Hybrid Augmentation Mammoplasty

Natural look of breast after augmentation mammoplasty is a common end of both plastic surgeons and patients. Palpability and visible rippling after augmentation mammaplasty is not a simple complication to correct in relatively thin patients especially when there is not much soft tissues remain to cover the implant for smooth contour. And asymmetry of the breast in accordance with the skeletal deformity, such as pectus excavatum, can not be easily reformed with insertion of silicone implant alone. In the present study, volume enhancement was accomplished by silicone implant augmentation and contour management was improved with the help of fat graft technique. We named the technique "Hybrid Augmentation Mammoplasty". From May 2011 to Feb. 2012, the hybrid augmentation mammoplasty procedure were performed on 9 patients who expected to have palpable implants, visible rippling or asymmetry due to their soft tissue and skeletal condition. Breast augmentation with silicone implant was done in regular pattern followed by grafting fat tissues utilizing Harvest-jet device into the pre-pectoral, sub-glandular and subcutaneous layer. During the follow-up period, any patient complained palpability of the implant and all of them were satisfied with the contour of their breast. Hereby we suggest that the hybrid augmentation mammoplasty can be an ideal, effective and useful option in management of thin skinned patients or patients with chest wall deformities.

Treatment of a Case of Wound Infection after Intramuscular Augmentation Gluteoplasty

Gluteoplasty is getting more concerns among female population with their rather flat contour of upper hips. We experienced a case of wound infection after intramuscular gluteal augmentation and cured with several steps of treatment protocol. We hereby report the case with treating devices and treatment protocol. A 38-year-old female who underwent gluteal augmentation with silicone implant 9 days ago, presented with prulent discharge at the suture site with general myalgia. Under IV general anesthesia, the wound was explored and more than 50 cc of prulent discharge was evacuated from the right gluteal pocket and subcutaneous tunnel. Massive irrigation and wound debridement was done with the help of Water-jet device and left the wound open for drainage. Several cautious steps are applied for reoperation including isolation of perianal skin, protection from skin maceration and contamination, Water-jet debridement, tight bleeding control with endoscope, progressive tension sutures, negative suction drains, occlusive dressings and stabilizing the buttock with Fixmull cotton tape splints. Wound infection is not a rare complication in gluteal augmentation surgery but if it is not treated properly, that would lead to a disastrous result. Therefore surgeons must be well accustomed to the treatment protocol for treating gluteal infection.

Telecanthus Associated with Blepharoptosis

PURPOSE: Blepharoptosis is often associated with telecanthus and the presence of epicanthal fold in telecanthus is one of unique features in Asian eyelids. The purpose of this article is to define telecanthus and pseudotelecanthus, and to determine optimal surgical procedure depending on classification of telecanthus. METHODS: Among 187 patients with blepharoptosis who had the advancement procedure of the Muller's muscle-levator aponeurosis composite flap for ptosis, 55 patients underwent Flowers' split V-W plasty concomitantly with shortening the medial canthal tendon for correction of telecanthus from September 2003 to January 2011. Among them, 52 patients were followed up for 16 months. We newly defined telecanthus because Mustarde ratio is inaccurate to measure in certain cases and then made a definition of pseudotelecanthus. Besides, we also classified telecanthus into mild, moderate and severe types based on its severity. RESULTS: Telecanthus is defined when the ICD (inner canthal distance) is greater than 110% of normal ICD. Pseudotelecanthus is a telecanthus like a wide skin bridge formed between the eyes because of the epicanthal fold in the normal ICD. Flowers' split V-W plasty combined with shortening medial canthal tendon was very effective in mild and moderate telecanthus with almost invisible scar and no recurrence occurring. In severe types, however, it showed high incidence (28%) of incomplete correction of telecanthus. CONCLUSION: New definition of telecanthus can be easily applied to any case and we think the classification of telecanthus is useful to select an appropriate operative procedure. Split V-W plasty with shortening of medial canthal tendon is a very effective procedure in mild and moderate telecanthus. Besides, it is also effective in improving the treatment outcomes of ptosis in cases of blepharoptosis associated with telecanthus.

Effect of Carboxymethylcellulose with Low and High Degree of Substitution on Wound Healing

PURPOSE: Wound healing is a dynamic and complex process of tissue repair that involves a number of cellular and molecular events, which is characterized by intercalating degradation and re-assembly of connective tissue and epidermal layer. Carboxymethyl cellulose (CMC) is one of the most common hydrofiber dressing. This material have a various degree of substitution. Our goal was to test the efficacy of Carboxymethyl cellulose with low and high degree of substitution on wound healing. METHODS: Four round (diameter 2 cm) wounds were made bilaterally on the dorsum of the all rat's trunk and were divided into four groups of dressing material: Group A with gauze dressing as a negative control group, Group B with high gel (DS=0.3), Group C with Aquacel(R) (ConvaTec, US) as a positive control group, Group D with low gel (DS= 0.15). We compared each group with gross findings by means of percentage of wound contraction, percentage of wound epithelization, and percentage of total wound healed area by tracing the remained wound area on each time periods. RESULTS: Group B and C show statistically higher percentage of wound contraction and higher percentage of wound healed than the other groups until 14th day after wound formation. Group D shows higher percentage of wound epithelization rate in early days, but it was reversed that Group B and C show statistically higher percentage of wound epithelization on 21st day after wound formation. Histologically, Group B and C show less inflammatory cell infiltration, faster and more prominent angiogenesis. On the 21st day after wound formation, collagen fibers was more regularly and densely arranged on Group B and C than the other groups. CONCLUSION: This study suggest Carboxymethylcellulose with high degree of substitution induces stable reepithelization and collagen synthesis in the wound healing process and have optimal effective results and is expected as more application of a various property of Carboxymethylcellulose for treatment of wound healing.

Treatment of Postburn Facial Hyperpigmentation with Vitamin C Iontophoresis

PURPOSE: Many facial burn patients suffer from hyperpigmentation and its treatment has been challenging. Vitamin C(ascorbic acid) has important physiologic effects on skin, including inhibition of melanogenesis, promotion of collagen biosynthesis, prevention of free radical formation, and acceleration on wound healing. The purpose of this study is to evaluate the effectiveness of Vitamin C iontophoresis for the treatment of postburn hyperpigmentation. METHODS: The authors performed a retrospective analysis of 93 patients who were admitted for the treatment of facial burn from February 2008 through February 2010. Among them, 51 patients were treated with Vitamin C iontophoresis to control postburn hyperpigmentation and 42 patients were not. Experimental group was chosen 20 of 51 patients who had been treated with Vitamin C iontophoresis and had normal facial skin on the comparable contralateral aesthetic unit. Control group was chosen 20 of 42 patients who were not treated with Vitamin C iontophoresis and had also contralateral normal aesthetic unit. The resulting color of 20 patients who were treated with Vitamin C iontophoresis was compared with the color of the contralateral normal facial skin using a digital scale color analysis. Results were analyzed with Wilcoxon signed rank test. RESULTS: The analysis revealed significant improvement of hyperpigmentation in the experimental group compared to control group. The difference of intial value and the value in 6 months showed significant change. Mean(Delta(initial)-Delta(6month)) of experimental group was 11.61 and control group was 7.23. Thus, the difference between the experimental group and the control group was 4.38. Therefore, Vitamin C iontophoresis revealed significant improvement of hyperpigmentation in the experimental group compared with control group. CONCLUSION: Vitamin C iontophoresis is an effective treatment modality for postburn hyperpigmentation.

A Case of Multiple Basal Cell Carcinomas in Nevoid Basal Cell Carcinoma Syndrome

No abstract available.

Comparative Study Between Inaba's Procedure and Modified Inaba's Procedure with Delayed Suture in the Treatment of Osmidrosis Axillae

PURPOSE: The Inaba's procedure, the treatment of osmidrosis axillae, has the advantages of low recurrent rate and easiness in learning, yet it produces early postoperative discomfort and scar formation by tie-over dressing. The authors modified the Inaba's procedure by using delayed suture of the incision wound and omitting tie-over dressing. The comparative study of Inaba's procedure and its modification was performed to confirm the advantages of modified procedure. METHODS: The study contains the retrospective analysis of the medical records of 296 patients with osmidrosis who were treated using the Inaba's procedure from December, 1996 to February, 2007. The study also contains the prospective analysis of 20 patients, from March, 2007 to July, 2008, who were treated by the modified Inaba's procedure with delayed suture of the incision wound and gentle pressure dressing instead of tie-over dressing. The operative results of two groups were compared and verified by Mann-Whitney U test (SPSS 12.0). RESULTS: The incidence of complications was 14.5% in the Inaba's procedure, whereas 6.2% in the modified Inaba's procedure. Both procedures have the same basic surgical procedure in terms of the location of incision site and subdermal shaving of the sweat glands, and therefore similar good results were obtained in the aspect of postoperative axillary odor, recurrent rate and postoperative condition of axillary hair. Certainly, the modified Inaba's procedure had better outcome in each element of PSS (Patient Scar Self-Rating Scale), compared to the Inaba's procedure. In addition, the modified Inaba's procedure showed a statistical significance in dressing-related pain reduction and overall satisfaction. CONCLUSION: The modified Inaba's procedure had advantages of decreasing early postoperative complications such as hematoma, discomfort and pain caused by tie-over dressing, and decreased scar formation. However, the drawback was delayed suture of the incision wound after 48 hours.

Treatment of Blepharoptosis by the Advancement Procedure of the Muller's Muscle-Levator Aponeurosis Composite Flap

PURPOSE: Even in a small levator resection for blepharoptosis, 10-13mm of Muller's muscle and levator aponeurosis is resected. To solve the problem, Muller's muscle was detached from the superior tarsal border and conjunctiva, and the muscle with overlying levator aponeurosis was advanced on the upper tarsus as a composite flap. The purpose of this study is to evaluate the effectiveness of the Muller's muscle-levator aponeurosis complex advancement technique for the correction of blepharoptosis. METHODS: From 2003 to 2008, 107 patients(183 eyes) underwent the advancement procedure of the Muller's muscle-levator aponeurosis composite flap for blepharoptosis. The advanced composite flap was fixed 3 mm below the superior tarsal border and 2-3mm of distal flap stump was left after trimming up to 5mm. The results of the operations were evaluated. RESULTS: The mean age of the patients was 35.2 years and 83 patients(145 eyes) were followed up for a mean of 16.7 months. 128 eyes(88.3%) showed a normal level of upper eyelid margin(MRD1 4.1-5.0mm) or less than 1mm ptosis(MRD1 3.1-4.0mm). 10 eyes(6.9%) showed 1-2mm ptosis(MRD1 2.1-3.0mm). 7 eyes(4.8%) showed more than 2mm ptosis which required secondary correction. About 80% of the 183 eyes needed no trimming of the flap stump with 5-6mm of composite flap advancement and 20% had about 3mm of the flap stump trimmed with 8-9mm of composite flap advancement (shortening of the levator complex). CONCLUSION: Muller's muscle-levator aponeurosis complex advancement technique offers several advantages: There is no, or minimal, sacrifice of the normally functioning Muller's muscle; it is more physiological; it is reproducible and it is predictable-with gratifying results for blepharoptosis.

Internal Fixation of Medpor(R) Implant for Prevention of Enophthalmos in Posteriorly Extended Orbital Floor Fracture

PURPOSE: The purpose of this study is to evaluate the effectiveness of internal fixation method of Medpor(R) implant with BioSorb(TM)FX screw which is used for prevention of enophthalmos in posteriorly extended large orbital floor fracture. METHODS: From Jun. 1997 to Dec. 2007, 21 patients who were diagnosed with posteriorly extended large orbital floor fractures were classified into two groups. One group(n=11) had undergone reduction surgery with regular Medpor(R) sheets without any fixation method, while the other group(n=10) had their Medpor(R) sheets fixed with the BioSorb(TM)FX screws. The two groups were evaluated by comparison of their enophthalmos degree and effectiveness. RESULTS: In the non-fixation group, six patients had enophthalmos preoperatively and three of them showed persistent enophthalmos postoperatively. In postoperative CT examination, displacement of Medpor(R) implant with soft tissue impaction into maxillary sinus was observed in the patients. In the screw fixation group, three patients had enophthalmos preoperatively, but none of them suffer from complication such as residual enophthalmos, soft tissue impaction, muscle entrapment or optic nerve compression postoperatively. CONCLUSION: Internal fixation method of Medpor(R) implant with BioSorb(TM)FX screw on the medial surface of orbital floor provides firm stabilization of implants and surrounding soft tissues and can be an effective option especially when postoperative implant displacement or malposition was expected.