Treatment of Fingertip Amputation in Adults by Palmar Pocketing of the Amputated Part

BACKGROUND: First suggested by Brent in 1979, the pocket principle is an alternative method for patients for whom a microsurgical replantation is not feasible. We report the successful results of a modified palmar pocket method in adults. METHODS: Between 2004 and 2008, we treated 10 patients by nonmicrosurgical replantation using palmar pocketing. All patients were adults who sustained a complete fingertip amputation from the tip to lunula in a digits. In all of these patients, the amputation occurred due to a crush or avulsion-type injury, and a microsurgical replantation was not feasible. We used the palmar pocketing method following a composite graft in these patients and prepared the pocket in the subcutaneous layer of the ipsilateral palm. RESULTS: Of a total of 10 cases, nine had complete survival of the replantation and one had 20% partial necrosis. All of the cases were managed to conserve the fingernails, which led to acceptable cosmetic results. CONCLUSIONS: A composite graft and palmar pocketing in adult cases of fingertip injury constitute a simple, reliable operation for digital amputation extending from the tip to the lunula. These methods had satisfactory results.

Malignant Peripheral Nerve Sheath Tumor of Abdomen

PURPOSE: Malignant peripheral nerve sheath tumor without neurofibromatosis type 1 is very rare neoplasm. Development in the superficial soft tissue is exremely rare. Authors experienced one rare case of primary malignant peripheral nerve sheath tumor developed on abdomen. The clinical and histologic findings were described. METHODS: An 83-year-old man visited hospital with an 11x6.5x4.5 cm sized ulcerated and hemorrhagic mass on abdomen. The tumor was localized in abdominal skin and started growing 3 years ago. RESULTS: Wide excision with safety margin of 2cm and limberg flap was done. The postoperative biopsy revealed a malignant peripheral nerve sheath tumor. There was no evidence of recurrence of tumor for 16 months. CONCLUSION: Malignant peripheral nerve sheath tumor is an aggressive malignant tumor. An abrupt enlargement of size, ulceration and bleeding are suggestive of malignant chnages of the tumor. We recommand early wide excision with enough safety margin as treatment of malignant peripheral nerve sheath tumor.

Difference of Gene Expression between Hypertrophic Scar Keratinocytes and Normal Keratinocytes

PURPOSE: There is no clear evidence of the original cause of hypertrophic scar, and the effective method of treatment is not yet established. Recently the steps of searching in gene and molecular level are proceeding. we are trying to recognize the difference between keratinocytes of hypertrophic scar and normal skin. Then we do support the comprehension of the scar formation mechanism and scar management. METHODS: Total RNAs were extracted from cultured keratinocytes from 4 hypertrophic scars and normal skins. The cDNA chips were prepared. A total of 3063 cDNAs from human cDNA library were arrayed. And the scanning data were analyzed. RESULTS: On microarray, heat shock protein, pyruvate kinase, tumor rejection antigen were more than 2 fold intensity genes. Among them, heat shock 70 kd protein showed the strongest intensity difference. CONCLUSION: In this study, it can be concluded that heat shock proteins play an important role in the process of wound healing and scar formation. This study provides basic biologic information for scar research. The new way of the prevention and treatment of scar formation would be introduced with further investigations.

Stress Induced Cardiomyopathy after Local Infiltration of Epinephrine for Plastic Surgery in Young Adult

PURPOSE: Epinephrine itself exhibits some cardiotoxicity. However, it rarely induces cardiomyopathy when used in standard doses during surgery for local hemostasis. This paper reports a rare case of stress-induced cardiomyopathy in a young woman after the local infiltration of epinephrine. METHODS: Corrective rhinoplasty was planned in a 20-year-old woman. Lidocaine mixed with epinephrine 1:100,000 was injected around the skin of the nose and nasal septum after inducing anesthesia, which resulted in sinus tachycardia and hypotension. Postoperative ECG showed a T wave inversion in the lead V2 and echocardiography revealed transient hypokinesia in the cardiac apex. Cardiac enzyme was mildly elevated. RESULTS: Symptoms and laboratory findings improved considerably, and the patient was discharged from hospital without complications on the sixth day after surgery. CONCLUSION: The prognosis of catecholamine-induced cardiomyopathy is generally favorable. However, it is important to be aware of the possible adverse effects of local epinephrine infiltration. This case highlights the need for caution when using epinephrine.

The Usefulness of Allogenous Costal Cartilage Graft for Correction of Short Nose and Tip Plasty

PURPOSE: Autogenous cartilage is generally first choice in rhinoplasty because of its biocompatibility and resistance to infection. On the other hand, allogeneous cartilage graft might preferred over an autogenous graft to avoid additional donor site scars, morbidity and lengthened operating time. Allogenous costal cartilage(Tutoplast(R)) not only have the advantage of averting donor site morbidity but also are resistant to infection, resembling autogenous cartilage graft. We report here a technique for rhinoplasty by using allogenous costal cartilage graft. METHODS: Through open rhinoplastic approach, alar cartilage is released from upper lateral cartilage and relocated caudally. After relocation of alar cartilage, allogenous costal cartilage is immobilized by nonabsorbable suture material at caudal aspect of septal cartilage. Caudal end of allogenous costal cartilage is sutured between medial crura of alar cartilage. Tip projection is improved by using interdormal suture, transdormal suture and shield-shape cartilage graft which is harvested from concha RESULTS: No significant resorption and infection was detected in any of patients. Aesthetic and functional results were satisfactory. CONCLUSION: The low incidence of major complication and versatility of allogeneous costal cartilage graft make safe and reliable source of cartilage graft in rhinoplasty

The Usefulness of Allogenous Costal Cartilage Graft for Correction of Short Nose and Tip Plasty

PURPOSE: Autogenous cartilage is generally first choice in rhinoplasty because of its biocompatibility and resistance to infection. On the other hand, allogeneous cartilage graft might preferred over an autogenous graft to avoid additional donor site scars, morbidity and lengthened operating time. Allogenous costal cartilage(Tutoplast(R)) not only have the advantage of averting donor site morbidity but also are resistant to infection, resembling autogenous cartilage graft. We report here a technique for rhinoplasty by using allogenous costal cartilage graft. METHODS: Through open rhinoplastic approach, alar cartilage is released from upper lateral cartilage and relocated caudally. After relocation of alar cartilage, allogenous costal cartilage is immobilized by nonabsorbable suture material at caudal aspect of septal cartilage. Caudal end of allogenous costal cartilage is sutured between medial crura of alar cartilage. Tip projection is improved by using interdormal suture, transdormal suture and shield-shape cartilage graft which is harvested from concha RESULTS: No significant resorption and infection was detected in any of patients. Aesthetic and functional results were satisfactory. CONCLUSION: The low incidence of major complication and versatility of allogeneous costal cartilage graft make safe and reliable source of cartilage graft in rhinoplasty

Combination Treatment of Osmidrosis by Liposuction and Rasping

PURPOSE: Excessive apocrine gland secretion and bacterial decomposition cause axillary osmidrosis, which results in physical discomforts and social problems of patients. Many surgical procedures have been introduced such as skin excision and simple closure, local flap, skin graft, subcutaneous shaving and liposuction method, but the results were not satisfactory to patients and several complications, such as symptom recurrence, hematoma, seroma, delayed wound healing, skin flap necrosis and scarring remain as problems. METHODS: For the purpose of reducing these problems, we employed combined treatment of liposuction and rasping method. From January 2006 to February 2008, total of 54 patients were treated with this procedure for bilateral axillary osmidrosis. RESULTS: Follow-up evaluation period was from 2 months to 12 months, and the results were satisfactory. In our method, the length of skin incision is less than 1 cm, so the resultant scar is negligible. Apocrine glands in subcutaneous tissue were mostly removed by liposuction apparatus and remained other glands in subdermal area were mostly removed by rasping. The recurrence rate and postoperative complication were minimal. CONCLUSION: Our method is very simple, short in operation time, and generates excellent results without specific complication.

Aesthetic Labia Minora Reduction with Bilateral Deepithelialization and Straightforward Technique

The hypertrophic labia minora presents many problems in both cosmetic and functional aspects. Local irritation, problems of personal hygiene during menses or after bowel movements, interference with sexual intercourse, and discomfort during cycling, walking, or sitting are generally accepted as indications for surgical reduction. We preserved the natural contour and anatomy of the labia minora by simply reducing its most prominent part (anterior two thirds) width through bilateral deepithelialization and primary closure of the edges with preservation of the neurovascular supply to the edges. This method is very simple and straightforward technique only the most prominent part of the tissue removed without morphologic alteration and minimal aesthetic and functional morbidity. Six patients have undergone this aesthetic procedure with excellent results without specific complications. This new technique is very simple and effective wound healing methods and can greatly enhance the patient`s confidence.

Breast Reconstruction after Modified Radical Mastectomy with Becker Permanent Tissue Expander

PURPOSE: Report of the good results of breast reconstruction using Becker permanent tissue expander that showed a short operation time and a quick post- operation recovery time, little side effects and usually superb aesthetic results without the need for additional incisions or donor site morbidity. The authors, after carrying out breast reconstruction operations using Becker permanent tissue expander on patients with appropriate indications, attempted to analyze several factors such as complication rates and patient satisfaction measurements. METHODS: 11 cases of breast reconstruction using Becker expander implants were carried out on a total of 10 patients between March 2000 and February 2003. The patients were followed up at outpatient visit for an average of 6 months. RESULTS: The most common post-operation complication was pain resulting from saline injection into the expanders, complained by 5 patients(50%). rib fractures, skin necrosis, implant removal due to infection, and breast cancer recurrence each occurred in 1 patient (9.9%). There was no occurrence of skin contracture complications which occurs frequently in case of silicone implant insertion. Patient complacency was surveyed by patient interviews made right after the operations and during outpatient follow-up periods: 5(50%) patients out of 10 showed excellent, 3(30%) good, and 2(20%) showed fair, leaving no patients who were disappointed with operation results. On routine follow-up, 80% of patients expressed satisfaction with the cosmetic outcome of their post-mastectomy beast reconstruction. CONCLUSION: Breast reconstruction using the Becker expander is a reliable alternative to other reconstructive methods but good patient selection is essential for satisfactory results.

Level of Platelet Derived Growth Factor(PDGF) in Blood Bank Platelet Concentrate

PURPOSE: The purpose of this pilot study was to investigate a potential of platelet concentrate obtained from blood bank(PCBB) in accelerating wound healing and to determine an effective treatment protocol by quantifying levels of platelet derived growth factor (PDGF)-BB in PCBB in vitro. METHODS: The first study was designed to investigate quantity of PDGF-BB over stored time of the PCBB. The stored times for each PCBB were 1, 3, 5, 7, 9, 11 and 13 days. The second study was designed to determine efficacy of adding thrombin to stimulate release of PDGF-BB from the platelets of PCBB. The platelets were suspended and incubated in either with or without thrombin. On 30 minutes and days 1, 3, 5, 7 after incubation, the levels of PDGF-BB were measured. RESULTS: PDGF-BB level showed a linear decrease over stored time of PCBB from the first day to the 13th day. Addition of thrombin increased PDGF-BB release from 30 minute through the 5th day. CONCLUSION: The results indicate that PCBB can provide sufficient amount of growth factors to stimulate wound healing and adding thrombin accelerate it.

Histologic Changes and Photographic Analysis of AlloDerm(R) at Tip Plasty of the Nose

AlloDerm(R) is human cadaveric dermis that has been decellularized. It is easy to handle and simple to use, and has superb tissue compatibility; hence it has been used in several fields. But studies about the effect and the histologic changes of AlloDerm(R) in soft tissue augmentation are lacking. We measured the heights of pronasale and supretip breakpoint through Pre-and post- operative photographs in 13 patients who had undertaken AlloDerm(R) tip plasty surgery from April 2004 to July 2005. Histologic changes were investigated by H&E and CD34 immunochemistry staining of tissue samples from 10 patients who had AlloDerm(R) removed by re-operative procedures from January 2005 to March 2006. The result of photographic analysis is as follows supratip breakpoint heights were 2.43+/-0.36, 2.64+/-38, 2.52+/-0.38mm in the pre-operative(T1), early post-operative(T2) and late post-operative(T3) periods, respectively. Pronasale heights were 2.68+/-0.33, 2.93+/-0.44, and 2.79+/-0.38mm, respectively. Statistical analysis of corrective value of T1-T2, T2-T3 and T1-T3 revealed a statistically significant difference in both pronasale and supratip breakpoint heights. Histological analysis showed chronic inflammatory signs with foreign body reactions around grafted AlloDerm(R). We concluded that AlloDerm(R) neovascularization and fibroblast ingrowth were also noted. AlloDerm(R) is effective in raising the nasal tip, but considering the late-term partial absorption, an overcorrection of about 50% is recommended.

A Case of Huge Keloid in the Both Earlobes

Keloid is a benign proliferative disease of dermal collagen which extends beyond the original wound. Management of keloids is still controversial. Many different treatment modalities may be used for this purpose, however, no one method has been found completely successful. Therefore, we combined three techinques, which is surgical excision, lesional steroid injection and compression, to improve therapeutic outcomes for earlobe keloids. In the first session, surgical excision of the keloid was performed. It was followed with triamcinolone acetonide injetion to the surgical field on the postoperative one week, and then followed at two weekly interval for two months. Slight pressure was applied by earring for six months. The authors found that a combination of three techniques for treatment of ear lobe keloid is recommended even for the recurrent lesion.

Wound Healing Effect of the Chitosan Sponges Containing the T-CAM or Regenin

Tetra cell adhesion molecule(T-CAM) is a new recombinant mixture of fibronectin and ig-h3. Fibronectin and ig-h3 are extracellular matriprotein involved in each phase of wound healing, and the combination of these materials may generate a synergistic effect in wound healing. Regenin is easily attainable from protein recombination. It can be developed as wound healing material, and also it has a good effect in cell adhesion and proliferation. We combined the chitosan with regenin or T-CAM at different concentration, which are gene recombination material. They were applied to the artificial wound of white rabbit to compare the healing effect in each group. Round full thickness skin defects, 3 cm in diameter, were made bilaterally on the dorsolateral aspect of New Zealand white rabbit. Experimental group was divided into 6 groups, according to concentration of T-CAM and regenin with chitosan-based dressing materials as followings; Group C: control group - oint material dressing, Group Ch: chitosan base only, Group T1: chitosan base in combination with 25 microgram/ml of T-CAM, Group T2: chitosan base in combination with 625 microgram/ml of T-CAM, Group R1: chitosan base in combination with 25 microgram/ml of Regenin, Group R2: chitosan base in combination with 625 microgram/ml of Regenin. Gross findings by means of percentage of wound contraction, percentage of wound epithelization and percentage of total wound healed area were compared with surface tracing of the remained wound area at the time of 7, 14, 21 days after wound formation. Wound biopsy were performed at the time of 7, 14, 21 days after wound formation. T1, T2 group and R1, R2 groups have less infiltration of inflammtory cell, fast appearance of new vessels, fibroblast, increased volume of collagen fiber comparing to C and Ch group. there's more statistical significance between T1 and T2 group. The same results were shown in Regenin group. In conclusion, our results suggest that T-CAM and Regenin have good effect in wound healing and higher concentration of T-CAM and Regenin is more effective in wound healing than lower concentration. In addition, comparision of same concentration of T-CAM and Regenin group presented almost same results.