Clinical Analysis of Pediatric Mandibular Fractures

This retrospective study comprised 50 patients(57 fractures) with pediatric mandibular fractures sustained in various accidents and treated in the Department of Plastic and Reconstructive Surgery at the Dong-A Medical Center from September 1990 till May 2005. These patient's medical records were then retrospectively analysed in order to gain insight into a clinical pattern. 1.The seasonal and monthly incidence was the highest in Summer and August, the commonest accident time was between 12:00 p.m and 06:00 p.m. 2.The highest incidence in the age was between seven and nine years old, with male predominating over female in 1.7:1 ratio. 3.The most common cause of mandibular fractures was motor vehicle accidents followed by fall, exercise accident and others. 4.Nasal bone fracture was the commonest associate facial bone fracture. 5.Open reduction was done in 59% of total cases. 6.The cases of condyle fracture were treated with closed reduction or conservative management. Complications were malocclusion(4), TMJ limitation(2), asymmetry(2).

The Effect on Pulmonary Function after Abdominoplasty

Theoretically one might suggest the abdominoplasty can cause respiratory decompensation resulting from musculofascial plication, which reduces the respiratory reserve by decreasing intra-abdominal volume and diaphragmatic excursion. This prospective study was perfomed to evaluate the effect of abdominoplasty and the change of intraoperative Paw on the pulmonary function of 20 consecutive otherwise healthy subjects. The pulmonary function test was performed preoperatively, and repeated 2 months after the operation. Additionally, we monitored intraoperative Paw. Comparison of the pulmonary function test showed a significant decrease(p<0.001) in the mean forced vital capacity(FVC) and the mean forced expiratory volume in one second(FEV1) throughout the study period. Postoperatively, the mean FVC decreased by 11.65% and the mean FEV1 decreased by 16.15%. The mean Paw increased by 6.6cmH2O(3-12cmH2O) by musculofascial plication. And we found that the decrease in FVC and FEV1 was significantly correlated with intraoperative changing of Paw in abdominoplasty(p<0.001). FVC and FEV1 could be decreased by abdominoplasty due to decreasing intra-abdominal volume and diaphragmatic excursion, but there was no respiratory symptom clinically in all patients 2 months after the operation. In conclusion, We found that the decrease in FVC and FEV1 after 2 months of abdominoplasty was significantly correlated with intraoperative Paw change during operation. The intraoperative Paw was increased to 12 cmH2O without any respiratory symptom in this study. We suggested that the increase in intraoperative Paw less than about 10cmH2O can not affect on respiratory function clinically.

A Comparative Evaluation of Various Axillary Osmidrosis Treatment

Axillary osmidrosis caused by excessive secretion of apocrine glands, which causes an malodor and extreme social embarrassment. To remove the apocrine glands, various types of treatment methods for axillary osmidrosis have been introduced. They could be summarized as manual of instrumental subdermal shaving, ultrasonic assisted liposuction, Botox(R) injection, electrical probe, laser dessication, etc. Surgical removal of apocrine glands has been the favored treatment for the several decades, but such complications as long-term postoperative immobilization period, skin necrosis, hematoma, and visible scars have been frequent. Recently, for the purpose of reducing these complications, some operators have advocated other procedures such as axillary ultrasonic assisted liposuction, Botox(R) injection, laser dessication. From March 2002 to April 2003, we have corrected the axillary osmidrosis in 80 cases using the subdermal shaving(24 cases), ultrasonic assisted liposuction(20 cases), Botox(R) injection(10 cases), electrical probe(26 cases). Of these operation, manual dermal shaving had the lowest recurrence rate, but disadvantages of this procedure was 4-5cm axillary scar, moderate post operative complication, long immobilization period. Otherwise Ultrasonic assisted liposuction had many advantages which were simple operation technique, short operation time, early recovery of social activity, rare post operative complication, invisible scar, lower recurrence rate. In case of Botox(R) injection was also simple operation technique, but which was short term effect about 6 months so it was necessary to treat repetitive injection but relatively high recurrence rate in severe osmidrosis. In case of electrical probe was also simple operation technique, but which was vague treatment effect, need to repetitive operation and relatively high recurrence rate in severe osmidrosis. In comparative evaluation of these methods, ultrasonic assisted liposuction was considered better results to osmidrosis treatment than others method in many aspects.

Parasacral Perforator - Based Island Flap for Pressure Sore

For treatment of the pressure sore, variable methods have been developed such as skin graft, local flap, myocutaneous or fasciocutaneous flap. The myocutaneous flap has been used commonly for the coverage and padding of the wound. However, sacrifice of the deep muscles causes some problems such as intraoperative bleeding, functional disabilities of donor sites, and difficulty in controling the volume of the flap for the skin reability of myocutaneous flaps. To overcome these disadvantages, we tried perforator-based myocutaeous island flaps for reconstruction of buttock area. During the dissection of the flap, we could control the volume and shape of the flap exactly depending on the perforator. And minimal morbidity of the donor site is expected because of significant volume of gluteus maximus muscle need not be sacrificed. The perforator-based flaps are especially indicated for ambulatory patients, and for paraplegic patients as well. Clinically, total of 20 cases were treated with 13 parasacral perforator-based myocutaneous island flaps and 7 parasacral perforator-based fasciocutaeous island flaps. The mean operating time was 84 minutes, and the mean flap size was 8x9.2 cm. In donor sites, primary closure were done in all cases, post operative complications were wound dishescence in 1 case, venous congestion in 3 cases, but immediately improved. Recurrence was not reported.

Case Report of Merkel Cell Carcinoma in 5th Finger

Merkel cell carcinoma is an uncommon cutaneous tumor that is considerable locally aggressive and often spreads regionally through lymphatic channels. Evaluation of surgical treatment methods has been hampered by the low incidence of this tumor. Current standards of treatment include wide surgical excision and regional lymphadenectomy if clinically suspicious nodes are present. We report a first case of Merkel cell carcinoma in a 48-year-old female. She had solitary subcutaneous mass on left 5th finger. Wide local excision 1.5 cm along margin was done, and wound was covered by reverse radial forearm fascial flap. One month later, axillary lymph node was enlarged and treated by radiotherapy. Further evaluation and follow-up were needed.