Comparison of irradiated and non-irradiated acellular dermal matrices in breast reconstruction under radiotherapy

Background@#Acellular dermal matrices (ADMs) have become an essential material for implant-based breast reconstruction. No previous studies have evaluated the effects of sterility of ADM under conditions of radiation. This study compared sterile (irradiated) and aseptic (non-irradiated) ADMs to determine which would better endure radiotherapy. @*Methods@#Eighteen male Balb/C mice were assigned to the control group with no irradiation (group 1) or one of two other groups with a radiation intensity of 10 Gy (group 2) or 20 Gy (group 3). Both sterile and aseptic ADMs were inserted into the back of each mouse. The residual volume of the ADM (measured using three-dimensional photography), cell incorporation, α-smooth muscle actin expression, and connective tissue growth factor expression were evaluated. The thickness and CD3 expression of the skin were measured 4 and 8 weeks after radiation. @*Results@#In groups 2 and 3, irradiated ADMs had a significantly larger residual volume than the non-irradiated ADMs after 8 weeks (P<0.05). No significant differences were found in cell incorporation and the amount of fibrosis between irradiated and non-irradiated ADMs. The skin was significantly thicker in the non-irradiated ADMs than in the irradiated ADMs in group 3 (P<0.05). CD3 staining showed significantly fewer inflammatory cells in the skin of irradiated ADMs than in non-irradiated ADMs in all three groups after 4 and 8 weeks (P<0.05). @*Conclusions@#Under radiation exposure, irradiated ADMs were more durable, with less volume decrease and less deposition of collagen fibers and inflammatory reactions in the skin than in non-irradiated ADMs.

Distribution, side involvement, phenotype and associated anomalies of Korean patients with craniofacial clefts from single university hospitalbased data obtained during 1998–2018 / 대한치과교정학회지

Objective@#To investigate the distribution, side involvement, phenotype, and associated anomalies of Korean patients with craniofacial clefts (CFC). @*Methods@#The samples consisted of 38 CFC patients, who were treated at Seoul National University Dental Hospital during 1998–2018. The Tessier cleft type, sex, side involvement, phenotype, and associated anomalies were investigated using nonparametric statistical analysis. @*Results@#The three most common types were #7 cleft, followed by #0 cleft and #14 cleft. There was no difference between the frequency of male and female. Patients with #0 cleft exhibited nasal deformity, bony defect, and missing teeth in the premaxilla, midline cleft lip, and eye problems. A patient with #3 cleft (unilateral type) exhibited bilateral cleft lip and alveolus. All patients with #4 cleft were the bilateral type, including a combination of #3 and #4 clefts, and had multiple missing teeth. A patient with #5 cleft (unilateral type) had a posterior openbite. In patients with #7 cleft, the unilateral type was more prevalent than the bilateral type (87.0% vs. 13.0%, p < 0.001). Sixteen patients showed hemifacial microsomia (HFM), Goldenhar syndrome, and unilateral cleft lip and palate (UCLP). There was a significant match in the side involvement of #7 cleft and HFM (87.5%, p < 0.01). Patients with #14 cleft had plagiocephaly, UCLP, or hyperterorbitism. A patient with #30 cleft exhibited tongue tie and missing tooth. @*Conclusions@#Due to the diverse associated craniofacial anomalies in patients with CFC, a multidisciplinary approach involving a well-experienced cooperative team is mandatory for these patients.

Chondrocutaneous transposition flap for congenital tragal malformation with dystopic cartilage

Due to the variety in the shape of dysmorphic cartilage, tragus reconstruction is one of the most challenging goals in otoplasty. The authors describe a method to reconstruct a prominent tragus in a simple way suitable for accounting for the size, shape, and location of the remaining ear. We present a case of tragus deformity in an 11-year-old female patient after a previous excision of pretragal skin tags. There was a small remnant of the deeply located dystopic cartilage in a horizontal orientation. The dystopic cartilage was used to reconstruct the tragus using a chondrocutaneous transposition flap. Only a small portion of the pre-existing cartilage was used to create a chondrocutaneous transposition flap that supplemented the portion of cartilage during tragus reconstruction. The result was a new tragus that showed acceptable improvement in shape, location, and projection. Patients with a small portion of pre-existing cartilage near the tragal wall may benefit from the use of this method for tragus reconstruction.

Tragus formation during concha-type microtia repair using a chondrocutaneous island flap

Formation of an ideally-shaped tragus remains one of the most challenging issues during staged tragus reconstruction in microtia patients. The authors describe a new method used to treat a unique case of concha-type microtia in which the 10-year-old male patient had only a portion of pre-existing cartilage at the tragus site. An anomalous skin lump was also present. During the initial stages of the reconstruction, the two-stage Nagata method was used for surgical correction of the microtia. An autologous rib cartilage graft was used to form the ear framework. A temporoparietal fascia flap was also constructed. Remnant skin tags and anomalous cartilage that accompany microtia are usually removed during microtia repair. However, the cartilage and skin lump were preserved during the reconstruction. The skin lump was later used to form a vascularized chondrocutaneous island flap that supplemented the portion of cartilage during tragus formation. The result was a new tragus that was satisfactorily improved in both size and shape. Patients with concha-type microtia may benefit from the use of this new method for tragus formation.

Recurrence Rate and Survival Analysis of the Lumbar Disc Herniation After Open Discectomy / 대한정형외과학회잡지

PURPOSE: The aim of this study was to estimate the true recurrence rate of lumbar disc herniation after open discectomy, and to compare these results with those from other studies. MATERIALS AND METHODS: From January 1992 to June 2002, the medical records and radiological findings, including a telephone survey were studied retrospectively. This study examined 306 cases, who had been operated by an open discectomy on a single level and had no other spinal lesions such as spondylolisthesis, spondylolysis, or spinal stenosis. MRI was used to confirm the diagnosis of a lumbar disc herniation in all cases. The recurrence of lumbar disc herniation was diagnosed only in those cases who had the same pattern of symptoms and was confirmed by MRI. The cases who had undergone additional surgery at another hospital at the same spinal level were also included as recurrence. In order to make up for weak points such the losses to a long term follow-up, statistical survival analysis was carried out using a life table method. In the life table method, the assumption is that all patients undergo surgery simultaneously. The longest follow-up duration was 11 years. RESULTS: In 252 of the 306 cases (82%), follow-up study was possible. The average duration of the follow-up was 5.9 years (from 1 to 11 years). The average age of the patients was 27.1 years (17 to 75), and the male to female ratio was 11.6: 1. The most common lesion of lumbar disc herniation was L4-5 (74%) at the initial diagnosis. The simple recurrence rate was 8.3% (21 cases) using the conventional method, in which the cases lost to follow-up were excluded. Survival analysis showed that, the annual recurrence rate was highest at the first year postoperatively as 3.4%, but decreased with time. At the last follow-up of 11 years, the cumulative survival rate was 88.9% and the recurrence rate was estimated to be 11.1% at final stage. CONCLUSION: Using survival analysis, the true rate of a recurrence of lumbar disc herniation after an open discectomy calculated. Even though the annual recurrence rate decreased with time, the true recurrence rate using the conventional method may be higher than the results obtained suggest.

Clinical and Radiological Results of Revision Acetabular Arthroplasty using an Acetabular Roof Reinforcement Ring / 대한정형외과학회잡지

PURPOSE: We evaluated the clinical and radiological results of acetabular reconstructions using an acetabular roof reinforcement ring (ARR). MATERIALS AND METHODS: From May 1993 to November 1999, 18 hips revised with ARR were evaluated. The mean age at operation was 53 years. The average follow-up period was 51 months (24-94 months). Acetabular defects were classified based on the AAOS classification system. There was one case of type IIA defect, six cases of type IIB defect, ten cases of type III defect and one case of type IV defect. All were treated with morselized allografts and autografts, and three were reconstructed with additional structural autografts. RESULTS: The average Harris hip score improved from 54 preoperatively to 76 postoperatively, but five patients complained of intermittent hip pain. On the last follow-up radiographs, the bone grafts were united and remodeled in all cases, but only partial resorption was observed in two hips. We found evidence of osteolysis in four hips and observed cup migration in three hips. Three hips, in which Muller rings were used, were re-revised during the follow-up period. CONCLUSION: Acetabular reconstruction using ARR led to good clinical and radiological results, but a relative high rate of rerevision was shown in the cases fitted with the Muller ring. Appropriate ARR should be used depending on the extent of the acetabular defect.

Evaluation of Biodegradation and Osteosynthesis in CaO-SiO2-B2O3 Glass-ceramics by Posterolateral Fusion of Rabbit Lumbar vertebrae / 대한정형외과학회잡지

PURPOSE: To compare the biodegradation and osteoconduction properties of CaO-SiO2-B2O3 glass-ceramics (CS10B), hydroxyapatite(HA), and tricalcium phosphate (TCP). MATERIALS AND METHODS: Porous CS10B implants were prepared by the polymer sponge method. Single-level posterolateral spinal fusions were performed on thirty rabbits. The animals were divided into three groups by implant material: HA, TCP and CS10B. Radiographs were performed every two weeks. All animals were sacrificed 12 weeks after surgery. The proportion of the area occupied by the ceramicsin the final over the initial radiographs was calculated. Uniaxial tensile strength was determined from 7 cases in each group. RESULTS: The proportion of the area occupied by HA (88.7+/-16.1%) was significantly higher than the others (p<0.05), and the proportion of the area occupied by CS10B (28.2+/-9.3%) was significantly lower than those of HA and TCP (37+/-9.6%) (p<0.05). The mean values of the tensile strengths of HA (191.4+/-33.5 N) and CS10B (182.7+/-19.9 N) were significantly higher (p<0.05) than those of TCP (141.1+/-28.2 N). CONCLUSION: CS10B had similar tensile strengths of the fusion masses as HA, however, it degraded more rapidly than HA or TCP. These findings suggest CS10B grafts as possible bone replacement materials.

Porous Beta-Calcium Pyrophosphate as a Bone Graft Substitute in a Canine Bone Defect Model / 대한정형외과학회잡지

PURPOSE: To evaluate the possibility of using porous beta-calcium pyrophosphate (beta-CPP) as a bone graft substitute by comparing its osteoconduction and degradation with porous hydroxyapatite (HA). MATERIALS AND METHODS: Porous HA and porous beta-CPP were implanted in the proximal tibia of 7 dogs. Two animals were sacrificed at 8weeks and 5 animals were sacrificed at 20 weeks after surgery. Radiographs and histologic sections were evaluated. RESULTS: The mean period required for the radiolucent zone to disappear was 7.1+/-1.1 weeks in HA and 6.4+/-1.1 weeks in beta-CPP. By serial radiography, resorption was more prominent in porous beta-CPP than in porous HA at 8 weeks (p=0.04) and at 20 weeks. The proportion of bony tissue in the pore was 16.8% in HA and 29.7% in -CPP. The proportion of pores with bony tissue was 70.2% in HA and 62.5% in beta-CPP at 8 weeks. CONCLUSION: In beta-CPP, the new bone growth was as vigorous as in HA, but the degradation was more rapid than in HA. These results suggest that beta-CPP is a more ideal new bone graft substitute.

Surgical Treatment of Nonunions of the Surgical Neck of the Humerus in Elderly Patients / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the results of surgical treatment of nonunion of the surgical neck of the humerus in elderly patients. MATERIALS AND METHODS: Seven patients over 60 years of age surgically treated for nonunion of the surgical neck of the humerus with follow- up over 1 year were investigated. Of the three patients with severe osteoporosis, multiple K-wires were used in 1 patient, and Ender nails were used in 2. The other 4 patients with relatively good bone quality were treated with plate and screws. Functional results were evaluated using the University of California, Los Angeles (UCLA) shoulder rating scale and statistical significance was tested using the Wilcoxon signed rank test. RESULTS: Radiological union was obtained in six patients, and 1 patient had no evidence of union at a postoperative 5 years. Active elevation improved from an average of 73 (range, 20-100) degrees to 139 (range, 110-160) degrees. The UCLA score improved from 10.9(range, 7-16) points to 27.3 (range, 10-33) points on the average. CONCLUSION: Open reduction with internal fixation and bone grafting for nonunion of the surgical neck of the humerus in elderly patients may result in significant functional improvement.

SMA Syndrome after Corrective Surgery of Thoracic Kyphoscoliosis: A Case Report / 대한척추외과학회지

Superior mesenteric artery (SMA) syndrome is a rare condition that results from an extrinsic compression of the third portion of the duodenum, between the SMA and the aorta. The symptoms for the condition consist of abdominal pain and recurrent vomiting, caused by ileus, and can be followed by an electrolyte imbalance and nutrient deficiency. SMA syndrome can follow surgical correction of a spinal deformity, as the aorta migrates forward as the degree of the lumbar lordosis increases, and the retroperitoneal fat tissue decreases, during perioperative abstinence. Any symptoms suggestive of SMA syndrome, after correction of a spinal deformity, should be investigated, as SMA syndrome carries a prolonged hospital stay, with the potential for mortality. An 11 year 10 month old boy, who underwent correction for thoracic kyphoscoliosis, developed postoperative abdominal distension, pain and bilious vomiting. An upper gastrointestinal contrast study revealed SMA syndrome, which required a laparotomy.

Osteoid Osteoma and Osteoblastoma of the Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVE: To analyze the clinical and radiological findings, and the results of the surgical treatment of osteoid osteomas and osteoblastomas of the spine. SUMMARY OF LITERATURE REVIEW: With the development of new imaging techniques, earlier diagnoses have been reported. However, a few reports of unexpected misdiagnosis, and postoperative results, have also been published. MATERIALS AND METHODS: Between January 1980 and September 2002, twelve patients were diagnosed with an osteoid osteoma or osteoblastoma of the spine, and were surgically treated. The average preoperative symptom-duration and follow-up period were 20 and 33 months, with ranges from 6weeks to 96 months, and 4 to 120 months, respectively. All the patients were younger than 30 years old, with the majority being of growing age, and underwent at least a bone scan, CT or MRI, as part of the diagnostic procedures. RESULTS: The most common symptom was pain at the lesion, with 2 torticollis and 4 scoliosis observed as combined spine deformities, respectively. Neurological abnormalities were seen more often in the osteoblastomas (80%) than in the osteoid osteomas (43%). From the radiological findings, a CT scan was a more effective procedure than any of the other diagnostic modalities in differentiating an osteosclerotic bony lesion and a nidus. In three out of the five MRI, 2 cases were misdiagnosed as infections and the other as a malignant tumor, with no significant abnormal findings in the simple roentgenogram. A wide excision was performed in all patients, and a fusion, with a bone graft, was also performed in 8. There were no postoperative spinal instabilities or complications. CONCLUSION: In a differential diagnosis, careful history taking for pain, and a physical examination for spine deformity, are required. Without any clinical information, these tumors can be misdiagnosed as malignant tumors, or other infectious diseases, in a MRI. With regard to the surgical treatment, there were no cases of recurrence reported due to the wide excision, but a fusion, both with or without instrumentation, can be considered to prevent postoperative spine instability.

Distribution of Lengths of the Normal Femur and Tibia in Korean Children from Three to Sixteen Years of Age

To develop a standard growth curve of the lower extremity in Korean children from 3 to 16 yr of age, the lengths from a total of 2087 normal long bone segments (582 femurs and 645 tibias in boys, and 417 femurs and 443 tibias in girls) were measured. Children were grouped by years of bone age, which was determined by using the Korean specific bone age standard; TW2-20 method. The growth spurt occurred in girls from eight to eleven years by bone age, and in boys from eleven to thirteen years. The mean tibial length relative to the mean femoral length was 0.78 in boys and 0.79 in girls. The overall growth pattern was similar to that observed in American children in the 1960s. Korean children and adolescents appear to have a different tempo of skeletal maturation during pubertal growth from that of English and American children and adolescents. The Korean standard growth curve and the Korean bone age chart allow determination of the presence of any existent growth abnormalities and prediction of future remaining growth in lower extremities. These normative growth standards can be used for leg-length equalization purposes in children with anisomelia.

The Explanation of Postoperative Change of Vertebral Rotation and Rib Hump Using 3 Dimensional Finite Element Scoliosis Model / 대한척추외과학회지

STUDY DESIGN: An analytical study using a mathematical 3-D finite element model for thoracic scoliosis. OBJECTIVE: To find the important kinematics and post-operative changes of the spine and rib cage, in the corrective surgery for scoliosis, using the rod derotation method. SUMMARY OF LITERATURE REVIEW: A conventional corrective surgery for scoliosis was performed, based on empirical knowledge, and an increase in the secondary postoperative change in the rib hump, and a shoulder level imbalance, were reported. However, no analytical data exists for the kinematics and optimal correction method. MATERIALS AND METHODS: A mathematical finite element model of a normal spine, including the rib cage, sternum, both clavicles and pelvis, was developed. Using geometric mapping, with standing radiographs and CT images, a 3-D FEM of scoliosis was reconstructed, after translating and rotating the 3-D FEM of a normal spine, with the amounts analyzed from 12 built-in digitized coordinate axes for each vertebral image. With this model, three elements; distraction, translation and derotation, in operative kinematics, were investigated by analyzing the Cobb angle, apical vertebrae axial rotation (AVAR) and thoracic kyphosis. A simulation of a segmental pedicle screw fixation, with rod derotation for scoliosis, was performed. The changes in the Cobb angle, kyphotic angle, AVAR and rib hump were compared after 0 degrees, 15 degrees, 30 degrees, 45 degrees, 60 degrees and 90 degrees rod derotations. RESULTS: In kinematics, the vertebral rod derotation of a major curve, without rod deformation, is less influential in the correction of scoliosis, simply causing an increase in the rib hump. During the simulation, the co-action of distraction and translation, during rod insertion, has a major impact on the decrease in the Cobb angle and in the maintenance of the kyphotic angle. However, after a 30 degrees rod derotation, a decrease in the kyphosis, and increases in the rib hump and AVAR were observed. CONCLUSIONS: The distraction and translation factors were more important in operative kinematics than the rod derotation. With excessive rod derotation, the Cobb angle progressively decreased, but increases in the secondary change in the rib hump and rotation of the apical vertebrae were found.

Results of Subcutaneous Lengthening with Smooth CD Rod in Young Children with Scoliosis before Growth Spurt / 대한정형외과학회잡지

For young children with scoliosis before growth spurt, suhcutaneous lengthening without fusion was designed by Harrington and modified by Moe and Luque. However, many problems including spontaneous fusion, rod breakage, and hook disloclgement have been ohserved. CotrelDubousset(CD) instrumentation was sometimes used, but it usually resulted in failure due to soft tissue adhesion around the rough surface of ordinary CD rod. We tried to use the smooth CD rod, transvcrse-pedicle clawing on the upper part, and pedicle screw inscrtion on upper and lower part of the curve to reduce the hardware failures. Among 8 patients in whom suhcutaneous lengthening with smooth CD rod was carried out hetween October l992 and Suly 1996. 4 cases perfomed with final spinal fusion were analysed. There were I central core disease, 1 multicore disease and 2 idiopathic scoliosis(infantile and juvenile type). Mean age at the first operation was l0.0(8.8-11.8) years, and the Risser sign was all grade 0 except one with grade 1. Suhcutaneous lengthening was performed every 5 or 6 months Mean lengthening duration was 22(9-39) months and mean age at spinal fusion was 11.7(9.6-13.8) years. Mean Cobb angle decreased from 7ldegrees (55degrees-88degrees) at preoperative stage to 32 (10degrees-59degrees) at the last follow-up. There were 5 complications during 21 operations, and three hardware failures comprised 2 hook dislodgcment and 1 screw pull-out. Crankshaft phenomenon happened in I case who had had a posterior fusion in young age(9.6 years) due to laminar fracture. The suhcutaneous lengthening with smooth CD rod can he another option of treatment for young children with severe scoliosis. prescrving the powth potential of involved vertebrae with few complications.