Intraoral Reconstruction using Palatal Island Flap

A Principle of reconstruction is to minimize secondary morbidity using a simple and safe technique, which is to make the best result of shape and fuction after reconstruction using like tissue. Among the many method for oral cavity reconstruction, the palatal island flap is just one of methods which satisfies the principle of reconstruction. We have retrospectively reviewed 7 cases between June 1997 and January 2003 in which palatal island flap were used for the primary reconstruction of postablative intraoral defect. The Incision was made 1cm medial to the teeth and 0.5cm anterior to the junction of the soft and hard palate. The vascular pedicle was carefully identified. We fractured the hamulus of the pterygoid plate and resected the greater palatine foramen as a wedge shape to get an extension of vascular pedicle. The flap to be rotated through 180? into the surgical defect. Postoperative complications containing necrosis, inflammation, wound dehiscence, oronasal fistula did not occur. The palatal donor site was left granulate after applying Terudermis(R) and recovered by secondary intention in 2 weeks with little residual deformity. Palatal island flap offers a reliable method of primary reconstruction for intraoral defect.

A Case Report of Maxillary Reconstruction by Using Vascularized Calvarial Bone and Free Rectus Abdominis Myocutaneous Flap

Total maxillectomy usually results in defects on anterior, posterior, medial and lateral wall of the maxilla besides the palate and the orbit floor. The traditional reconstructive approaches to maxillectomy include skin grafting to line the internal cavity and palatal prosthesis to obturate the palate and serve as a denture. This method is easy to detect tumor recurrence by direct examination. The drawback of this method is that the infection rate is very high and it can not yield structural support to the upper midface. It is not possible to repair the maxillary defects effectively when using only the hard tissue like bone. The reconstruction by using soft tissue makes it possible to repair the defects on the medial nasal wall, eye socket and the palate, but it is impossible to reconstruct the malar eminence. Therefore, the transfer of soft and hard tissue is recommended for the ideal and effective reconstruction of the defect after the total maxillectomy. We have acquired satisfactory results for both fuctional and aesthetical purposes in the cancer patient who received the maxillectomy by using the vascularized calvarial bone and the free rectus abdominis myocutaneous flap.

Clinical trial of daclizumab in living renal transplantation / 대한내과학회지

BACKGROUN: Despite improvements in immunosuppressive therapy for use in renal transplantation, acute graft rejection remains a risk factor of chronic rejection and a major cause of graft loss and patient death. Recently, daclizumab, an anti IL-2 receptor monoclonal antibody has been shown to reduce the incidence of acute rejection. METHODS: To investigate the immunosuppressive effect of daclizumab and the incidence of acute rejection, we administered daclizumab intravenously (1 mg/kg of body weight within 24 hours before transplantation and once every other week afterward, for a total of 5 doses) in combination with cyclosporine microemulsion (CsA), steroid and mycophenolate mofetil (MMF) to 68 transplant recipients RESULTS: Among them 62 were undergoing their first transplantation and 6 were undergoing their second transplantation. 32 patients received living-related transplants and 36 patients received living-unrelated transplants: their HLA match were as follows:1 case with 1 Ag match, 13 cases with 2 Ag matches, 18 cases with 3 Ag matches, 3 cases with 4 Ag matches, 1 case with 5 Ag matches. The clinical characteristics of patients treated with daclizumab were as follows: 42 were male, 26 were female; the mean age of recipients was 42.94 +/- 11.2 years and that of donor was 34.1 +/- 9.9 years. The underlying renal diseases were glomerulonephritis (n=47), reflux nephropathy (n=6), diabetic nephropathy (n=12), polycystic kidney disease (n=2) and acute renal failure (n=1). During the observed period (17.41 +/- 4.34 months; min. 6 months, max. 26 months), 2 cases had acute rejection in the third month after transplantation and 1 case in the 6th month after transplantation, 1 case in the 24th month after transplantation (4/68, 5.8%). In the historical control, 20.8% of acute rejection (10/48) were noted in CsA, MMF and steroid regimen group and 36% of acute rejection (22/60) in CsA, azathioprine and steroid group. Serum creatinine level was 1.21 +/- 0.23, 1.31 +/- 0.25, 1.35 +/- 0.28 and 1.34 +/- 0.31 (mg/dL) during the 1st, 3rd, 6th month and 1 year after transplantation respectively. 10 patients developed herpes-zoster infection and 6 patients had CMV infection. 1 patient expired due to CMV pneumonitis on the 3 months after transplantation. The 2-year graft survival rate was 98.5% with daclizumab and 45 months graft survival rates were 92.9% and 89.3% for MMF group and azathioprine group respectively. CONCLUSION: Daclizumab, used in combination with CsA, MMF and steroid, reduced acute rejection episodes without serious short term side effects. Further observation is needed to evaluate the graft survival rate and uncover any long-term side effects.

Morphological Study on the Dorsalis Pedis and First Dorsal Metatarsal Arteries in Koreans / 대한해부학회지

Morphological variation of the dorsalis pedis and the first dorsal metatarsal arteries are important because these arteries are used as flap pedicles during surgery of hands and feet with tissue defects. The purpose of this study was to investigate variations in the running pattern of the dorsalis pedis and first dorsal metatarsal arteries. We investigated the dorsalis pedis artery in 92 adult cadaver feet and 50 first dorsal metatarsal arteries that arose from these dorsalis pedis arteries were studied. The dorsalis pedis artery was classified into six types according to its running direction. The dorsalis pedis artery running in the direction of the first intermetatarsal space and branching into the first dorsal metatarsal artery was observed in 79.3%. The dorsalis pedis artery coursing laterally and becoming the first dorsal metatarsal artery after changing its direction medially was seen in 5.4%. The dorsalis pedis artery was thin and did not connect to the first dorsal metataral artery, split in the region of ankle and came to an end, and ran laterally and did not connect to the first dorsal metatarsal artery in 8.7%, 2.2%, and 3.7%, respectively. The dorsalis pedis artery ran superficial to the deep fascia in 1 of the 92 specimens (1.1%). The first dorsal metatarsal artery was classified into three types according to the positional relationship between the first dorsal metatarsal artery and the first dorsal interosseous muscle. The first dorsal metatarsal artery ran above or into the first dorsal interosseous muscle in 72% and ran below the first dorsal interosseous muscle in 22%. The first dorsal metatarsal artery that was either above or inside the first dorsal interosseous muscle but could not used as a flap pedicle because it was too small was seen in 6%.