Reconstruction of Soft - Tissue Defects in the Lower Extremities Using Local or Free Muscle Flaps

According to increment of industrial accidents and traffic accidents, complex injuries of the lower extremity accompanied with broad soft-tissue defects. Lower extremity possess disadvantageous anatomical characteristics includes poor vascularity easily result in compromised circulation, rigid tissue distensibility, easy infectability followed by soft-tissue defects and relatively long healing periods. Furthermore, it easily happens that osteomyelitis or non-union was followed by bony exposure or fractures, and it must considered to weight-bearing or gate. So, It is impotant to select a appropriate method in reconstruction of the lower extremities and it is applicable to variety of surgical techniques according these considerations. The goal of flap coverage in the lower extremity should be not only satisfactory wound coverage, but also acceptable appearance and minimal donor site morbidity. The Authors estimated that skin graft and local flap surgery for bony exposed area and soft-tissue defect in weight- bearing area may not be successful. In this article, we have tried to established a reconstruction method in the lower extremity based on experiences and clinical analyses of reconstruction of the soft-tissue defects using local or free muscle flap transfer in 54 cases(49 patients) from 1993.3 to 2000.2. Results revealed 93% flap survival, but there were flap failure noted in 4 cases: one appears in the local muscle flap transfer, other three appear in the free muscle flap transfer. Among the 49 patents, 28 patients(58%) accompanied with open comminuted fractures and 11 patients (22%) visited us with infection. We think that soft-tissue defects in lower extremities associated with open comminuted fractures and infections should be reconstructed by flaps that include healthy muscles effectively due to benefits of muscle itself.

Nerve Regeneration After Autogenous Nerve Graft Using Perfabricated Adiponeural and Myoneural Flap: An Experimental Study

Most of the peripheral nerve injuries from crushing or compressive forces are accompanied by surrounding soft tissue injuries. As a result, poor vascularity due to fibrosis and sacr formation compromises regeneration of the grafted nerve. Vascularized nerve graft shows superior regeneration to that of a non-vascularized one. However, the human body provides few donor sites of vascularized nerve graft clinically. We presumed that the prefabricated myoneural or adiponeural flap, which include fabricated nerves wrapped with surrounding vascularized muscle or adipose tissue flap, influences superiorly on the regeneration of grafted nerve because that surrounding vasculatity indirectly enhances the vascularity of the grafted nerve itself. Thirty adult male Sprague-Dawley rats were divided into three groups: 1) conventional reversed autogenous graft of the femoral nerve alone(n=10); 2) nerve graft entubulated with abdominal adipose tissue flap with a pedicle of inferior epigastric artery(n=10); 3) nerve graft entubulated with adductor muscle flap with a pedicle of the first muscular branch of the femoral artery(n=10). At three months postoperatively, grafted nerves were examined by electrophysiologic study to check amplitudes and motor nerve conduction velocities, as well as histopathologic study for evaluation of regenerated nerve cells, fibrosis and neo-vascularization. Consquently, nerve regeneration was found in all three groups. Both the myoneural and adiponeural flap groups had better improved results of nerve regeneration compared to that of the conventional nerve graft group. The result of myoneural flap group was superior to that of the adiponeural flap group. The myoneural flap group showed minimal fibrosis and less prominent neovascularization around moderately regenerated nerves. The adiponeural flap group showed more severe perineural and endoneural fibrosis, as well as vascular proliferation around focal regenerated nerves. The results of myoneural flap group proved to be statistically significant. We concluded that it is possible to use nerve graft entubulated with a vascularized muscle flap (myoneural flap) as a substitute for vascularized nerve graft.

The effects of hyperbaric oxygen therapy on the survival of dorsal random skin flap: an experimental study in streptozotocin-induced diabetic rats

There have been increasing interests of diabetes in the realm of plastic surgery due to problems like foot ulcer as a complication, delayed wound healing or higher failure rates of flap surgery. Main pathology in diabetes is microvascular compromise as well as metabolic derangements. The disturbance in microvascular circulation results in ischemic environments in the body and acts as a main factor that determines the limit of reconstructive or aesthetic plastic surgery. A useful method to overcome such problems is the use of hyperbaric oxygen therapy, which is known to be effective in the treatment of ischemic skin ulcer or osteoradionecrosis. However, there have been few studies on the survival of diabetic random skin flap or the effects of hyperbaric oxygenation directed to increase survival of such flap. In our study, we supposed that the survival of diabetic random skin flap was diminished owing to compromised microvascular pathology and blood rheology, and metabolic derangements, so we hypothesized that hyperbaric oxygen therapy has both reversible and irreversible effects on the survival of ischemic random skin flap in Streptozotocin-induced diabetic rats. Increase of local transcutaneous oxygen concentration, O2 affinity in blood and dysmorphogenesis of red blood cells are reversible and relatively short-term effects and promotion of neoangiogenesis is irreversible or long-term effects. We intended to confirm that hyperbaric rats and to compare the effects between preoperative and postoperative hyperbaric oxygenation on the survival of such flap. And we expect the additional effects of hyperbaric oxygenation on metabolism in diabetic rat, such as lowering the blood glucose level and solving the arrested weight gain. We divided Streptozotocin-induced diabetic rats into three groups: the first was non-treatment diabetic group, the second was preoperative hyperbaric oxygen treated diabetic group(100% O2, 2 atm, 90min, 15sessions, twice a day), and the third was postoperative hyperbaric oxygen treated group(100% O2, 2atm, 90min, 15sessions, twice a day). After elevation of random skin flap on dorsum of diabetic rats, we evaluated the extent of flap survival by measuring the necrotic areas at 3rd, 7th, 10th, and 13th postoperative days. At that time, we intended to evaluate both effects on flap survival by preoperative and postoperative hyperbaric oxygen therapy. As a result, flap survival of non-treated diabetic group was 41% at 13th postoperative days. In diabetic groups with preoperative and postoperative hyperbaric oxygen therapy, flap survival were increased to 64.6% and 62.4% respectively. Diabetic groups with hyperbaric oxygen therapy have a tendency of meaningful decrement in blood glucose level. However, there were no meaningful differences between preoperative and postoperative hyperbaric oxygen therapy. Hyperbaric oxygen therapy has no effective correlations with body weight changes. We conclude that hyperbaric oxygen therapy has some useful effects on the survival of diabetic random skin flap.

Studies of Relationship between P-A Cephalometric Measurements and Vidual Facial Asymmetry / 체질인류학회지

The degree of facial asymmetry in P -A cephalogram may differ from that we felt in clinical examination. The purpose of this study was to find out the P -A cephalometric measurements affecting the visual facial asymmetry. Fifty four adult patients who had been diagnosed as the facial asymmetry in clinical examination were selected for this study. Through the analysis of facial photograph and P -A cephalogram, the following results were obtained: 1. In linear measurements, Me (Menton) to MSR (Mid -sagittal reference line), Cd (Condylion) to Me, Ag (Antegonion) to Me, and Ag to MSR were significantly related with facial asymmetric index. 2. In angular measurements, angle Cg -Me plane to MSR, angle ANS -Me plane to MSR, and angle Cd - Ag -Me were significantly related with facial asymmetric index. Especially, angle Cg -Me plane to MSR, angle ANS -Me plane to MSR were highly related. 3. In surface measurements, Cg -Ag -Ag ' and Cd -Ag -Me -Cd ' were significantly related with facial asymmetric index. The results of this study suggested that menton point was the most affected landmark in visual facial asymmetry.

The Perception of Facial Profile in Korean / 체질인류학회지

This study was performed to compare the attractiveness of facial profile among the patients, parents and orthodontists. Six untreated patients between the ages 15 ~25 with Angle 's Class I, Class II, Class III malocclusion were chosen from the Chonnam National University hospital orthodontic department. The images were altered with of the computer to simulate varying degrees of mandibular retrusion and protrusion. The results of this study were obtained as follows: 1. No significant differences in attractiveness of facial profile among the patients, parents and orthodontists. 2. More protrusive lip position was preferred in female than male. 3. More protrusive chin was preferred in orthodontist group than patients, and parents, but there were no significant differences.

The size of upper airway of the snorer in upright and supine position / 대한치과교정학회지

The purpose of this study was to compare and evaluate the upper airway structure between the snorers and asymptomatic control subjects depending on the positional change. Lateral cephalograms in the upright and supine position were taken in 25 female snorers and 20 female asymptomatic control subjects, The length and the area of the soft palate, tongue and airway were measured and evaluated statistically. The results obtained were as follows : 1. The snorers showed longer and higher tongue, narrower and longer airway, inferiorly positioned hyoid bone, longer and broader soft palate and narrower hypopharynx than the control subjects both in the upright and supine position. In addition, the snorers showed broader tongue area and narrower oropharynx area than the control subjects in supine position. 2. Depending on the positional change from upright to supine position, the controls and the snorers showed decreased airway length and superior positioned the hyoid bone. In addition, the snorers showed decreased tongue length and height, airway length and thickness and oropharynx area, but increased tongue area and soft palate area.

Dental Anthropologic Study on the High School Students of Che-ju island / 체질인류학회지

This dental anthropological study was performed to analyse male and female students of Che-ju high school students. Cephalometric X-rays and dental casts were obtained of 60 male and 60 female students and the Mean and Standard Deviation were obtained. There was no difference in craniofacial morphology between male and female students but the size of craniofacial skeleton of the male is bigger than that of the female. The distance from NB line to pogonion is longer in the male group, and it meant that mandibular symphysis of the male is well developed than the female. The size of teeth of the male is larger than that of the female and is significant in upper and lower canine and first molar. The size of upper arch width, intercanine width, basal arch width and lower basal arch width of the male is larger than that of the female, but arch length of the male and the female showed no significant difference.

Dentofacial Changes in Class I Cases Treated With and Without Extraction / 체질인류학회지

In order to compare the changes of dentofacial skeleton, teeth and soft tissue profile in Class I malocclusion patients treated with and without extraction, cephalometric radiographs were taken in 22 female patients as extraction group and 23 female as nonextraction group who were treated in the Department of Orthodontics in Chonnam National University Hospital. The results were as follows. 1. At the beginning of treatment, average age was 19.0 years in extraction group and 15.9 years in nonextraction group. Duration of treatment was 2.8 years in extraction group and 1.7 years in nonextraction group. 2. Before treatment, there were significant difference between 2 groups in the amount of protrusion and proclination in upper and lower central incisor and lower lip protrusion. After treatment, these differences were decreased. 3. In comparison before and after treatment in extraction group, upper and lower central incisor protrusion and lower lip protrusion were significantly improved. In nonextraction group, retrusion and improvement of inclination of upper and lower central incisor were not found.