The Effect of Doxorubicin and Allopurinol in Chemomyectomy

This study was designed to identify doxorubicin as a permanent chemomyectomy agent that overcomes reversible effect of botulinum toxin A. Doxorubicin was assessed for its ability to bring about a permanent chemomyectomy and the effects of pretreatment were observed to assess its ability to prevent any complications brought about by doxorubicin. A total of thirteen rabbits were assigned to the control group(n=3) and two experimental groups(n=5 for each group). To investigate the myopathic changes following the injections of the agent, both orbicularis oculi muscles of the lower eyelids of each rabbit in the control group were directly injected with single dose of 0.2ml normal saline. Group I were injected with 0.5mg/0.2ml of doxorubicin into the right eyelid and 1.0 mg/0.2 ml of doxorubicin into the left. Group II were given an intravenous injection of 35mg/kg of allopurinol as the pretreatment, then 30minutes later injected with 0.5mg/0.2ml of doxorubicin into the right and 1.0mg/ 0.2ml of doxorubicin into the left. The rabbits were examined daily to monitor the onset, duration and size of skin necrosis and histologically examined two and four months after initial injections. The myopathic change after doxorubicin injection was persistent and irreversible. The dose related effects of doxorubicin chemomyectomy were confirmed by the histologic finding. Skin necrosis occurred in all cases of doxorubicin injection(both 0.5mg and 1.0mg), however the allopurinol pretreatment decreased the size of the skin necrosis in case of the high dose(1.0mg) of doxorubicin. The combined use of allopurinol and doxorubicin reduced the myopathic change more effectively than doxorubicin use alone. Further study is needed to determine optimal dose and administration method, which we feel will contribute to safer and permanent chemomyectomy.

Advantage of the Presence of Living Dermal Fibroblasts within Restylane(R) for Soft Tissue Augmentation

For the correction of facial wrinkles and skin contour defects, commercially prepared nonanimal stabilized hyaluronic acid(Restylane(R)) is now widely used. Although this suspension has been shown to be relatively safe and convenient to administer, varying degrees of resorption have required repeated percutaneous injection. Therefore, this study was undertaken to evaluate the feasibility of Restylane(R) combined with cultured human dermal fibroblasts to enhance the persistence of the injected implant. For the experimental group, fibroblasts from the dermis of healthy adults were isolated and cultivated. Five hundred thousand fibroblasts suspended in 200mul of Dulbecco's phosphate buffered saline(DPBS) were then dispersed in 200mul of Restylane(R) to form a human fibroblast mixed Restylane(R) that measured 400mul in volume. For the control group, 200mul of DPBS without fibroblasts was mixed with 200mul of Restylane(R) These implants were injected subdermally into the back of athymic nude mice at six sites; control group into the left three sites and experimental group into the right three sites. Twelve nude mice were injected to form total of 36 injections per group. The nodular swellings that resulted from the injections were excised wide enough to include skin beyond the swelling points down to panniculus carnosus layer using 5 mm punches, and the weights were measured at 1, 2, 4, 8, 12, and 16 weeks after the injections. Histologic comparisons were also made to confirm the presence of human collagen in the fibroblast mixed Restylane(R) group using immunohistochemical study with anti-human collagen type I polyclonal antibody. The mean weight of the control group nodules decreased throughout the examination period. The mean weight at 16th week was 60% of the weight at first week. On the other hand, the mean weight of the experimental group nodules decreased over the first 2 weeks only. Beyond 2 weeks, there was no further significant weight change. The mean weight at 16th week was 91% of the weight measured at first week. Histologic examination of the control group taken at each examination period exhibited negative immunohistochemical staining for human collagen. That of experimental group exhibited positive staining after 2 weeks, indicating the presence of human collagen. These results indicated that Restylane(R) mixed with cultured human dermal fibroblasts could be successfully injected as living grafts for long-term retention of the implants.

Comparison of Effect of Polyurethane Foam Dressings on Epithelialization of White Rat

Polyurethane foam dressings are becoming widely used in partial and full thickness skin wounds since they are safe and convenient for both patients and physicians. However, the influence of polyurethane foam dressings on epithelialization has not been fully determined yet. This study was designed to compare 2 internationally available polyurethane foams and 3 locally made polyurethane foams as to their effects on the epithelialization in vivo. Twenty white rats were used. A 5 mm punch was employed to excise skin and subcutaneous tissue in a round fashion at six sites in the back area of 10 rats. After creating 6 open wounds, above mentioned 5 polyurethane foams and gauze dressings were applied. On the 5th day the lengths of the nonepithelialized area were measured under light microscope. In addition, partial thickness wounds were created using carbon dioxide laser at six sites on the back of the another 10 rats. Six dressings were applied on the wounds as same as above. On the 4th day the degree of the epithelialization was measured and compared. In full thickness wound study the best wound closing was also seen in chitin mixed Medifoam-N group. In partial thickness wound study the best epithelialization was seen in chitin mixed Medifoam-N and chitosan mixed Medifoam-N groups. These results demonstrated that polyurethane foam dressings influenced the epithelialization, and chitin mixed Medifoam-N showed the best result.

Effects of Release of Tip Supporting Fibrous Tissues for Short Nose Correction

A short nose is one that extends less than one third of the vertical height of the face or whose distance from nasion to tip-defining point is short. Lengthening short noses has been regarded as one of the most challenging and at times vexing tasks in secondary nasal surgery. For correction of short nose, nasal tip supporting tissues from alar cartilages are released and nasal tip is positioned and fixed again. There are five important nasal tip supporting tissues, fibrous connection between upper lateral cartilage and lower lateral cartilage, hinge region(fibrous connection between lateral border of lateral crus and pyriform aperture), interdormal attachment to anterior septal angle (fibrous tissue between anterior septal angle and middle crus), fibrous connection between septum and foot plate of medial crus and dermocartilaginous ligament. This study is to find out which one of the five nasal tip supporting tissues is the most important in short nose correction except dermocartilaginous ligament which has to be released during rhinoplasty. We dissected ten noses from ten fresh cadavers. Five were male and five were female with an average age of sixty three for all ten. We measured the distance between anterior septal angle and tip-defining point in every step of soft tissue dissection releasing the alar cartilage and mucosa, that are often released in short nose corrections and caudally pulling them to the direction of tip-defining point. First, distances were measured in resting and in pulling of alar cartilage. Further, changed distance were measured after releasing nasal tip supporting tissues beginning from the dissection of soft tissues between lateral crus and upper lateral cartilage to that of mucoperichondrium underneath upper lateral cartilage and septal mucoperichondrium. In each process, we found the average and standard variation, confirmed effects of those values to the lengthening of short noses. Dissecting upper lateral cartilage and lateral crus of alar cartilage was most effective in short nose correction. We also found it effective to release the hinge area and dissect the mucoperichondrium under upper lateral cartilage in lengthening the short noses.

Arterialized venous flap

Paget-Schroetter syndrome is synonymous with spontaneous or effort-induced thrombosis of the axillosubclavian vein that is characterized by swelling and pain on upper extremity. Though axillosubclavian thrombosis represents only 1 - 2%, its frequency of diagnosis has increased over the past years due to improvement of ultrasonography. Although the cause of catheter and drug-related cases is clear, several studies have invested the etiology of Paget- Schroetter syndrome, a condition more commonly seen in the young and otherwise healthy individual. Factors often cited include compression of the vein by the anatomic structure, stress, or excessive effort to the extremity, and repetitive shoulder-arm motion. In the view of treatment, thrombolysis by direct infusion of urokinase has proven to be superior to surgical thrombectomy and is now treatment of choice. We successfully treated a 30-year-old man who suffered from swelling and pain on the right upper extremity by using direct urokinase infusion on thrombosis of subclavian vein. This is very rare disease in plastic and reconstructive surgery, thus diagnosis will seldom be made on clinical evaluation. It should be included in the differential diagnosis of upper extremity swelling compared with lymphedema.