The Relationship of a Combination of Human Adipose Tissue-Derived Stem Cells and Frozen Fat with the Survival Rate of Transplanted Fat

BACKGROUND: The survival rate of grafted fat is difficult to predict, and repeated procedures are frequently required. In this study, the effects of the freezing period of harvested adipose tissue and the addition of human adipose tissue-derived stem cells (ASCs) on the process of fat absorption were studied. METHODS: Adipose tissue was obtained from patients who underwent a lipoaspirated fat graft. The fat tissue was cryopreserved at -20degrees C in a domestic refrigerator. A total of 40 nude mice were used. The mice in the experimental group received three different subcutaneous injections in the back: an injection of fresh fat and ASCs, an injection of fat that had been frozen for one month and ASCs, and an injection of fat that had been frozen for two months and ASCs. The control mice received fat grafts without ASCs. The mice were sacrificed at four or eight weeks after the procedure, and the grafted fat tissues were harvested. The extracted fat was evaluated using photographic analysis, volume measurements, and histological examination. RESULTS: In the control group, the fat resorption rates four weeks after transplantation in the grafts of fresh fat, fat that had been frozen for one month, and fat that had been frozen for two months were 21.14%, 22.46%, and 42.56%, respectively. In the experimental group, the corresponding resorption rates were 6.68%, 13.0%, and 33.9%, respectively. CONCLUSIONS: ASCs can increase the fat graft survival rate. The use of ASCs in fat grafting can reduce the need for repeated fat grafts and provide good long term results.

The Usefulness of the Endonasal Incisional Approach for the Treatment of Nasal Bone Fracture

BACKGROUND: Among all facial fractures, nasal bone fractures are the most common, and they have been reduced by closed reduction (CR) for a long time. But several authors have reported suboptimal results when using CR, and the best method of nasal bone reduction is still being debated. We have found that indirect open reduction (IOR) through an endonasal incisional approach is a useful method for more accurate reduction of the nasal bone. METHODS: A retrospective chart review was performed of 356 patients who underwent reduction of a nasal bone fracture in our department from January, 2006, to July, 2011. We treated 263 patients with IOR. We assessed patients' and doctors' satisfaction with surgical outcomes after IOR or CR. We evaluated the frequency of nasal bleeding owing to mucosal injury, and followed the surgical outcomes of patients who had simultaneous dorsal augmentation rhinoplasty. RESULTS: According to the analysis of the satisfaction scores, both patients and doctors were significantly more satisfied in the IOR group than the CR group (P<0.05). Mucosal injury with nasal bleeding occurred much less in the IOR group (5.3%) than the CR group (12.9%). Dorsal augmentation rhinoplasty with IOR was performed simultaneously in 34 cases. Most of them (31/34) showed satisfaction with the outcomes. CONCLUSIONS: IOR enables surgeons to manipulate the bony fragment directly through the endonasal incisional approach. However, we propose that CR is the proper technique for patients under 16 and for those with comminuted nasal bone fractures because submucosal dissection in IOR can damage the growth or circulation of nasal bone.

Anatomical Measurement of the Masseter Muscle and Surface Mapping of the Maximal Thickness Point Using Computed Tomography Analysis

PURPOSE: Masseter muscle is an important muscle of mastication. Because it has a great influence on the shape of low facial contour, patients who have masseteric hypertrophy show square-shaped jaw appearance. As aesthetic procedures for the reduction of the masseter muscle volume, radiofrequency ablation or botulinium toxin injection is at the center of attention. Authors studied the anatomical measurement of the thickness and width of masseter muscle and the surface mapping of the maximal thickness point using computed tomography(CT) scan to identify the useful guide for the injection of botulinum toxin in masseteric hypertrophy patients. METHODS: We analyzed 2 mm-thickness OMU(ostiomeatal unit) CT of 112 normal people(224 masseter muscles) taken from June 2009 to May 2010. First, we measured the thickness, width and depth of the masseter muscle from the skin surface and analysed each by side, sex and age, respectively. The distribution of the thickness of the muscle and the correlation of thickness and width of the muscle were studied also. Second, we underwent surface mapping of the maximal thickness point using CT analysis by means of checking the vertical and horizontal distance from the angle of the mandible. RESULTS: The average thickness and width of the masseter muscle was 17.73 mm and 40.78 mm in the male patients and were 14.33 mm and 37.42 mm in the female patients. Statistically, both figures of the male patients were larger than those of the female patients. However, the depth of the muscle from the skin surface in female patients (7.37 mm) was larger than that of the male patients(6.15 mm). There were no statistical difference in side or age. The width and thickness of the masseter muscle were in the positive correlation. The location of maximal thickness point of the masseter muscle was 27.77 mm vertically and 27.68 mm horizontally in the male patients, and 25.19 mm vertically and 25.42 mm horizontally in the female patients from the angle of mandible. CONCLUSION: We were able to present statistical evidence of the diagnosis and treatment of the masseteric hypertrophy regarding the anatomical measurements such as the thickness and width. And the maximal thickness point of the masseter muscle may be a useful guide for the clinical procedures of botulinium toxin injection.

A Case Report of Focal Ossification of the Auricular Cartilage

PURPOSE: The focal ossification of auricular cartilage is an unusual clinical entity in which the ear becomes partially or totally rigid and immalleable. This condition may result from cold injury, local trauma, inflammation, or various systemic diseases. Patients may feel mild discomfort, but there are usually no other serious symptoms. We present a case of focal ossification of auricular cartilage in which the cause is unknown. METHODS: A healthy 58-year-old man presented with a 2-year history of hard mass of right posterior auricular area. He denied any precipitating historical events like cold injury and inflammation. Routine testing did not demonstrate systemic abnormalities. Ultrasonographic examination revealed a 22 x 10 x 11 mm sized heterogenous isoechoic mass showing an acoustic shadow. RESULTS: Excisional biopsy was performed under local anesthesia. Histological examination revealed the ossification with deposition of trabecular bone in normal elastic cartilage. The patient was healed without any problems and satisfied with the result. CONCLUSION: We report clinical experience of focal ossification of auricular cartilage, which is quite a rare clinical entity. It should be considered that there is the possibility of ossification of cartilage when it meets the benign mass of the ear.

Removal of a Movable Foreign Body in the Flexor Tendon Sheath of the Hand: A Case Report

Traumatic implantation of foreign material into the hand is common. Such material may be palpable or identified by plain radiographs or ultrasonography. Surgical exploration and removal is usually a simple procedure, with the foreign material found close to the point of insertion. However, migration of foreign material within the flexor sheath can occur very rarely. We report the patient who had a movable foreign material in the flexor tendon sheath of the hand. Using milking method, foreign material in the flexor sheath was successfully removed.

Correlation Analysis of Ocular Dominance and Levator Palpebrae Superioris Muscle Function

PURPOSE: Most of the bilateral structures in our body are not perfectly balanced, such that one side is preferred than the other or it has physiological superiority. Eyes also have an imbalance; the eye with sensory and motional superiority compared to the other is called dominant eye. Authors of this study focused on analyzing the correlation between the dominant eye and levator palpebrae superioris muscle. METHODS: The subject of this study was 42 patients with no ptosis and with no past history of blepharoplasty. Hand dominance was identified through questionnaire and dominant eye was identified by hole-in-the-card dominance test (Dolman's test) in all patients. The function of levator palpebrae superioris muscle was measured by MLD (marginal limbal distance). During the measuring procedure, frontalis muscle was not inhibited to avoid the eyelid skin hooding. RESULTS: Out of 42 patients, 27 patients(64.3%) were right ocular dominant, 15 patients(35.7%) were left ocular dominant, 36 patients(85.7%) were right hand dominant and 4 patients(9.5%) were left hand dominant. Out of 27 right ocular dominant patients, right MLD was larger than the left in 26 patients(96.3%). It was larger in average of 0.47mm(p<0.001) in 27 right ocular dominant patients. Also, left MLD was larger than the right in 11 patients (73.3%) out of 15 left ocular dominant patients. It was larger in average of 0.57mm(p=0.003) in 27 left ocular dominant patients. MLD on the side of the dominant eye was larger in average of 0.50mm(p<0.001) than the MLD of non-dominant eye side. Right MLD was larger than the left in average of 0.28mm(p=0.010) in right hand dominant patients, and left MLD was larger than the right in average of 1.15mm(p=0.025) in left hand dominant patients. CONCLUSION: The function of levator palpebrae muscle differs in right and left, and the difference correlates with the dominant eye. Also, the function of levator palpebrae muscle is stronger in the dominant eye. We were able to present statistical evidence regarding the difference of the function in right and left levator palpebrae muscle. This may be a factor worth consideration in terms of balancing the eyes during the blepharoplasty.

Survival of a Neartotally Amputated Auricle by Simple Closure and Medical Leech

PURPOSE: In an amputated auricle, a microvascular anastomosis is the best treatment of choice. But, the neartotally amputated auricle which is connected by very narrow tissue pedicle to the head, can survive by simple attachment without a microvascular anastomosis owing to the rich vascular network through the superficial temporal artery and posterior auricular artery. In cases of venous congestion resulting from a lack of vein anastomosis, medical leeches (Hirudo medicinalis) can solve the problem. We are reporting the case of a 6-year-old boy who had a neartotally amputated auricle with successful results by simple closure and medical leech treatment without a microvascular anastomosis. METHODS: A 6-year-old male patient had an left auricular injury by an escalator accident. The left auricle was neartotally amputated from the temporal head with connection only by very narrow skin and subcutaneous pedicle(about 1cm in width) at the helical root of upper and anterior part of auricle. Marginal bleeding from the avulsed auricle was noted and the arterial blood was supplied from a branch of upper auricular branch of the superficial temporal artery. The auricle was repaired by simple closure including cartilage and skin without any vascular anastomosis. After simple closure, the auricle showed good circulation with pink color. But on the 2nd day after the operation, there was a venous congestion with severe swelling, which resulted in a purplish colored auricle. The venous congestion disappeared after using medical leeches by the 5th day after the operation. RESULTS: The repaired auricle showed aesthetically and functionally satisfactory result with normal development at the 9 months follow-up check after the operation. CONCLUSION: In cases of neartotally amputated auricles of children or crushing injury in which microsurgery is difficult, we can try simple closure with the use of medical leeches in treating a of venous congestion for a successful result.

Survival of a Neartotally Amputated Auricle by Simple Closure and Medical Leech

PURPOSE: In an amputated auricle, a microvascular anastomosis is the best treatment of choice. But, the neartotally amputated auricle which is connected by very narrow tissue pedicle to the head, can survive by simple attachment without a microvascular anastomosis owing to the rich vascular network through the superficial temporal artery and posterior auricular artery. In cases of venous congestion resulting from a lack of vein anastomosis, medical leeches (Hirudo medicinalis) can solve the problem. We are reporting the case of a 6-year-old boy who had a neartotally amputated auricle with successful results by simple closure and medical leech treatment without a microvascular anastomosis. METHODS: A 6-year-old male patient had an left auricular injury by an escalator accident. The left auricle was neartotally amputated from the temporal head with connection only by very narrow skin and subcutaneous pedicle(about 1cm in width) at the helical root of upper and anterior part of auricle. Marginal bleeding from the avulsed auricle was noted and the arterial blood was supplied from a branch of upper auricular branch of the superficial temporal artery. The auricle was repaired by simple closure including cartilage and skin without any vascular anastomosis. After simple closure, the auricle showed good circulation with pink color. But on the 2nd day after the operation, there was a venous congestion with severe swelling, which resulted in a purplish colored auricle. The venous congestion disappeared after using medical leeches by the 5th day after the operation. RESULTS: The repaired auricle showed aesthetically and functionally satisfactory result with normal development at the 9 months follow-up check after the operation. CONCLUSION: In cases of neartotally amputated auricles of children or crushing injury in which microsurgery is difficult, we can try simple closure with the use of medical leeches in treating a of venous congestion for a successful result.