Delay Phenomenon by Lipo-PGE1 in Single Perforator-based Abdominal Skin Flap of Rat

The perforator based flap has been used successfully as a pedicle or free flap and has gained popularity in clinical use. Although Lipo-PGE1 effect on survival rate of musculocutaneous flap is good, but effect on survival rate of perforator based flap is not well known. Therefore, the purpose of this study is to find pharmacological delay effect by using Lipo-PGE1 in abdominal skin perforator flap of rats. Thirty Sprague- Dawley rats were divided into 3 groups. Perforator flaps were designed in rectangular shape, sized 3x7cm to 4x8 cm on abdomen. Flap incision was made deeply enough to the panniculus carnosus, from lateral to medial side and we found four musculocutaneous perforators at each side. Right second cranial perforator was saved, and the others were electrocauterizied. The experimental groups included group I(control): no procedure before the flap elevation; group II(surgical delay): right second cranial perforator was saved, one week before the flap elevation, the others cauterizied. But left four perforators were not injuried.; Group III(pharmacological delay): before the flap elevation, Lipo-PGE1(0.5microgram) was given intraperitoneally for 5 days. On the seventh day after operation, the results were evaluated and compared in terms of flap survival area, vessel counts by Hematoxylin-Eosin stain and Vascular Endothelial Growth Factor (VEGF) protein expression by Western blot. The results were as followings. First, The mean percentages of the flap survival area in Group II(83.75+/-11.07%) and Group III(76.95+/-11.99%) were significantly higher than that in Group I(44.06+/-15.29%)(p<0.05). Second, The vessel counts of Group II(4.4+/-0.84) and Group III(4.3+/-0.82) were significantly higher than that of Group I(2.0+/-0.67) significantly(p<0.05) Third, The VEGF expression is increased in two experimental groups than that of control group. In conclusion, the use of Lipo-PGE1 could increase flap survival area in rat skin perforator flap model, as likely as surgical delay. This phenomenon is thought to be due to choke vessel dilatation and new vessel formation. Therefore, we expect that Lipo-PGE1 can increase rate of flap survivability in perforator based flap as well as that of musculocutaneous flap, only short term use.

The Effects of Time Dependent Lipo-PGE1 Administration on Survival of a TRAM Flap in the Rat

The purpose of the present study was to examine a number of various times of Lipo-PGE1 administration in an attempt to determine the most effective time. In addition, this study examined the possible role of vascular endothelial growth factor(VEGF) on Lipo-PGE1 stimulation of a TRAM flap in the rat. Forty Sprague-Dawley rats were divided into 4 groups and a left inferior epigastric vessel pedicled TRAM flap, sized 5.0x3.5cm was created on the upper abdomen of each rat. Experimental groups included group 1(control): the flap was dissected and replaced, group 2(pharmacologic delay): Lipo-PGE1(0.5microgram) was given intraperitoneally for 5 days before elevation of flap daily, group 3(flap enhancement): Lipo- PGE1(0.5microgram) was given intraperitoneally for 5 days after flap elevation daily, group 4(pharmacologic delay and flap enhancement): Lipo-PGE1(0.5microgram) was given intraperitoneally for 5 days before elevation of flap then for 5 days after elevation of flap daily. On postoperative 5th day, we evaluated and compared the results of flap survival area, the number of blood vessel, and the VEGF expression using the western blot method. The results were as following: First, the mean percentage of the flap survival area of group II(63.9+/-12.6%), III(54.9+/-20.5%), IV(68.1+/- 18.2%) were higher than that of group I(28.7+/-15.2%) significantly(p<0.05). Second, the number of blood vessels were of group II(3.8+/-1.4), III(3.5+/-1.8), IV(4.0+/-1.5) were higher than that of group I(1.0+/-0.6) significantly(p<0.01). Third, the western blot method demonstrated a qualitatively greater amount of VEGF expression in the experimental groups. These results suggest that Lipo-PGE1 increased VEGF production and that Lipo-PGE1 may thereby enhance flap survival through VEGF production regardless of the time of Lipo-PGE1 administration.

The Effect of Duration of Lipo-PGE1 Administration on Flap Survival in a Rat TRAM Model

This study was designed to find out an effective duration of pharmacological delay using Lipo-PGE1 to prevent the ischemic compromise of TRAM flap in rats. Fifty Sprague-Dawley rats were divided into 5 groups evenly and a left inferior epigastric vessel pedicled TRAM flap, sized 5.0 X 3.5 cm was created on the abdomen. Experimental groups included group I(control): no procedure before the flap elevation; group II, III, IV and V(pharmacological delay groups): Lipo-PGE1(0.5mug) was given daily intraperitoneally for 3, 5, 7 and 14 days before the flap elevation. On the seventh day after the operation, we evaluated and compared the results of flap survival rate, vessel distribution through Barium microangiography and histological findings by the hematoxylin-eosin stain and the VEGF immunohistochemistry. The results were as follow: 1) The mean percentage of the flap survival area of group II(52.84 +/-27.03%), III(63.15+/- 16.57%), IV(63.53+/- 13.15%), V(61.44+/- 17.17%) were higher than that of group I(30.42 +/- 14.58%) significantly (p < 0.05). 2) The vessel distribution of the pharmacologic delay groups were more abundant than that of the control group. 3) the vascularity of the pharmacological delay groups were more diffused than that of the control group in the hematoxylin-eosin stain. 4) There was no difference in the expression of VEGF protein within the endothelial cell between the control and the pharmacological delay groups. In conclusion, the use of Lipo-PGE1 for a relatively short term period(about 3-5 days) could remarkably increase the flap survival area in rat TRAM model compared to the surgical delay(2 weeks).

Correction of the Nasal Hump considering the Height of the Nasal Root

Oriental hump nose is characterized by mild degree of the hump, broad dorsum, low nasal height and drooping tip. Therefore, conservative humpectomy followed by either tip-plasty or augmentation rhinoplasty yields more satisfactory results than classical Joseph's nasal hump reduction. However, the degree of the hump as well as the length of the nose can be affected by the height of the nasal root. That is, if the nasal root is too low, the hump nose may stand out and the nose will seem longer than the actual measurements. We think that it is important to consider the height of the nasal root in the course of the nasal hump reduction. During the last 2 year periods, we have classified twenty eight patients with hump nose into three groups, low(group A: 7 patients), moderate(group B: six patients) and high(group C: fifteen patients), based on the nasal root height. Each group went through different operative procedures according to their nasal root height and favorable results were obtained.

Effect of Prostaglandin E1 and the Surgical Delay on the Survival of the Transverse Rectus Abdominis Musculocutaneous Flap in the Diabetic Rat

Transverse rectus abdominis musculocutaneous (TRAM) flap is one of the best flap in breast reconstruction. Even though many trials have been attempted to increase the rate of the flap survival, the necrosis of distal flap area due to vascular compromise is troublesome. The aim of this study was to evaluate the effect of prostaglandin E1(PGE1), surgical delay and the combined procedure on TRAM flap survival rate in vascular compromised rat by diabetes. Left inferior epigastric vessel pedicled TRAM flaps(5.0 x 2.5 cm) were elevated in 40 Sprague-Dawley rats. In control group(N=10), there was no procedure before the flap elevation. In surgical delay group(N=10), the left superior epigastric vessels and the contralateral rectus perforators were ligated 2 weeks before the flap elevation. In PGE1 injection group(N=10), PGE1(0.5microgram) was given intraperitoneally for 2 weeks before the flap elevation daily. In combined procedure group(N=10), the same surgical delay and injection of PGE1 were done simultaneously. On the seventh postoperative day, we evaluated and compared the flap survival rates, the vessel distribution status through Microfil casts, the vessel area rates by histomorphometric analysis in each group. The results were as follows 1) The mean percentages of surviving flap areas of surgical delay group(73.41+/- 10.43%), PGE1 injection group(68.95 +/- 7.13%) and combined procedure group(79.39 +/- 13.44%) were greater than that of control group(44.85 +/- 18.08%) with a statistical significance(p< 0.05). 2) The vessel distributions of each procedure group were more abundant than those of control group in Microfil casts. 3) The mean percentages of vessel areas of surgical delay group(2.74 +/- 0.23%), PGE1 injection group(2.58 +/- 0.49%) and combined procedure group(3.15+/- 0.25) were greater than that of control group(1.24 +/- 0.40%) with a statistical significance(p< 0.05). The results indicated that PGE1 injection or surgical delay procedure could be used to increase the TRAM flap survival area in diabetic condition and the effect of PGE1 was comparable to that of surgical delay procedure. But, the synergistic effect of surgical delay and PGE1 injection was not observed statistically.

A Frontal Sinus Osteoma Presenting as Periorbital Cellulitis

Osteoma is the most common benign tumor of the paranasal sinuses and the frontal sinus is the most frequently involved site. Osteomas are slow growing osteoblastic lesions commonly seen in the outer table of the calvarium, the mandible, the frontal and ethmoid sinus, and occasionally in tubular bones. They are usually detected during the second to fifth decades of life, and reported ratio of male to female is 1.5:1 to 2:1. The symptoms of osteomas are usually developed as gradual growth. They are headaches, facial pain, proptosis, decreased visual acuity, chemosis, diplopia, epiphora, nonpulsating exophthalmus, and transient blindness. Posterior intracranial extension of a frontoethmoid osteoma may lead to brain abscess, intracranial mucocele, tension pneumocephalus. We experienced a 60-year-old male patient who came to the emergency room with acute and severe left periorbital swelling, red eye, and epiphora lasted for 10 days. In a plain radiographs and computerized tomographic scans, a 2.5 x 2.5 x 3.0 cm well marginated mass impressed by osteoma in frontoethmoidal sinus was detected. After the symptoms subsided by conservative treatment, total excision was made by bicoronal approach. Authors reported a frontoethmoidal osteoma presenting periorbital cellulitis without orbital mucocele, which is very rare symptom.

A Case of Malignant Eccrine Spiradenoma / 대한피부과학회지

Malignant eccrine spiradenoma is an exceedingly rare neoplasm. To date about 30 cases have been reported in the literature and there have been 2 reports in Korea. Herein we report a case of malignant eccrine spiradenoma in a 56-year-old female, who had 25-year history of solitary mass on the abdomen. Histologically, the mass consisted of benign eccrine spiradenomas adjacent to carcinomatous area showing nuclear pleomorphism and marked mitotic activity.

Complications after Open Reduction of Blow-out Fracture using Silicone Sheet

Many kinds of alloplastic implants have been used for surgical reconstruction of orbital wall fractures. Although complication rates caused by them are known to be higher than that by autologous grafts such as calvarian bone graft, there are few reports about collective cases for individual alloplastic implants. A retrospective review was performed on 115 patients who underwent orbital blow-out fractures reconstruction with silicone sheet(Silastic(R)) implants between 1989 and 1998. After the follow-up period from 1 month to 5 years, six patients(4.3%) had to undergo reoperations for implant removal because of complications such as infection, hematoma, displacement and extrusion of implant. Symptoms of Silicone sheet complications were progressive periorbital swelling, tenderness, proptosis, hypesthesia and persistant diplopia. Complications were diagnosed by history of Silicone sheet insertion, physical examination and follow-up facial bone or orbit CT. Mean duration of onset was 23.3 months. In all cases of complication, implants were surgically removed and proper antibiotics were used postoperatively. The symptoms subsided immediately without any other sequelae. The reconstruction of blow-out fractures with silicone rubber implant may cause serious late complications such as infection, displacement, hematoma, migration and extrusion. Therefore, careful follow up is nesessary, and prompt sheet removal should be considered first, if such complications are confirmed.

Treatment of Malignant Eccrine Spiradenoma

Malignant eccrine spiradenoma is very rare neoplasm of cutaneous adnexal origin, arising from previously benign eccrine spiradenoma. We present an additional case of malignant eccrine spiradenoma in abdomen of 56-year-old female patient. The mass was stable for 25 years and recently increased in size and became strikingly painful and tender. The excised mass showed typical findings of eccrine spiradenoma 8 its malignancy. There was no evidence of local invasion & distant metastasis. We resected the tumor mass with 3 cm safty margin and have followed up the patient.

Delay Effect of PGE1 on Rat Transverse Rectus Abdominis Musculocutaneous Flap

This study was designed to find an effective delay method for preventing the ischemic compromise of TRAM flap in rat. Forty Sprague-Dawley rats were divided into 4 groups evenly and a left inferior epigastric vessel pedicled TRAM flap, sized 5.0 x 3.5 cm was created on the upper abdomen. Experimental groups included group 1(control): no delay procedure before elevation of flap, group 2(surgical delay): the left superior epigastric vessels and the contralateral rectus perforators were ligated 2 weeks before elevation of flap, group 3(pharmacological delay): prostaglandin E>(0.5 microgram) was given intraperitoneally for 2 weeks before elevation of flap daily, group 4(surgical and pharmacological delay): the same surgical and pharmacological delay have been done simultaneously. On the seventh day after operation, we evaluated and compared the results by the measurement of the flap survival area, the observation of the vessel distribution through Microfil casts and the measurement of vessel surface area through histologic slides. The results were as follows; 1) The mean percentages of the flap survival area of group 2(73.32+/-21.07%), 3(71.77+/-l 17.49%) and 4(89.54 +/-11.38%) were higher than that of group 1(41.23 +/- 14.26%) significantly(p < 0.05). 2) The vessel distributions of group 2, 3 and 4 were much abundant than that of group 1 in Microfil casts. 3) The vessel surface areas of group 2, 3 and 4 were higher than that of group 1 significantly(p < 0.01) and that of group 4 was higher than that of group 2(p < 0.05). In conclusion, prostaglandin E could be used to increase the flap survival area in rat TRAM flap model as a pharmacological delay and the effect of prostaglandin E was comparable to that of the surgical delay.

K-wire Insertion Beneath Zygomatic Arch Under the Fluoroscope for Rigid Fixation of Zygomatic Arch Fracture

The fracture of zygomatic arch is one of the common fracture of the facial bone and commonly reduced by Gillies or Dingman method However, if the reduced bone segments are unstable after reduction, they tend to be displaced by mastication or unintentional external forces. Though many techniques have been introduced for the treatment of the unstable zygomatic arch fracture, all of those techniques have their own shortcomings. We devised a new fixation method to prevent the displacement of the reduced zygomatic arch segments with 0.047 inch K-wire under the fluoroscope. After reduction of zygomatic arch using Gillies method under the fluoroscope, a thin K-ire was inserted along the undersurface of the zygomatic arch through zygoma body for rigid fixation. The inserted K-wire was removed in 4 weeks. In ten cases, good cosmetic and functional results were observed without complications such as infection, facial nerve injury, displacement of fractured segments, and operative scar during the follow up period of 3 months. However, while the pin was being inserted, patients complained discomfort on their cheeks. This technique may be an available method to prevent the displacement of the reduced zygomatic arch and to obtain the rigid fixation.

Retrospective study on the local redurrence and distant metastasis of malignant skin tumors

The results of a retrospective study on 197 cases of malignant skin tumors, which were operated from July 1991 to June 1996 were presented. 1. Primary malignant skin tumors in our series included basal cell carcinoma (42%), squamous cell carcinoma (39%), melanoma (7%). Eighty five percentage of them were developed after 5th decade. There was a slight male preponderance (male to female ratio; 1.2:1). 2. seventy five percentage of malignant skin tumors were occurred in the head and neck. However 34% of squamous cell carcinoma occurred in the extremities. 3. Overall recurrence rate was 7.1% and overall metastasis rate was 7.6%. Seven cases (8.5%) of basal cell carcinoma were recurred without metastasis and seven cases (53.8%) of melanoma were meatastasized without recurrence. 4. Overall recurrence occurred at average 27 months after primary resection and 79% of them occurred in the head and neck. Among 14 recurred tumors, one recurred secondarily and three were metastasized elsewhere. 5.Two thirds of metastasis occurred within one year of resection. Mortality rate in the patients with metastasis was 40%. Metastases involved multiple organs and involved lymph nodes most frequently. 6.Fifteen patients with metastasis were treated with surgery alone (2 cases), surgery and adjuvant therapy (3 cases), radiation and/or chemolherapy without surgery (6 cases), and no therapy(4 cases).

A Case of Subdermal Basal Cell Carcinoma / 대한피부과학회지

Basal cell carcinomas usually arise from the epidermis and show some epidermal connections. It is very unusual that basal celi carcinomas occur as subderrnal mass without epidermal connections. A 51 year-old female h;d an asymptomatic skin colored indurated plaque with linear old scar on the left side of nose fcr about 20 years. She had had a tumor that supposed to be a epidermal cyst, on the same site and the lesion was excised about 20 years ago. We performed the punch biopsy on her first visit which revealed hypertrophic scar. She was treated with intralesional injection of triamcinolone acetonide to reduce the size of hypertrophic scar. However, the lesion had not been reduced. She underwent the surgery to remove the scar at plastic surgery and the excisional biopsy showed a subdermal basal cell carcinoma. We recommend that the newly developed skin tumor in the pre-excised region should be required excisional biopsy instead of punch and close observation