Correction of Inverted Nipple Using Modified Teimourian Method

Inversion of nipple is a common condition occurring with an incidence of 2% in women. It not only causes irritation and inflammation, but also causes aesthetic problems, affecting sexual relationships and psychological well-being of the patients. Several methods have been introduced to treat this condition in the past century, but the major principle of correction is based on the concept suggested by Schwager, that inverted nipple develops because of the lack of connective tissue located directly beneath the nipple. Based on this concept, many surgeons including Broadbent, Teimourian, and Elshy etc. have proposed that adding bulk of connective tissue and scarifing the ductal system is the principle of the treatment. Author`s method is also based on such a concept, and we have modified the Teimourian method. First, an intraglandular section in the shape of an inverted cone was performed. The crator-like glandular section was closed using horizontal mattress suture, leading to circumglandular V-Y advancement. Second, the donor sites on the areolar area were closed with V-Y advancement. Third, purse-string suture was performed to achieve neck tightening and to compensate for the lack of connective tissue beneath the nipple. Dermal flap suture was done by Foot-plate manner. We operated on 52 cases using this method, 28 patients during past 2 years. After 1 year following the operation, there were just two cases of relapse and virtually no complications. We obtained satisfactory projection of the nipples in all patients except in 2 cases. The resulting shapes and scars were acceptable to all patients.

Two Cases of Ear Reconstruction Using Prefabricated Radial Forearm Free Flap

Deformities of the auricular region that have been resulted from burns or other traumatic injuries emotionally devastate the patients and frustrate the surgeons. The surgical procedure for ear reconstruction varies depending upon the quality and quantity of available skin in the auricular region after burns and other facial trauma for the coverage of cartilage framework. Postauricular skin, postauricular fascia, temporoparietal fascia have been used for traumatized ear reconstruction according to the literature. But toral ear reconstruction in the cases of severe trauma like burn or traffic accident is one of the most difficult problems because of its paucity and poor quality of the available skin in the auricular region. The author reports two cases of traumatized ear reconstruction using a prefabricated radial forearm fasciocutaneous free flap made of an autogenous costal cartilage framework. This flap is valuable for the reconstruction of severely traumatized ear when local tissue or other free flaps are improper to select.

Endoscopic Reconstruction of Zygomatic Bone Fracture without Periorbital Incision

Endoscopic techniques have revolutionized current surgical techniques and have now been introduced to plastic surgery including zygomatic fracture repair. The main advantages of endoscopic zygomatic fracture repair are the minimization of scars, avoidance of undesirable risks and sequelae of the traditional open method. In previous endoscopic techniques for repair of zygomatic fracture, some used various additional percutaneous incisions besides temporal scalp and intraoral incisions for approach of the infraorbital rim and the zygomaticofrontal region, and others who did not use those additional incisions skipped the infraorbital rim fixation. The authors performed 16 cases of the reconstructions of the zygomatic bone fractures with endoscopic approach between September 1999 and April 2002, and all the fracture sites showing fracture displacement were approached using temporal and intraoral incisions only. The fracture sites over the zygomaticofrontal area and arch were stabilized with plates and screws through temporal scalp incisions under endoscopic control. Also the fracture of the zygomaticomaxillary buttress and the infraorbital rim were restored through upper buccal sulcus incision. All the patients showed rapid recovery without visible scar, and obtained acceptable zygoma symmetry, which was confirmed on the postoperative CT scans. With the use of the endoscope, we could minimize morbidity, and obtained favorable functional and aesthetic results.

Comparative Effects of Retin-A and Vitamin C on Photoaging Skin

Photoaging skin occurs as a result of long-term exposure to ultraviolet radiation. In contrast to intrinsic aging, skin changes of photoaging can be reversed by the topical use of skin care products. Several skin care products have now undergone sufficient evaluation and have a well-defined role in our practice. Retin-A and alpha hydroxy acids have a significant number of data available for evaluation; data for Vitamin C and antioxidants are still emerging. We conducted clinical trial to compare the anti-photoaging effects of Rein-A and Vitamin C in 25 women volunteers. Each formulation wes applied daily to the randomly assigned hemifaces over the 8-month study period. Comparative evaluations of anti-photoaging effects were made using subject self-appraisal questionnares, plastic surgeon's assessment, ultraviolet revelations, and histologic examinations. Subject self-appraisal and plastic surgeon's assessment showed predominance of Retin-A over Vitamin C. But both Retin-A and Vitamin C provided objective and subjective improvement in photodamaged facial skin and no significant difference was found between Retin-A and Vitamin C in histologic examinations.

Treatment of a Giant Pigmented Nevus using an Alloderm: A Case Report

Because a giant pigmented nevus has the risk of malignant transformation to malignant malanoma, early surgical excision is recommended. There have been various types of surgical methods in a giant pigmented nevus, for example dermabrasion, staged excision, skin graft, local flap and tissue expander. The authors have used an alloderm combined with a very thin split thickness skin graft in the treatment of a giant pigmented nevus. Among the 3 patients we operated in 1999, we could not find a significant cosmetic difference compaired with the conventional split thickness skin graft. Our method with the use of an alloderm combined with a very thin split thickness skin graft would be considerable in the treatment of a giant pigmented nevus, because it shows less visible scars in donor site than conventional split thickness skin graft. Moreover, we could harvest skin graft from the same site twice or more times.

Correction of Facial Soft Tissue Defects Using Acellular Human Dermal Allograft

The augmentation of soft-tissue defects in the facial region is a challenging task for plastic and reconstructive surgeons. Numerous materials, both autologous and nonautologous materials including alloplastic implants, have been used for augmentation of soft-tissue defects of the face. Each has its limitations. There is no ideal material for soft-tissue augmentation. Acellular human dermal allograft (Alloderm, LifeCell Corporation, Woodlands, Texas, U.S.A.) combines the benefits of autografts and allografts. Alloderm does not appear to be resolved, it is a much more cost- effective treatment than fat injection, collagen injection, or other treatments that require multiple surgical operations or repeated application. Using Alloderm eliminates the need for creating a donor site. The authors report its use in 13 patients who have soft-tissue defects in the face. No serious complications such as rejection, absorption, dislocation, or extrusion were encountered. Alloderm appears to be an easily handled, safe material to use as an implant for permanent soft-tissue augmentation. Further long-term tudies are warranted to monitor the persistent volume maintenance of Alloderm.

Surface Cooling Effect on Epidermal Damage by 585-nm Pulsed Dye Laser

Extensive clinical research has demonstrated that the 585-nm pulsed dye laser(PDL) is effective in eradicating port-wine stains(PWS) and telangiectasia with an extremely low incidence of scarring. The successful treatment of laser therapy is based on selective photothermolysis of blood vessels without damaging the normal overlying epidermis. Unfortunately, the native epidermal melanin acts as an optical shield that absorbs the laser light and reduces the heat generated in blood vessels. When melanin absorbs laser light, the resultant temperature increase can induce epidermal blistering. In these patients, the laser treatment dosages must be kept low, often subtherapeutic, to avoid damage to the epidermis and to prevent the possibility of scarring. Cryogen spray cooling of skin may be an effective method for minimizing epidermal thermal injury. The objective of this study is to determine histologically the effectiveness of the cryogen cooling by spraying the skin with a brief spurt of cryogen prior to the laser pulse, so as to reduce epidermal damage (hypo/hyperpigmentation) caused by this laser. We present a histologic study of the thermal response of the skin of the Sprague-Dawley rats to spray cooling in conjunction with 585-nm pulsed dye laser irradiation with 6J/cm. Both treatment sites with and without the use of the cryogen spray were compared. Under light microscope, the epidermal and dermal histologic changes were compared. A significant reduction in epidermal damage was found in study groups using the cryogen cooling without changing the efficacy of the laser treatment statistically. And a significant reduction in healing periods was observed in study groups using the cryogen cooling prior to the laser pulse. This study suggests that cryogen cooling can reduce epidermal damage during PWS treatment with the 585-nm PDL without reducing treatment efficacy. The absence of epidermal damage suggests that precooling with the cryogen may allow the use of higher laser input to expedite clearance without inducing epidermal change.