Volume and Weight Changes of Autologous Costal Cartilage Grafts with and without Perichondrium in Human

Autologous cartilage grafts have become an integral part of aesthetic and reconstructive plastic surgery. However, little objective information is available about the actual quantitative resorption of cartilage in human. This study sought to objectively quantify and compare the resorption of costal cartilage in human. To compare the resorption characteristics of rib cartilage autografts, we harvested rib cartilage grafts from 37 microtia patients. All autografts were implanted subcutaneously on chest and then removed after 6 to 17 months. Graft mass and volume were compared before and after implantion. Rib cartilage grafts with perichondrium averaged 10.8+/-7.4% resorption by volume, On the other hand rib cartilage grafts without perichondrium 25.5+/-6.8%. There was no evidence of necrosis or inflammatory changes. The rib cartilage is the preferred source of autogenous cartilage for auricular reconstruction. Short-term resorption of rib cartilage without perichondrium appears to be higher than with perichondrium. The low resorption of cartilage with perichondrium may be due to in part to cartilage forming capacity of the perichondrium. It remains to be seen whether these differences in resorption persist in the long term.

Breast Reconstruction with the Extended Latissimus Dorsi Musculocutancous Flap

Breast cancer patients who underwent mastectomy often experience stress, depression from body changes and loss of femininity. Choice of surgical method is important, because Korean women tend to be sensitive to the shape of the reconstructed breast, donor site scars and the changes in body contour. The latissimus dorsi musculocutaneous flap was one of the first methods of breast reconstruction. However, due to lack of volume, the latissimus dorsi flap has become a secondary choice for breast reconstruction. The authors evaluated the clinical cases who underwent breast reconstruction with the extended latissimus dorsi flaps at the authors' institution from March 2002 to February 2005. During the period, 87 cases of breast reconstruction with the extended latissimus dorsi flap were performed in 86 patients. All flaps survived completely. There occurred no partial necrosis and fat necrosis. The extended latissimus dorsi flap alone without implant could provide good to excellent autologous breast reconstruction for small to moderate sized breasts. Free TRAM flap is currently considered the "Gold standard" in autogenous breast reconstruction. But, the extended latissimus dorsi flap without implant could provide sufficient volume for breast reconstruction in selected cases and it is a reliable method for autologous breast reconstruction.

The Effects of the Application of Human Amniotic Membrane Ointment in Filtering Surgery on Rabbits

PURPOSE: We investigated the anti-inflammatory and anti-fibrotic effects of amniotic membrane(AM) ointment in filtering surgery of rabbits. METHODS: After filtering surgery was performed on both eyes of 10 rabbits, the AM ointment was applied over and under the scleral flap on one eye whereas base ointment excluding AM element was applied to the other as a control. The shapes of blebs were observed under slit-lamp biomicroscopy at postoperative 3 days, 1 week, 2 weeks and 4 weeks, and the tissues were excised for histologic studies. RESULTS: Serial changes of intraocular pressures had no significant difference. Slit-lamp biomicroscopy demonstrated that conjunctival blebs of AM ointment group were more elevated and cystic at 1 and 2 weeks. The heights of conjunctival blebs were significantly higher at 1, 2 and 4 weeks, and the width of scleral tracks was significantly wider at 1 and 2 weeks in AM ointment group. The number of inflammatory cells in the scleral track was significantly less at 3 days and 1 week, the number of fibroblasts in scleral track was significantly less at 2 and 3 weeks in AM ointment group. Masson s trichrome stain was less positive in AM ointment and the stain area of alpha-smooth muscle actin-positive fibroblasts was insignificant with image analysis system. Collagen type 3 appeared in scleral track from postoperative 1 week in control group, however, in AM ointment group, from 4 weeks. CONCLUSIONS: AM ointment is beneficial to suppress fibroblast differentiation, proliferation and inflam-matory reaction in filtering surgery and might be safe and effective adjunctive for enhancement of success in filtering surgery.

A Clinical Study of Small Incision Trabeculectomy

No Abstract Available.

Clinical Efficacy of Trabeculecto my Combined with Aminiotic Membrane Transplantation

We analyzed the clinical result of trabeculectomy with amniotic membrane transplantation which has antifibrotic and antiinflammatory action in risky glaucoma patients. Subjects were included four eyes of four patients with neovascular glaucoma, one eye of one patient with primary open angle glaucoma and four eyes of three patients with congenital glaucoma. After limbal based scleral flap was made in triangular shape with 5x4 mm sized, amniotic membrane, sized by 6x6 mm with epithelial side up, was placed on the scleral flap and then sutured to medial and lateral portion at 3 mm superior to base of scleral flap base with 10-0 nylon(2 points). The state of bleb, intraocular pressure and complications were observed at postoperative 1st, 3rd, 6th and 9th week. The IOP was reduced from 33.6+/-11.1 mmHg, to 15.5+/-6.5 mmHg at postoperative one week, 17.0+/-8.3 mmHg at three weeks, 16.9+/-8.1 mmHg at six weeks, 17.1+/-6.4 mmHg at nine weeks. 6 eyes(77.7%)had controlled IOP under 21 mmHg without antiglaucomatous agents at last follow up. Avascular blebs were observed throughout postoperative period in all subjects. Postoperative complications were shallow anterior chamber in one eye at 1st week and low intraocular pressue in one eye at 1st, 3rd week, that resolved at six weeks. Trabeculectomy with amniotic membrane transplantation on the scleral flap appeared to be effective as an augment therapy for filtering surgery in risky glaucoma.