Nipple Reduction Preserving C-V Flap Tissue in Male Nipple Hypertrophy: Idea Innovation

PURPOSE: Male nipple hypertrophy is a rare condition but is a social embarrassment for individual. The currently available techniques of nipple reduction already described in the literature for female patients are discussed, but the goal of treatment is different in male patients. In male patient, the diameter as well as vertical height should be reduced simultaneously to achieve better aesthetic results. Our new technique can reduce the diameter of the hypertrophic nipple as well as the vertical height efficiently and simply. METHODS: A 19-years-old man with nipple hypertrophy on the right chest presented. The flap is designed based on the site of left nipple, symmetry, the diameter, and the projection desired. The widths of the V flaps determine projection, whereas the diameter of the C flap determines the diameter of the nipple and top of the new nipple. Unnecessary hypertrophic tissues are extirpated and the V flaps are elevated. The nipple base is reduced by purse-string suture technique. The V flaps are wrapped around, and C flap is used as a cap. RESULTS: No complication including nipple necrosis or sensory loss were found during follow-up period. The normal symmetry of the nipple contour was restored. CONCLUSION: We describe a simple technique for male nipple reduction using a C-V flap with purse-string suture. In our experience, this technique has provided good aesthetic result and patient satisfaction.

Late Vascular Complication after Mandibular Ramus Sagittal Split Osteotomy: A Case Report

PURPOSE: The mandibular ramus sagittal split osteotomy is a common procedure in cosmetic surgery. A late complication of this procedure, pseudoaneurysm rarely happens. The purpose of this case is to present our experience that is rare late vascular complication after mandibular ramus sagittal split osteotomy. METHODS: A 21-year-old male was operated by local plastic surgeon for treatment of mandibular prognathism. After 9 days, the man was transferred to our hospital with persistent bleeding and swelling on the mandibular area. We operated the man three times and failed to control hemorrhage. Therefore, we did angiography and found the pseudoaneurysm on the buccal and pterygoid branches of internal maxillary artery. Then we did selective embolization for removal of the pseudoaneurysm. RESULTS: The man was operated using the therapeutic embolization, and the pseudoaneurysm was removed. The results were successful, and we couldn't find any bleeding and the pseudoaneurysm during the follow-up of 12 months. CONCLUSION: The selective embolization is the good therapeutic method of late vascular complication after mandibular ramus sagittal split osteotomy.

Late Vascular Complication after Mandibular Ramus Sagittal Split Osteotomy: A Case Report

PURPOSE: The mandibular ramus sagittal split osteotomy is a common procedure in cosmetic surgery. A late complication of this procedure, pseudoaneurysm rarely happens. The purpose of this case is to present our experience that is rare late vascular complication after mandibular ramus sagittal split osteotomy. METHODS: A 21-year-old male was operated by local plastic surgeon for treatment of mandibular prognathism. After 9 days, the man was transferred to our hospital with persistent bleeding and swelling on the mandibular area. We operated the man three times and failed to control hemorrhage. Therefore, we did angiography and found the pseudoaneurysm on the buccal and pterygoid branches of internal maxillary artery. Then we did selective embolization for removal of the pseudoaneurysm. RESULTS: The man was operated using the therapeutic embolization, and the pseudoaneurysm was removed. The results were successful, and we couldn't find any bleeding and the pseudoaneurysm during the follow-up of 12 months. CONCLUSION: The selective embolization is the good therapeutic method of late vascular complication after mandibular ramus sagittal split osteotomy.

Restoration of the Injured Fingertip with Eponychial Cutaneous Flap

The restoration of the fingernail is not simple in case of amputated distal fingertip which involved the pulp and nail. The nail should maintain a length of at least 2mm from the eponychium for an adequate grip and decent appearance. Various methods to reconstruct the fingernail bed are available. The nail bed graft from amputated finger or great toe, and free onychocutaneous flap are commonly used. The nail bed of the injured tip tends to be atrophied, deformed and failed as a graft. And the great toe is often turned down as a donor. We have restored satisfactorily the nail beds of three injured finger tips with eponychial cutaneous flaps. The pulps were reconstructed with either a reverse dorsal digital island flap or free pulp graft. Repeated again. A mean follow- up was six months. The nail grew up to the average of 3.7mm. All patients were satisfied with the length of the nail and met with good cosmetic results. An eponychial cutaneous flap is useful to restore the nail of the distal fingertip amputation. The procedure is relatively simple and morbidity is minimum.

Distraction Osteogenesis for Early Correction of Sagittal Craniosynostosis

Sagittal synostosis with related functional aspects of elevated ICP, hydrocephalus, mental retardation and visual abnormalities, or with multiple suture synostosis, surgical correction is imperative. But, craniofacial surgery may impose a threat to an infant or small child. The blood volume in these patients is small and a minor hemorrhage may induce proportionately greater blood loss, resulting in a greater stress to the patient's system. Mortality resulting from craniofacial surgery is uncommon, mostly from operative hemorrhage and infections. Releasing the stenosis and reshaping the cranial vault is the primary operative goal. Authors sought to minimize surgical stress on the child and attain control of cranial vault reshaping by gradual distraction osteogenesis in treating children with sagittal suture synostosis. Three sagittal synostosis patients, aged from 11 months to 3 years old were treated. One of the patients had multiple suture synostosis. Patient follow-up ranged from 3 months to 3 years. Biparietal bone flap was elevated and external distraction devices were inserted. Distraction rate varied from 0.5 to 1mm/day, without a latency period. After a consolidation period of 2-3weeks, the devices were removed. Functional aspects of ICP and mental retardation subsided post surgery. Radiological follow-up showed cessation of enhancement of bone deposition at the frontal and occipital sutures. Excellent aesthetic results were accounted for in all three of the patients. Application of distraction osteogenesis in correcting sagittal craniosynostosis is very effective; surgical stress on the patients is minimal and controlled cranial vault reshaping is possible.

Histologic Change of Injected Fat Cell Taken by Different Technique

No abstract available.

Evaluation of the Interfaces Between Implants And Regenerated Bone Using Bone Morphogenetic Protein and Demineralized Freeze-dried Bone

Various methods and graft materials have been used to fill in the defect adjacent to the implants and considered as clinically acceptable. But it is not clear whether the regenerated bone increases the implant-bone contact and supports the implant. The purpose of this study is to evaluate regenerated bone surrounding implants using bone morphogenetic protein(BMP) and demineralized freeze-dried bone(DFDB), and the interfaces between implants and regenerated bone. bBMP was extracted and partially purified from the bovine bone matrix using heparine chromatography. Demineralized freeze-dried bone was made from the dog. Inactive insoluble collagenous bone matrix(IBM) of dog was used as carrier of bBMP. Interfaces of titanium coated epoxy resin implants were processed for demineralized section for transmission electron microscopy(TEM) and those of screw type implants were for nondemineralized section for light and fluoromicroscopic examination. Implants were inserted in the inferior border of mandible of adult dogs and artificial bony defects (3x3x4mm) were made at the mesial and distal side of implants. Defects were filled with BMP(BMP group) and DFDB(DFDB group). For the fluoromicroscopic examination, the fluorescent dyes (oxytetracycline, calcein green, alizarin red) were injected 2, 4, 6, 8, 12 weeks after implantation. The experimental animals were sacrificed at the 6th and the 12th week and their mandible were extirpated and processed for examination with light microscopy, fluoromicroscopy and TEM. The obtained results were as follows : 1. By the light microscopic findings, the defects were filled with woven bone at the 6th week and compact bone at the 12th week, and the osseointegrations were seen in both groups. There was no histological difference between them. 2. On the basis of the histomorphometric analysis, BMP group (6th week: 40.25%, 12th week: 56.04%) had higher bony contact ratio than DFDB group (38.37%, 42.63%). There was significant difference between two groups at the 12th week (P<0.05). 3. The amount of bone formation in BMP group was more prominent than in DFDB group. Significant difference was noted among two groups at the 6th and the 8th week (P<0.05). 4. By the transmission electron microscopic findings, 0.4-2micrometer soft tissue layer was found in adjacent to the interfaces and over the collagen fibrils of bone at the 6th week. However, about 100nm amorphous layer was noted at the interface or collagen fibrils directly extended to the titanium surface at the 12th week. There was no significant difference between two groups. 5. These results suggest that BMP and DFDB can be used as good graft materials in the regeneration of bone adjacent to implant, and BMP is more valuable as a bone inducer than DFDB.