectively as Osteoset(R) does.

Craniofacial Contouring Using Porous Polyethylene(Medpor(R)) Implant

Among the alloplastic implants, porous polyethylene (Medpor(R)) is one of the ideal materials for augmentation of the craniofacial region. The interconnecting open pore structure of Medpor(R) allows for tissue ingrowth which promotes host integration and prevents migration. The firm nature allows easy carving and prevents collapsing. Because of these advantages, Medpor(R) has been well used for reconstruction of orbital wall. From March 1994 to December 2002, 27 patients were performed the craniofacial contouring surgery using Medpor(R). Thirteen patients were male, 14 were female. The causes of operations were as follows: trauma, 16; cosmetic, 8; and others, 3. The sites of implant were as follows: frontal, 8; temporoparietal, 6; zygoma, 5; maxilla, 3; mandible, 3; and periorbital, 2. The follow up period was 6 months to 48 months with an average of 12 months. The implants were placed into the subperiosteal plane, and fixed with titanium screws. After fixation, the final contouring was performed by carving with a knife or shaving with a high speed bur. There was no infection. All implants were in place, and there was no extrusion. All patients were satisfied at the results of the operation. The irregular margin of implant was felt in 3 cases. However, reoperation was not performed in these patients because of minimal irregularity. In conclusion, Medpor(R) allows ingrowth of soft tissue without adverse tissue response, and there is no donor mobidity. Implanted Medpor(R) were not absorbed or distorted. With these advantages, Medpor(R) could be one of ideal implants for craniofacial contouring.

Wound Healing Effect of the Chitosan Sponges Containing the T-CAM or Regenin

Tetra cell adhesion molecule(T-CAM) is a new recombinant mixture of fibronectin and ig-h3. Fibronectin and ig-h3 are extracellular matriprotein involved in each phase of wound healing, and the combination of these materials may generate a synergistic effect in wound healing. Regenin is easily attainable from protein recombination. It can be developed as wound healing material, and also it has a good effect in cell adhesion and proliferation. We combined the chitosan with regenin or T-CAM at different concentration, which are gene recombination material. They were applied to the artificial wound of white rabbit to compare the healing effect in each group. Round full thickness skin defects, 3 cm in diameter, were made bilaterally on the dorsolateral aspect of New Zealand white rabbit. Experimental group was divided into 6 groups, according to concentration of T-CAM and regenin with chitosan-based dressing materials as followings; Group C: control group - oint material dressing, Group Ch: chitosan base only, Group T1: chitosan base in combination with 25 microgram/ml of T-CAM, Group T2: chitosan base in combination with 625 microgram/ml of T-CAM, Group R1: chitosan base in combination with 25 microgram/ml of Regenin, Group R2: chitosan base in combination with 625 microgram/ml of Regenin. Gross findings by means of percentage of wound contraction, percentage of wound epithelization and percentage of total wound healed area were compared with surface tracing of the remained wound area at the time of 7, 14, 21 days after wound formation. Wound biopsy were performed at the time of 7, 14, 21 days after wound formation. T1, T2 group and R1, R2 groups have less infiltration of inflammtory cell, fast appearance of new vessels, fibroblast, increased volume of collagen fiber comparing to C and Ch group. there's more statistical significance between T1 and T2 group. The same results were shown in Regenin group. In conclusion, our results suggest that T-CAM and Regenin have good effect in wound healing and higher concentration of T-CAM and Regenin is more effective in wound healing than lower concentration. In addition, comparision of same concentration of T-CAM and Regenin group presented almost same results.

Effect of Furlow Palatoplasty for Correction of Submucous Cleft Palate: Cephalometric and Speech Analysis

The purpose of this study was to investigate the anatomic and functional changes of submucous cleft palate operated with Furlow palatoplasty. A total of 36 patients with submucous cleft palate underwent Furlow palatoplasty from 1993 to 1998. The mean follow-up period was 5 years 3 months. Midfacial growth was measured using lateral cephalograms in 18 patients, whose age was older than 8 years of age. Speech analyses were performed in 25 patients by the same speech pathologist for the degrees of nasality and articulation. The parameters obtained in the lateral cephalogram were compared with a healthy population in Korea. ANS-PNS was in 61.1% within the clinical normal range for the age group. SNA and SNB were in 55.6% within the normal range. ANB was in 72.2% and Ba-PNS was 50.0% within the range. The postoperative nasality scores of open vowels and round vowels were 24.2% and 25.2%, respectively, which were lower than preoperative scores. The mean articulation accuracy value was 92.9% which was higher than preoperative value. Our results suggest that Furlow palatoplasty is a useful procedure as the initial treatment of the submucous cleft palate and has the advantages in both aspects of speech results and facial growth.

Distally-Based Sural Artery Flap

Reconstruction of soft tissue defect with exposure of the tendons and bone in the lower third of the leg and the heel represents a challenge to plastic surgeons. The sural artery flap is a fasciocutaneous flap supplied by the sural artery that accompanies the sural nerve and connects with a septocutaneous perforator of the peroneal artery via a suprafascial network of vessels. For the coverage of soft tissue defects, we operated on 10 patients using a distally-based sural artery flap. The sites of the soft tissue defect were the lower third of the leg in 7 cases and the heel in 3 cases. The size of flap varied from 3.5x4cm to 12x18cm. Nine of 10 flaps survived completely. One flap in which the sural nerve was preserved showed partial necrosis but healed spontaneously. Two flaps showed slightly venous congestion which disappeared after a few days. The advantages of the sural flap are a reliable blood supply, easy and quick elevation of the flap, preservation of the major artery and minimal donor site morbidity. The disadvantage of the flap is hypoesthesia at the lateral part of the foot. In conclusion, the distally-based sural artery flap can be used safely for soft tissues coverage in the lower third of the leg and the heel.

Facialplasty and Orbicularis Oculi Muscleplasty for the Crow's Feet Deformity

No abstract available.