ABSTRACT
In patients having a short nose with a short septal length and/or severe columellar retraction, a septal extension graft is a good solution, as it allows the dome to move caudally and pushes down the columellar base. Fixing the medial crura of the alar cartilages to a septal extension graft leads to an uncomfortably rigid nasal tip and columella, and results in unnatural facial animation. Further, because of the relatively small and weak septal cartilage in the East Asian population, undercorrection of a short nose is not uncommon. To overcome these shortcomings, we have used the septal extension graft combined with a derotation graft. Among 113 patients who underwent the combined procedure, 82 patients had a short nose deformity alone; the remaining 31 patients had a short nose with columellar retraction. Thirty-two patients complained of nasal tip stiffness caused by a septal extension graft from previous operations. In addition to the septal extension graft, a derotation graft was used for bridging the gap between the alar cartilages and the septal extension graft for tip lengthening. Satisfactory results were obtained in 102 (90%) patients. Eleven (10%) patients required revision surgery. This combination method is a good surgical option for patients who have a short nose with small septal cartilages and do not have sufficient cartilage for tip lengthening by using a septal extension graft alone. It can also overcome the postoperative nasal tip rigidity of a septal extension graft.
Subject(s)
Humans , Asian People , Cartilage , Congenital Abnormalities , Ear Cartilage , Nasal Cartilages , Nasal Septum , Nose , TransplantsABSTRACT
Among several techniques to maintain the lengthened cartilagenous tip structure, septal extension graft with septal cartilage or rib cartilage is most widely used. But in many cases, nasal tip rigidity with unnatural appearance on smiling is one of the major drawbacks of septal extension graft. The authors used a piece of elastic cartilage graft harvested form ear that can act as a cushion buffer between alar cartilage and septum instead of directly fixing the alar cartilage to extended septum for obtaining a less stiff nasal tip with sufficient nasal tip elongation. We called this graft "derotation graft". Derotation graft was performed in 1197 patients via the open nasal approach. Among them, 432(36%) patients had preoperative short nose deformity and 765(64%) patients developed intraoperative cephalic rotation of the tip resulting from procedures for tip projection such as columellar strut. Excellent results were achieved in 1110(93%) patients. 87(7%) patients had unsatisfactory results requiring a revision surgery because of overcorrection or undercorrection of tip rotation, poor tip projection and visible graft on supratip. Derotation graft is a simple, and effective procedure for short nose correction preventing with less post-operative nasal tip rigidity.
Subject(s)
Humans , Cartilage , Congenital Abnormalities , Ear , Ear Cartilage , Elastic Cartilage , Nose , Nose Deformities, Acquired , Rhinoplasty , Ribs , Smiling , Succinates , TransplantsABSTRACT
Many qualitative studies examining the chondrogenic potential of perichondrium have suggested that it may be useful for correction of microtia or for reconstruction of trachea, nasal septum, ala and eyelids, as well as to resurface the temporomandibular joint and small joints in the hand. This study was designed to evaluate cartilage formation by free rabbit auricular perichondrium placed on the muscle fascia of the back of the rabbit for 8 weeks. In addition to free perichondrial graft, AlloDerm(R) and Chitosan, as a scaffold wrapped with perichondrium, were transplanted to the same site respectively. In each case, the chondrogenic potential of perichondrium was examined. The new cartilage was morphologically indistinguishable from normal cartilage. Histologic differences were observed and measured under the light microscope. The mean cartilage thickness for free perichondrium was 0.38 +/- 0.01 mm, 0.64 +/- 0.04 mm for AlloDerm(R) , and 0.55 +/- 0.03 mm for Chitosan after 8 weeks. AlloDerm(R) and Chitosan contributed to produce significantly more neocartilage formation compared with perichondrial graft alone(p < 0.05). No statistic significance was found between AlloDerm(R) and Chitosan grafts. The above result shows AlloDerm(R) and Chitosan could act as a scaffold for generating cartilage and promote the effect on the chondrogenesis of perichondrium.
Subject(s)
Cartilage , Chitosan , Chondrogenesis , Eyelids , Fascia , Hand , Joints , Nasal Septum , Temporomandibular Joint , Trachea , TransplantsABSTRACT
Auricle is frequently used as a donor site of autogenous cartilage graft, but a lot of cartilage donation can make auricular deformity. In various animal studies, perichondrium has been described as the source of new cartilage. However, if any cartilage was formed, the amount was variable and limited. This study was designed to investigate the effect of Alloderm, Chitosan mesh and Gelfoam as a template for chondrogenesis at the donor site of auricular cartilage graft and to compare the effect of single layer perichondrium and double layer perichondrium in chondrogenesis. In each experimental group, one of Alloderm, Chitosan mesh and Gelfoam were implanted at the donor site of cartilage graft in New Zealand White rabbits(n = 18) into two groups. In group I(n = 9), both(ventral & dorsal) sides perichondrium were preserved and in group II(n = 9) only one(ventral) side perichondrium was preserved. Each 3 rabbits were sacrificed at 3, 8 weeks, postoperatively. Formation of neocartilage was evaluated with histological examination. Neocartilage was formed in all control and implanted sites. Templates wrapped with perichondrium groups generated much more neocartilage than control group and there was little difference among each template groups. These results indicat that the amount and regeneration velocity of neocartilage may be controlled by implantation of templates. The template serves as an inducer for the perichondrium to produce chondrogenic cells and serves as a scaffold for the cartilage differentiation. Therefore templates may be helpful in decreasing auricular deformity after graft donation of auricular cartilage and in correcting other structural defects that also require new cartilage formation.
Subject(s)
Animals , Humans , Rabbits , Cartilage , Chitosan , Chondrogenesis , Congenital Abnormalities , Ear Cartilage , Gelatin Sponge, Absorbable , New Zealand , Regeneration , Tissue Donors , TransplantsABSTRACT
No abstract available.
ABSTRACT
Tretinoin(all-trans retinoic acid) is a metabolite of vitamin A and it is useful in the treatment of photoaging skin. Photoaging skin is characterized by wrinkles, mottled pigmentation, dry and rough skin, and loss of skin tone. Current use of topical tretinoin mainly acts on the epidermis, requires a long period to obtain the desired results and may cause skin hyperpigmentation. A combination of topical and injectable tretinoin has been used to reduce the treatment period as a result of its potentialized effect on the dermis when compared to graditional topical cream use. in this study, we observed histologic alterations in 5 white rabbits after using 0.05% topical tretinoin cream and 0.1% injectable tretinoin. Tretinoin was treated on the rabbits ears-group 1 and 2 on the right ear for study 1, and group A and B on the left ear for study 2. Study 1 was done to differentiate whether the dermal thickening is due to the simple physical stretching of dermis by intradermal injection, or whether it is duer to the histologic change by tretinoin. In group 1, saline was injected intradermally and in group 2, tretinoin was injected intradermally. Study 2 was done to compare the dermal thickening between the topical tretinoin cream treatment group (group A) and the combined topical and injectable tretinoin group (group B). Injection was done once a week immediately followed by 340nm blue light skin exposure. These treatment were done for 12 weeks. We harvested skin stripe from all group, group 1 and 2, and group A and B respectively, after 2, 6, and 12 weeks after treatment. Histologic differences were observed and measured. Dermal thickening was observed in group 2 and in group B(p<0.05). The results showed that intradermal injection of tretinoin mainly acts on the dermis and potentialtes the effect on photo-aging skin and fine wrinkles.
Subject(s)
Rabbits , Dermis , Ear , Epidermis , Hyperpigmentation , Injections, Intradermal , Pigmentation , Skin , Tretinoin , Vitamin AABSTRACT
The injection of paraffin for cosmetic purpose is an illegal method as it evokes late complications such as the development of grauuloma, migration of foreign body, inflammation, ulceration, embolic phenomenon, etc. However, paraffin has been used by some unauthorized people for the augmentation of the soft tissue, i.e. face, breasts, as they can easily reansform the body contour in a short time and paraffin is not expensive to do so. Paraffinoma has been reported frequently as a delayed or late complication of foreign body reaction in the field of plastic surgery. And various mehtods of its surgical treatment also has been a topic of plastic surgeon, as postoperative outcome is not satisfactory. As the nose is located at the center of face, the patients who are suffering from paraffinoma in nose could not conceal their deformed appearance by cosmetics. Therefore the only method of improvement is surgical removal of paraffinoma. Paraffinoma of nose has been removed by transcolumellar, infracartilaginous, intercartilaginous incision. However, complete removal of the foreign material does not seem to be possible, may leave complications such as hematoma and overlying skin necrosis, and the remaining foreign material does not permit symmetric appearance. We experienced excision of paraffinoma by direct incision on nasal dorsum. 3 patients with paraffinoma of nose were successfully treated without any complications by vertical elliptical excision on the dorsum of the nose, and scars on nasal dorsum were acceptable with satisfaction by patients. Therefore, the authors concluded that excision of paraffinoma by direct incision on nasal dorsum is a good method for symmetric resection of foreign material, low risk of complication.
Subject(s)
Humans , Breast , Cicatrix , Foreign Bodies , Foreign-Body Reaction , Hematoma , Inflammation , Necrosis , Nose , Paraffin , Skin , Surgery, Plastic , UlcerABSTRACT
Short nose is characterized by decreased distance from the nasion to tip defining point and increased nasolabial angle with increased nostril show. Lengthening the short nose is arguably the most difficult operation in aesthetic rhinoplasty. We have described here a simple and easy technique that lengthen the short nose by using silicone implant has been popular among Asian for augmentation rhinoplasty. Through open rhinoplastic approach, wide undermining of the nasal skin is performed to allow redraping of the skin over the lengthened skeletal framework without excessive tension. Alar cartilage is released from upper lateral cartilage and relocated caudally. After relocation of alar cartilage, silicone implant is inserted in subperiosteal pocket and immobilized by nonabsorbable suture material at dorsal aspect of septal cartilage. Narrow caudal end of implant is sutured between medial crura of alar cartilage which were caudally rotated. This implant not only raise the nasion but can move the tip-defining point caudally by keeping the alar cartilage in new position. Tip graft is done with conchal cartilage. We have got the satisfactory result in cosmetic aspect without any complications.
Subject(s)
Humans , Asian People , Cartilage , Nose , Rhinoplasty , Silicones , Skin , Sutures , TransplantsABSTRACT
Extravasation necrosis due to intravenously administered fluids and drugs is an increasing problem in hospital practice. The incidence of extravasation is variable but skin necrosis is a potentially devastating complication of intravenous therapy. Local injection of hyaluronidase has been recommended for several types of infusion extravasations. The previous studies found hyaluronidase to be effective in the prevention of necrosis following intradermal nafcillin, 12% dextrose, sodium bicarbonate, aminophylline or vince alkaloids.The objectives of the study are to determine the dosage of hyaluronidase which is effective in reducing extravasation necrosis caused by 10% calcium-gluconate and to establish how soon after this extravasation it must be given to retain its effectiveness.Study I evaluated control versus only normal saline group and normal saline with hyaluronidase groups (dose:75,150,300,450 units; all in volume 2 ml, treatment delay:immediate, 15-minutes delay, half hour delay, one hour delay, three hour delay). Size and rate of eschar were compared between groups. Study II was undertaken to examine the evolution of calcium-gluconate induced soft tissue injury in the rabbit. The histologic findings of extravasation sites were compared between groups. A statistically significant protective effect was found in the treated group versus the nontreated group within 15 minutes to 30 minutes. The most effective protection was achieved by the immediate injection of 300 units dosage of hyaluronidase.In conclusion, in the 10% calcium gluconate-induced extravasation, the given data suggest that one can expect the most protective effect with a 300 units dosage of hyaluronidase and within half-hour delay in the treatment group.
Subject(s)
Aminophylline , Calcium , Glucose , Hyaluronoglucosaminidase , Incidence , Nafcillin , Necrosis , Skin , Sodium Bicarbonate , Soft Tissue InjuriesABSTRACT
No abstract available.
Subject(s)
Adult , Humans , Skin , Transforming Growth Factor beta , Wound Healing , Wounds and InjuriesABSTRACT
No abstract available.
Subject(s)
Animals , Rats , Vitamin A , Vitamins , Wounds and InjuriesABSTRACT
No abstract available.