Sandwich Graft using Ear Cartilage and Inferior Turbinate Mucoperiosteal Free Graft Via Open Rhinoplasty Approach for Repair of Nasal Septal Perforation

Repair of nasal septal perforation is a challenging problem to surgeons. Many surgical techniques which were reported through many literatures did not show high success rate constantly. The aim of this study was to examine the surgical technique of sandwich graft using inferior turbinate mucoperiosteal free graft and ear cartilage via open rhinoplasty approach. MATERIAL & METHODS: From May 2008 to December 2010, 7 patients who were suffered from nasal septal perforation underwent sandwich graft using ear cartilage and inferior turbinate mucoperiosteal free graft via open rhinoplasty approach. RESULTS: Mean age was 45+/-10.1 years (28~60 years old). We followed up 7 patients for 2 months after the surgery. Six of the 7 patients had a complete closure and one patient achieved incomplete closure. One patient who had incomplete closure was treated by primary closure again. CONCLUSIONS: Sandwich graft of inferior turbinate mucoperiosteal free graft and ear cartilage via open rhinoplasty approach showed high success rate and relatively easy surgical technique.

Surgical Correction of Whistle Deformity Using Cross-Muscle Flap in Secondary Cleft Lip

BACKGROUND: The whistle deformity is one of the common sequelae of secondary cleft lip deformities. Santos reported using a crossed-denuded flap for primary cleft lip repair to prevent a vermilion notching. The authors modified this technique to correct the whistle deformity, calling their version the cross-muscle flap. METHODS: From May 2005 to January 2011, 14 secondary unilateral cleft lip patients were treated. All suffered from a whistle deformity, which is characterized by the deficiency of the central tubercle, notching in the upper lip, and bulging on the lateral segment. The mean age of the patients was 13.8 years and the mean follow-up period was 21.8 weeks. After elevation from the lateral vermilion and medial tubercle, two muscle flaps were crossed and turned over. The authors measured the three vertical heights and compared the two height ratios before and after surgery for evaluation of the postoperative results. RESULTS: None of the patients had any notable complications and the whistle deformity was corrected in all cases. The vertical height ratios at the midline on the upper lip and the affected Cupid's bow point were increased (P<0.05). The motion of the upper lip was acceptable. CONCLUSIONS: A cross muscle flap is simple and it leaves a minimal scar on the lip. We were able to reconstruct the whistle deformity in secondary unilateral cleft lip patients with a single state procedure using a cross-muscle flap.

The Correction of Inverted Nipple Using Modified Purse-String Sutures

Inverted nipples have shortened lactiferous ducts and less fibrous and collagenous muscular tissue and less connective tissue present, thus giving less bulk and less tissue for nipple projection. Until now, many authors suggested various methods of correction of inverted nipple, but it shows that perfect method does not exist. From July 2008 to December 2010, 41 nipples in 21 patients were treated. 20 patients had bilateral inverted nipples. Under the local anesthesia with sedation, the nipple was everted. A small incision was made on both lateral side at the nipple-areola junction. After nipple traction, the lactiferous ducts and surrounding connective tissues were divided by sharp dissection only through vertical direction. Upper and lower purse-string sutures using Nylon 4-0 were performed for the maintenance of corrected nipple. The small incision was closed by the simple suture. The operation time averaged 15minutes for each nipple. The mean follow-up period was 6 months. There were no complications associated with surgery, such as recurrence, infection, hematoma, nipple necrosis and sensory loss. We applied modified purse-string sutures to mild and moderate inverted nipple patients, and acquired good results. So we report our experience with a review of literature.

The Effect of Nasal Packing with Rolled Silastic Sheet after Closed Reduction of Nasal Bone Fracture

PURPOSE: Nasal bone fracture is the most common type of facial bone fracture and most of nasal bone fracture is combined with septal fracture frequently. Nasal septum is important to support the distal nose and to maintain the nasal airway. But nasal septal fractures are usually unrecognized and untreated at the time of operation. Recently, various materials were using for nasal packing after closed reduction, however these materials are not focused on the correction of nasal bone and nasal septal fracture and many patients are suffered from nasal packing materials. Thus, the purpose of this study is to compare routine packing materials and rolled silastic sheet with respect to postoperative effect of correction of nasal bone fracture and discomfort of nasal packing materials. METHODS: We examined 320 patients treated nasal bone fracture from January 2008 to December 2010. For Group I(n=92), Merocel(R) was used for nasal packing, for Group II(n=152) vaseline gauze was used, and Rolled silastic sheet(RSS) with vaseline gauze packing(VGP) was used for Group III(n=76). Under the general anesthesia, all patients were operated by closed reduction and nasal packing was done using three kinds of packing materials. At the time of postoperative 7 days, packing material was removed and studied for pt's satisfaction and postop. complications. RESULTS: In patients with RSS with VGP, the complaints (nasal obstruction, foreign compressive sensation and discomfort during food ingestion) of keeping the nasal packing were decreased(p0.05). CONCLUSION: Postoperative nasal packing with RSS with VGP was more comfortable to the patients and it was more effective method to correct the nasal bone fracture and nasal septal fracture.

The Usefulness of Cultured Allogenic Keratinocyte (Kaloderm(R)) for 2nd Degree Burn Patient Treatment

PURPOSE: To minimize hypertrophic scar, contraction and color mismatch on 2nd degree burn wound, the choosing of dressing method is one of the major considerations. We report the result which is performed treatment using cultured allogenic keratinocyte (Kaloderm(R)) for 2nd degree burn patients who did not want to operation. METHODS: From February 2010 to April 2011, we treated 12 patients who suffered from 2nd degree burn using cultured allogenic keratinocyte (Kaloderm(R)). We followed up the degree of epithelization and scar formation. Average follow-up time was 7.8 months (2~16 months). RESULTS: Almost wound was healed without any complication. Epithelization of wound look an average 12.9 days after Kaloderm(R) application. We conducted split-thickness skin graft in 2 patients additionally. There were no severe hypertrophic scar, contraction and color mismatch. CONCLUSION: Using cultured allogenic keratinocyte (Kaloderm(R)) for 2nd degree burn patients is simple, effective method. It can be one of alternative treatments for 2nd degree burn patients.

A Case Report of Posttraumatic Pseudoaneurysm of the Superficial Temporal Artery

Posttraumatic pseudoaneurysm of the superficial temporal artery is very rare and occurs secondary to trauma. Clinical diagnosis is based on past history of trauma and physical examination and can be confirmed by duplex ultrasonogram, digital subtraction angiography, CT and MRI. Ligation of proximal and distal ends of the superficial temporal artery and excision of the pseudoaneurysm has been the standard treatment. Compressive therapy, endovascular coil embolization, percutaneous thrombin injection under ultrasound guidance have been reported as alternative treatment methods. When surgical excision of the superficial temporal artery pseudoaneurysm is performed, surgeon must be concerned about the anatomical relation between superficial temporal artery and temporal branches of the facial nerve. In this article, we report a rare case of superficial temporal artery pseudoaneurysm with some review of the literatures about anatomical relation between superficial temporal artery and temporal branches of facial nerve.

Treatment of Severe Blepharoptosis after Blow Out Fracture

PURPOSE: Blepharoptosis can result from either congenital or acquired causes. Blow out fracture or facial bone fracture including blow out fracture can be one of the causes. Authors experienced 3 cases of severe blepharoptosis after blow out fracture treated only with observation after reduction of associated fracture. METHODS: Reconstruction of orbital wall was conducted on all cases diagnosed as blow out fracture using 3 dimensional computed tomography, and conservative treatment was done on accompanying severe blepharoptosis. RESULTS: At the time of injury, all cases showed severe blepharoptosis requiring frontalis muscle transfer for correction. But blepharoptosis was recovered in an average of 18 weeks without any surgical procedure except reconstruction of orbital wall. CONCLUSION: Once Blepharoptosis occurred after blow out fracture, thorough evaluation must be done at first. If definitive cause of blepahroptisis cannot be found as authors' cases, injury of oculomotor nerve may result in blepharoptosis. So, as for blepharoptosis after blow out fracture, conservative treatment following reconstruction of fractured orbital wall can be one of good management.

Correction of Saddle Nose Deformity using Autogenous Cartilage Graft

PURPOSE: Correction of saddle nose remains problematic both in the technique of reconstruction and in the choice of implant material for nasal augmentation. A large variety of graft materials have been used for the reconstruction of the saddle nose deformity. The purpose of this study is to determinate an algorithm for deciding alternative graft materials used in correction of saddle nose deformity. METHODS: Six patients with saddle nose who were corrected using by auricular cartilage and costal cartilage at Chosun university hospital were analyzed. RESULTS: After a mean interval of 12 months, all patients were satisfied with the esthetic and functional result. CONCLUSION: Auricular cartilage is an excellent graft material for esthetic and functional reconstruction of mild to moderate saddle nose deformity.

Correction of Saddle Nose Deformity using Autogenous Cartilage Graft

PURPOSE: Correction of saddle nose remains problematic both in the technique of reconstruction and in the choice of implant material for nasal augmentation. A large variety of graft materials have been used for the reconstruction of the saddle nose deformity. The purpose of this study is to determinate an algorithm for deciding alternative graft materials used in correction of saddle nose deformity. METHODS: Six patients with saddle nose who were corrected using by auricular cartilage and costal cartilage at Chosun university hospital were analyzed. RESULTS: After a mean interval of 12 months, all patients were satisfied with the esthetic and functional result. CONCLUSION: Auricular cartilage is an excellent graft material for esthetic and functional reconstruction of mild to moderate saddle nose deformity.

A Surgical Experience of Cauliflower Ear with Osseous Metaplasia

Acute auricular hematoma is a common problem in wrestlers, boxers and secondary to trauma such as traffic accident. Early intervention can be limited to simple incision and drainage. Delay in treatment may allow the growth of ectopic fibroneocartilage derived from the damaged perichondrium and it can subsequently cause the unsightly cauliflower ear. Few paper deal with histopathologic analysis of removed excess cartilage fragment. Usual findings are cartilagenous tissue surrounded by fibrous tissue with hemosiderin deposits or cicatrix and foci of cartilage formation. But this case shows degenerative cartilage with osseous metaplasia and it has a stony hard consistency and is clinically a rare disease. The ear cartilage were exposed anteriorly and posteriorly. The deformed cartilage and bony tissue were removed and shaved to restore a normal form. The elevated cutaneous flap was sutured and silastic drainage was applied. We described histopathologic finding and surgical treatment of cauliflower ear with osseous metaplasia.

Reconstruction with the 'V-Y-S Flap' for the Facial Defect after the Excision of a Skin Cancer

PURPOSE: There are many methods for the reconstruction of the facial defect after an excision of a skin cancer; such as skin graft, local flap, free flap, etc... Skin graft has its' limitations; it could remain in different color with in regards of the recipient to donor, with an unfavorable scar. Free flap can lead to big donor site morbidity with long operation time and uncontrolled scar as a disadvantage factor. Compared to the prior, local flap offers several merits; sufficient blood supply, good tissue quality and short operation time. We revised 'V-Y-S flap' for the facial defect, which proved to have favorable outcomes. METHODS: Total 7 V-Y-S flaps were performed to patients with skin cancers(six squamous cell carcinoma and one basal cell carcinoma). Two of these flaps were combined with composite grafts, one with full thickness skin graft. Six patients were female and one male. The average diameter of defects after excision was 2.3cm. The follow-up period was 18 months maximally. RESULTS: We treated seven facial skin cancers with 'V-Y-S flap'. There were no flap necrosis, cancer recurrence and scar contracture as a result. Furthermore, this method also offers a favorable central scar line that is parallel to the nasolabial fold and the nasojugal groove, especially in the nasolabial area and superomedial side of the cheek. With this method, we could cover a maximum diameter of 4cm facial defect. CONCLUSION: In conclusion, it is suggested that V-Y- S flap is a useful mehtod to cover facial defects after the excision of a skin cancer.