Dressing with a Splint in Osmidrosis

For the surgical treatment of osmidrosis with subdermal excision in adolescent patients, immobilization of the axilla after the surgery is very important to prevent hematoma. Skin necrosis may occur when hematoma develops in the axilla after subdermal shaving. However, in case of young patients, they cannot maintain immobilization of the axilla after surgery for a long time, so they are relatively vulnerable to skin necrosis of the axilla due to hematoma after surgery. We used Yogips(R) splint for the dressing in 21 patients from January, 2002 to December, 2002 in our institute to prevent hematoma. The control group was composed of 46 patients only with tie-over dressing after subdermal excision for the dressing. We compared the incidence of hematoma 5 days after the surgery with that of the control group. There was no evident hematoma observed in the patients with Yogips(R)splint, but in case of the control group, hematoma developed in 16 patients of total 46 patients(33%). In this 16 patients with hematoma, 12 patients(75%) were adolescents. In conclusion, the dressing with a Yogips(R)splint seems to be a good method for immobilization of axilla and preventing hematoma after subdermal excision in young patients with osmidrosis.

Efficacy of Tie-over Dressing Using Silicone Gel Sheet in Skin Graft on Flat Surface

Success of skin grafts depends on sufficient immobilization and early intervention for hematoma, seroma, or infection. To stabilize and cover skin grafts with a tie-over technique was used with translucent silicone gel sheet on flat surface. Skin defect was resurfaced with skin grafts. A sterile silicone gel sheet was placed over the skin graft. Gel was fixed to the wound edges with skin sutures. Skin graft healed without any complications. Using silicone gel sheet in skin graft on flat surface is an effective method for stabilization, which also allows direct visualization of the graft designed to inspect hematoma-like complications.

A Clinical Study of the Nasal Bone Fracture: 1488 Cases Review

Nose is the most prominent of part of the face and prone to traumas. Therefore posttraumatic deformities are easily seen and play a major effect on the personal impression. Result of clinical analysis of nasal bone fracture that gives general understands and advices of diagnosis and treatment of nasal bone fracture is presented with reports discussed. The author has performed radiologic evaluation, clinical study and statistical analysis in 1488 cases of nasal bone fracture treated in Department of Plastic and Reconstructive Surgery, Inje University Sanggye Paik hospital, from March, 1992 to February, 2002 Most of operation were performed on 5th-10th posttraumatic days(80.7%), and 1040 cases were treated with closed reduction using C-arm. We could obtain satisfactory results using C-arm. In satisfaction rate, 1296 cases(87%) had satisfactory results. The rate of dissatisfaction was high in the patients performed operation after 11th posttraumatic days and who had septal fracture. The author used C-arm during closed reduction of nasal bone fracture and verified the outcomes intraoperatively and were able to get more accurate reduction. With this method, we could obtain satisfactory results cosmetically and functionally. We should follow-up for longer time and we think that further research will be needed in treatment of nasal bone fracture

A Comparison of Wound Repair by Tissue Adhesive(2-Octylcyanoacrylate, Dermabond(R) and Standard Wound Closure Techniques in Rats

The ideal method of wound closure should be simple, rapid, inexpensive, painless, and bactericidal, and should achieve optimal cosmetic results. Tissue adhesives offer many of these characteristics. Until recently, the only commercially available tissue adhesive was 2-butylcyanoacrylate. A new tissue adhesive, 2-octylcyanoacrylate (Dermabond(R)), offers several advantages over 2-butylcyanoacrylate. It is more pliable and less brittle. To compare a new tissue adhesive, 2-octylcyanoacrylate, with standard wound closure techniques for the repair of open wound, two groups of each 20 rats were studied. Two groups were similar for demographic and clinical characteristics. Photographs taken at three months were rated by seven plastic surgeons blinded to the method of closure. There was no difference between two groups for appearance or complication. In conclusion, wound treated with Dermabond(R) and standard wound closure techniques have similar cosmetic results 3 months later, and Dermabond(R) is a faster method of wound repair that has cosmetic results similar to the use of sutures.

The Bilobed Flap for Nasal Reconstruction

Various methods of nasal reconstruction were performed over time. The physiology and anatomy of nose were clarified and its aesthetic subunits were employed, more improvement and modification were performed. The bilobed flap is particularly suitable for reconstruction of small or medium sized nasal defect up to 1.5 cm in diameter. Authors performed 6 cases of the bilobed flap for the defect of nasal dorsum (4 cases: basal cell carcinoma, 2 cases: compound nevus) from March 2000 to February 2001. The bilobed flap was medially based and second lobe was positioned on the nasal alar groove. This flap results in little or no distortion around tissue, by which scars of nasal dorsum and dog-ear deformity are reduced. Moreover we could achieve better cosmetic results for the scar, primary repair site of the second lobe, which is concealed by nasal alar groove.

Double Eyelid Operation using Subconjunctival Buried Suture Method

Double eyelid operation is one of the most common aesthetic surgical procedure performed in Korea. In correlation with the cultural background and social changes, most patients prefer a nonincision method rather than an incision method at the present. Forty-two consecutive patients were operated on for creation of double eyelids, with the subconjunctival buried suture method through conjunctival approach, from June of 1999 to September of 2000. The choice of procedure was based on the age of the patient and the amount of subcutaneous fat and redundant skin. This method was especially advisable if the young patient wants not to leave any visible scar and rapid recovery. The follow-up period ranged from two months to one year. Of forty-two patients undergoing this procedure, three patients(7.1%) required reoperation because of asymmetry, disappearance of fold, and irrtation respectively. This method is similar to various ordinary nonincisional methods previously described except for subconjunctival buried suture. But authors could obtain better cosmetic result with the advantage of shorter operation time, less morbidity, no scarring, and natural look earlier in the appropriate candidates.

Treatment of Progressive Hemifacial Atropht (Romberg's Desease) with Microvascuar Free Flap

Romberg's disease is an uncommon condition manifested by progressive hemifacial atrophy of the skin, soft tissue and bone. Facial asymmetry with soft tissue deficiency in Romberg's disease causes a significant disability affecting the social life and can bring about many psychological problems. The aim of surgical treatment is cosmetic amelioration of the defect. Several conventional reconstructive procedures have been used for correcting facial asymmetry. They include fat injections, dermal fat grafts, silicone injections, cartilage and bone grafts, pedicled flaps and free flaps. We report our experience with 6 patients involving 6 free flaps with a minimun of 1 year follow-up who were treated from October 1989 to March 1998. All patients were classified as having moderate to severe atrophy. The average age of disease onset was 4.5 years. The average duration of atrophy was 5.2 years. No patient was operated on with a quiescent interval of less than 1 year. The average age at operation was 14.1 years, ranging from 10 to 24 years. Follow-up ranged from 1 to 9 years. Reconstruction was performed using 2 groin dermofat free flaps and 4 latissimus dorsi muscular free flaps. To achieve the finest symmetrical and aesthetic results, several ancillary procedures were performed in 4 patients. These procedures included Le-Fore 1 1/2 leveling osteotomy, sagittal split ramus osteotomy, reduction malarplasty and angleplasty, rib and calvarial bone graft, correction of alopecia and additional dermofat graft. All patients were satisfied with the results. We believe that free flap is one of the best choices for contoured restoration of facial asymmetry in Romberg's disease.

A New Treatment Method of Mandibular Fracture using Acrylic Splint

As modern society becomes increasingly complex, there has been a steady increase in violence, as well as in automobile and industrial accidents. This has resulted in an increased incidence of facial injuries, including mandibular fractures. Many methods have been advocated to achieve reestablishment of normal feature and function. The choice generally depends upon such factors as location of the fractures, displacements, status of the dentition and favorability of the fracture line. Many cases of mandibular fracture are treated by intermaxillay fixation using an arch bar or bite block(acrylic splint)for rapid bone union and minimal displacement. However, there had been some problems, such as discomfort to patients, limitation to eating and weight loss, poor oral hygiene, and temporomandibular joint ankylosis. As a consequence, we have modified the shape of the acrylic splint and method of fixation for circum-mandibular fixation instead of intermaxillary fixation. Acrylic splints are rigid, strong, easily adjusted and repaired, translucent, lightweight and well tolerated by the oral mucosa. The splints are properly secured to each tooth and bind all the teeth together as a single unit. Authors have used modified acrylic splints as tools of circum-mandibular fixation in 12 cases of mandibular symphysis and body fracture from May 1997 to August 1998, achieving the results of very good occlusal relationship, oral hygiene and comfort to patients.