Correction of Sunken Eyelid with Unfavorable Fold Using Autologous Fat Injection

PURPOSE: Sunken eyelid is a deformity of upper eyelid due to atrophy of periocular fat tissue, loss of skin elasticity. It causes the skin retraction of eyelid and unfavorable fold. Sunken eyelid occurs from the results of natural aging process, facial trauma, complication of previous periocular surgery, etc. We acquired a satisfied correction of sunken eyelid and unfavorable fold using autologous fat injection only. The aim of this study is a assessment of autologous fat injection for correction of sunken eyelid accompanied with unfavorable fold. METHODS: From August 2002 to March 2006, we performed 37 cases of correction of sunken eyelid with unfavorable fold using autologous fat injection. They were all females with ages ranged from 23 to 63. Fat was harvested from lower abdomen and centrifuged with Coleman system. Multi-layered injection of purified fat was done from orbital fat layer to orbicularis oculi muscle. RESULTS: Overall, improvement of sunken eye and unfavorable fold was observed in the majority of the patients. Discomfort of eye opening was improved in 24 patients. The average injection volume was 1.33mL in right eyelid, 1.31mL in left eyelid at first injection. Second injection was done in patients who absorption of injected fat was noted with. No specific complications were observed. CONCLUSION: Natural and attractive upper eyelid was acquired from fat injection only in sunken eyelid with unfavorable fold. To the authors' knowledge, it is desirable for sunken eyelid accompanied with unfavorable fold to be treated with autologous fat injection at first. Although some shortcomings are substantial, autologous fat injection is easy and effective method for correction of unfavorable fold in sunken eyelid without specific complication.

Reconstruction of Philtral Column with Overlapping of Orbicularis Oris Muscle Flap in Secondary Cleft Lip Nose Deformity

PURPOSE: Philtral deformity is a stigma of secondary cleft lip nose. It occurs from the false arrangement of orbicularis oris muscle and the scar of previous operation. Various methods have been used to correct this deformity. We successfully corrected philtral deformity using overlapping of orbicularis oris muscle flap. METHODS: From November 2000 to August 2007, we performed 39 cases of correction of philtral deformity in secondary cleft lip nose with overlapping of orbicularis oris muscle flap. Their age ranged from 5 to 53 years old. Existing scar tissue of previous operation was deepithelialized and preserved as scar flap. Lateral orbicularis oris muscle flap was elevated, advanced and overlapped upon medial muscle flap after dissection of orbicularis oris muscle of both sides. Reconstruction of philtral column was made from overlapping area by fixation of end part of lateral muscle flap to the point between philtral dimple and column. The degree of muscle flap advancement was decided by correction state of lateral muscle bulging. Correction of nostril floor depression or whistle deformity was also performed with preserved scar flap, if necessary. RESULTS: Realignments of orbicularis oris muscle were possible in the majority of the patients and final results of philtral reconstruction were satisfactory mostly. Correction of nostril floor depression and whistle deformity was also achieved. Additional correction was performed later to 4 patients in whom insufficient reconstruction was noted. No significant complication was observed. CONCLUSION: More natural and symmetric philtrum was acquired with overlapping of orbicularis oris muscle flap. To the authors' knowledge, it is an easy and effective method for correction of philtral deformity through anatomical rearrangement of distorted orbicularis oris muscle with relatively simple procedure.

A Comparative Study of the Effect of External Ultrasound with Power Assisted Liposuction(PAL)

This study was performed to compare the effect of external ultrasound assisted PAL(power assisted liposuction) with that of PAL alone. We performed 17 cases of liposuction from January 2003 to June 2003. For comparing both systems, we treated the right side(study group) with external ultrasound assisted PAL and the left side(control group) with PAL alone. To evaluate the difference in results between two groups, we surveyed three objective and four subjective items. Objectives were categorized as "Reduction rate of postoperative swelling", "Efficiency of suction" and "Histologic finding of aspirated fat tissue". Subjectives were also filed as "Degree of postoperative bruising", "Cannula resistance that operator felt", "Degree of postoperative pain" and "Patient's satisfaction". We assessed by questionnaire three times at 1day, 7 days and 30 days after operation. There were statistically significant differences in two of the subjective items; "Degree of postoperative pain at postoperative 1 day" and "Cannula resistance that operator felt". This study concludes that external ultrasound PAL is more effective high mobility of fat tissue and low tension of surrounding tissue. External ultrasound PAL will be more useful in case of large volume liposuction and revision procedures.

Effective Intravenous Conscious Sedation Using MAC(Monitored Anesthesia Care) and BIS(Bispectral Index) in Plastic Surgery Field

We replaced anesthesia of operations, which has done under local or general anesthesia, by MAC(monitored anesthesia care) with various patient's monitoring devices such as BIS(bispectral index). From April 2003 to March 2004, 48 cases of operations were done in MAC with supplemental equipments. Induction, maintenance of anesthesia was performed by propofol and midazolam. Pain control was done by fentanyl and ketamine. For monitoring the depth of anesthesia in real time, and BIS scale was checked and was maintained in 40-60. All anesthesias were done by the anesthesiologist that was communicated with operator for information between patient's status and operation procedures. All operations and anesthesias progressed with stability and safety, and there was no major postoperative complication. Because BIS was relatively accurate device, there was no over dose of anesthetic agents, which was induced by patient's uncertain pain complain under sedation and no anxiety of operator, that was raised by no responsive patient. BIS made possible that operation under MAC was effective and safe, operator perform it with non-stress condition and followed by good surgical result.

Influence of Keloid-derived Keratinocyte on TGF- beta1 Production of Fibroblast in Co-culture Model

Keloids represent a pathological response to injury interrupting skin integrity, creating disfiguring scars with no definitive pathophysiology. Transforming growth factor-beta1(TGF- beta1) has been regarded as one of the pathogenesis of keloids. The purpose of this study is to investigate the influence of keloid keratinocytes on TGF-beta1 expression in co-culture system. Recent studies have highlighted the important concept of epithelial- mesenchymal interactions in normal skin biology, and applying this concept to keloids in vitro studies demonstrated significantly increased proliferation of fibroblasts and collagen production in keloid fibroblasts co-cultured with keloid-derived keratinocytes as compared with normal keratinocytes. In this study, normal or keloid fibroblasts in lower chamber were co-cultured with keratinocytes derived either from normal skin or keloid tissue in upper chamber, separated from lower chamber by permeable membrane. Results obtained by ELISA showed equal TGF-beta1 expression when keloid fibroblasts were co- cultured with keloid keratinocytes, as compared with the normal keratinocytes at 24,48 hours, but significantly higher expression at 72 hours(p=0.0358). RT-PCR demonstrated that the TGF- beta1 expression level was not significantly related to the level of mRNA encoding TGF-beta1. These results suggest that overlying keloid keratinocytes play an important role in inducing high level of TGF- beta1 expression in keloid by paracrine effect or epithelial-mesenchymal interaction.

Experience with use of Expanded Polytetrafluoroethylene(Gore-tex(R)) in Cosmetic Facial Surgery

To date, for facial soft tissue augmentation, numerous implant materials have been used, including autogenous, homogenous, and alloplastic grafts. Among these, the porous material, Gore-tex(R) has a pore (0.5-30 microns, average 22 microns) which allows sufficient but limited soft tissue ingrowth to anchor implants, but not so much to make removal difficult or destructive to adjacent structures. In addition, this material has some advantage: non-carcinogenic, non-allergic, less capsule formation and reduced chance of infection due to high vascularity. In the past years Gore-tex(R) has found multiple applications in facial plastic and reconstructive surgery. However this alloplastic material can be associated with potentially severe complications and side effects such as soft tissue reaction, infection, extrusion, exposure, etc. There have been also adverse criticism of Gore-tex(R) : relative difficulties in postoperative removal, in carving implant, higher infection and extrusion rates in scarred tissue and thicker implant as well as postoperative volume reduction. In order to analyze results depending on the implantation site, the presence of scar on recipient site, thickness and type of implant, a retrospective chart review of 56 patients(69 cases) was undertaken of all patients who underwent facial soft tissue augmentation with Gore-tex(R) graft from November 1998 to November 2001 in a wide variety of situations. All cases were categorized as either primary(normal recipient site) or secondary(scarred recipient site) cases and the thickness of each graft used in millimeters was recorded. Postoperative follow up revealed a stable implant material with no major complications relating to the graft material and no differences in developing complications according to the implantation site, the presence of scar, thickness and type of implant. All patients were highly satisfied with their results.

Treatment of Wide Dermatofibrosarcoma Protuberans with Tissue Expander

Dermatofibrosarcoma protuberans is a slowly growing, locally invasive malignant tumor which originates in the dermis. Clinically, the initial appearance of the tumor is that of an indurated plaque which subsequently gives rise to multiple nodules. In the tumor's later stages, however, its growth rate accelerates, and it can ulcerate, bleed or become painful. but, metastasis is very rare. Dermatofibrosarcoma protuberans occurs most frequently on the trunk and proximal parts of the limbs, less commonly in the head and neck region, and only rarely in the extremities and external genitalia. A characteristic feature of dermatofibrosarcoma protuberans is the tendency to recur locally. This is apparently due to the infiltrative growth pattern between collagen bundles. Therefore, a wide excision is treatment of choice. Skin grafting is the usual reconstructive procedure, but flap reconstructions are used for cosmetic and functional concerns in many anatomic locations. We report the case of wide atrophic dermatofibrosarcoma protuberans and the clinical usefulness of the expanded cutaneous flap using tissue expander in reconstruction of the tissue deficit after wide and deep excision of dermatofibrosarcoma protuberans of the chest and anterior neck.

Treatment of Acute Sterno-Mediastinitis using Regional Muscle Flaps

Although the incidence of mediastinal wound infection after median sternotomy is relatively low, its associated devastating complications may be life-threatening. Treatment of sterno-mediastinal infection has evolved over the past several decades. Early treatment was wet soaking of debrided wound or irrigation through a closed indwelling catheter system and its mortality was quite high. Subsequent treatments focused on the debridement followed by muscle flaps such as pectoralis major and rectus abdominis muscle flap or by omental flap closure, which were considered as the ideal modalities for acute sterno-mediastinitis. Mortality rate was reduced significantly after application of this active treatment. However, to date, there has been no definite treatment strategy for sterno-mediastinitis and the choice of operations depends largely on the experience and personal preference of the surgeon. So we introduce our experience, including technique and outcome, with transposition of pectoralis major muscle and superiorly-based rectus abdominis muscle turn over flap for deep and extensive sterno-mediastinal wounds. Five patients(3 male and 2 female) had repair of an infected median sternotomy wound from July 2001 to september 2002. Complications after wound closure occured in 2 cases, 1 case of hematoma and 1 case of seroma, respectively. No other major complications have been noted. We treated MRSA or VRE- cultured acute sterno-mediastinitis successfully with early sternal wound debridement and immediate regional muscle flap coverage.

Anatomical Nasal Tip Plasty with Autogenous Cartilage Graft

Augmentaion rhinoplasty is one of the most common aesthetic surgery in Korea. Plastic surgeons have been more interested in not only simple augmentation of nasal dorsum, but making more beautiful and natural nasal tip. In the people who has depressed nasal bridge with round and blunted tip, simple augmentation of the nasal dorsum with silicone or Gore-Tex implants could aggravate the tip's disfigurement, so the need for tip plasty has been more emphasized in those persons. There have been used two traditional techniques in endonasal autogenous cartilage tip graft for increasing tip projection, Sheen's shield graft and Peck's onlay graft. But these techniques have several disadvantages such as displacement, visibility of graft margin and flattening of infralobule. The most criticizable problem is that these grafts have limitation in producing the natural and anatomical tip contour.We have done 45 consecutive nasal tip plasties using anatomically-shaped cartilage grafts which was developed from the idea of combination of Sheen's shield and Peck's onlay graft. We followed up the patients from 2 to 14 months. Most patients have been very satisfied with the results and no serious complications were noted. Author's graft was designed to minimize displacement by stable placement on both alar domal and lobular segments, minimize graft visibility by increasing graft contact to nasal tip skin, manipulate the cephalo-caudal length by modification of onlay thickness, and most of all, reproduce the anatomical tip projection and contour.

Effectiveness of Decortication Septorhinoplasty via External Approach

The purpose of this article is to describe an alternative approach to the nasal septum and the advantages offered by the decortication septorhinoplasty in correcting difficult nasal deformities. Using the Decortication septorhinoplasty approach, the entire cartilagenous septum can be exposed so that each specific deformity can be visualized and corrected appropriately. Retracting the lateral crura laterally, a midline plane is dissected, and the anterior septal angle and dorsal margin of the septal cartilage is identified. The elevation of the mucoperichondrium is started at the area of the anterior septal angle. After anterior approach, scissors are inserted between the septal cartilage and the upper lateral cartilage and their junction is sharply divided. Elevation of the rest of the mucoperichondrium is completed as a skeletonized single unit. Sculpting the entire cartilagenous and/or bony vault, as well as correcting difficult septal malalignments, can be carried out under better direct vision with great precision, accuracy, and predictability. From January 2000 till March 2001 the decortication approach is used for correcting difficult nasal deformity in 24 patients. Of these, 5 are secondary cleft lip nose, 10 are deviated nose, 5 are traumatic saddle nose, and 4 are hump nose. The mean follow up period is 12 months, ranging from 5 to 20 months. The patients are overall satisfied with the aesthetic and functional results. The disadvantage and complication of the Decortication septorhinoplasty is the same as compared to the conventional open rhinoplasty. The decortication approach is most suited for correction of deformities at the dorsal aspect of the nasal septum that causes a twisted nose deformity, of deformities at the anterior septal angle causing an asymmetric tip, and of deformities along the caudal aspect of the quadrangular cartilage producing columellar distortion, and of relational deformities between anterior nasal spine and septum. The decortication technique has provided a effective avenue for the correction of severe nasal deformities.

Scar Revision of Wide Facial Scar by Serial Excision Using the Sure-Closure(R)

Conventional methods of scar revision of wide facial scar are skin graft, local flap coverage, local flap using the tissue expander, and free flap method, but these methods have disadvantages such as color dismatching, deformity of facial structure, inevitable additional scar, great expense, and waste of time. From April 1996 to April 2001, we performed the scar revision of wide facial scar by serial excision using the Sure- Closure(R) in 8 patients. Of these, 4 had scars on the cheeks, 2 on the preauricle, and the remaining 2 on the mentum and temporal area. The mean follow-up period was 18 months, ranging from 6 to 24 months. By pinching the skin on the scar site, we got a rough idea as to whether the available skin on either side of excision margin was sufficient for closure. The tension on the skin margin was 3.0 kilograms and the device was employed over a duration of 50 minutes. A skin stretching device is designed to exploit the viscoelastic properties, that is mechanical creep and stress relaxation. In this study, we use the serial excision with the Sure- Closure(R), because excessive scar excision could result in the deformity of facial structure and wound dehiscence, hypertrophic scar, and skin necrosis. The skin stretching device is easy to use and achieves good aesthetic results in the scar revision of wide facial scar.

Role of Nitric Oxide in the Nickel and Cobalt Induced Cytotoxicity in RAW 264.7 cell / 대한산업의학회지

OBJECTIVES: The nickel and cobalt present in many industrial working environments and consumer products. They are two of the leading causes of allergic contact dermatitis, which is a typical delayed(type IV) hypersensitivity reaction. However, the mechanism by which nickel and cobalt causes this pathology is not well known. The nickel and cobalt induced contact dermatitis is mediated primarily through macrophages. This mechanism is similar to the autotoxicity procedure for NO. Therefore, this study was designed to examine whether the metals could modulate NO production and how the metals may affect ATP production and cell viability. In summary, the purpose of this study was to elucidate the role of NO in the nickel and cobalt induced cytotoxicity. METHODS: This study is based on observations of cultures of RAW 264.7 cells which are originated from a tumor of Balb/c mouse that was induced by Abelson murine leukemia virus. RAW 264.7 cells were treated with either Ni, Co, Ni plus Co, or Nmonomethyl-L- arginine(NMLA) for 24-72 h. The cytotoxicity of the nickel and cobalt was measured by cell viability and NO2-, and mitochondrial function was evaluated by adenosine triphosphate(ATP) production in RAW 264.7 cells. In addition, the morphology of cells was observed using an inverted microsope. RESULTS: The NO2- synthesis of RAW 264.7 cells increased with increasing concentrations of Ni and Co up to 50 microM after 24 and 48 h of exposure to Ni and Co but then decreased if the concentration was greater than 50 microM and the time period was greater than 48 h. However, the viability of cells was decreased by Ni and Co exposure in a dose and time dependent manner. Therefore, 50 microM Ni or Co and 48 h of treatment were used in this study. A complete inhibition of NO2- synthesis by Ni or/and Co occurred when iNOS inhibitor, NMLA, were pretreated prior to addition of Ni or/and Co, whereas Ni or/and Co induced decrease of synthesis of ATP and viability completely recovered when NMLA were pretreated prior to addition of Ni or/and Co. Ni or/and Co(50 microM) induced the characteristic morphological features of cytotoxicity which is characterized by a shrinkage of cytoplasm and irregular shape of the cells, but the pretreatment of NMLA resulted in a recovered morphological change of the cells to their normal appearance. CONCLUSIONS: These results suggest that NO plays an important role in the pathogenesis of the cytotoxicity of nickel and cobalt, and nickel and cobalt may exert their toxicities by means of modulation of NO production. The results from this study may facilitate further understanding the role of NO on nickel and cobalt induced immune and inflammatory processes.

One-Stage Reconstruction with Pericraniosubgaleal Flap after Removal of Skin Involved Severe Paraffinoma

Paraffinoma on nose from injection of paraffin by the quack doctor for the purpose of augmentation rhinoplasty has so many problem, especially when invaded overlying nasal skin. 6 cases of skin involved severe paraffinoma were treated by one step reconstruction with pericraniosubgaleal flap and follow up periods was 2 to 17 months. All patients were successfully treated without any complications and had satisfactory results. In cases of three telangiectasis among six patients, the severity of telangiectasis was improved, but not completely. We believe that the advantages of this method are one step reconstruction and good vascularity, which prevent infection and enable easy to make variable shape. When the overlying skin loss was developed, the flap became tolerable graft bed. The authors conclude that the pericraniosubgaleal flap is one of the reliable surgical options for treatment of the skin involved severe nasal paraffinoma.

Optic Nerve Injury Associated with Facial Trauma

The traumatic optic neuropathy occurs in 0.5 to 5% of closed head trauma cases. Because it may cause permanent blindness, the early diagnosis and proper treatment are very important. We have treated 6 traumatic optic neuropathy patients among 433 head trauma cases from Sep, 1997 to Aug, 1998. Four patients showed visual recovery with steroid therapy. The diagnosis can be made clinically when the patient suffers from acutely decreased vision, Marcus-Gunn pupil, with its relatively normal fundoscopic finding, is considered as the most sensitive indicator and the first herald of visual tract injury, even though visual acuity is normal at the initial stage. The megadose steroid therapy must be diagnosed for the recovery of incompletely injured axons rather than regeneration. The optic canal decompression surgery must be spared for the delayed onset optic neuropathy patients who do not respond to the steroid therapy. In a case of indirect optic neuropathy, the associated orbital fracture reduction should not be undertaken until the optic neuropathy has stabilized. But severely displaced blow-in fracture of the orbit that decreases orbital volume should repaired early for orbital decompression.

Appearance of Vancomycin-Resistant Enterococci(VRE) on Sore Wound: A case report

Enterococcus is a gram positive coccus and a normal flora in gastrointestinal tract, but it could raise opportunistic infection. In 1986, vancomycin resistant enterococcus(VRE) was reported in Europe at first. Recently, the incidence is increasing in USA and Korea(2~8%). In our hospital, sore and stool cultures for enterococcal identification were carried out on 4 patients with sore wound. By screening stool culture, VRE was detected in 3 of 4 pressure sore patients. VRE was also identified from the sore wound in 2 of 3 patients who had VRE positive in screening stool culture. 2 of 4, enterococcal positive patients, have the history of vancomycin use in the past. An increasing number of VRE infection in hospital suggest that VRE become an important cause of infected pressure sore. Therefore, culture of sore wound and stool for the identification of VRE should be performed routinely.

Effects of Acetyl-L Carnitine on Recovery from Sciatic Nerve Injury in Rats

A possible therapeutic effect of acetyl-L carnitine (ALCAR) on peripheral nerve injuries and the expression of Jun, the protein products of immediate-early genes(IEGs), in the spinal cord were investigated after sciatic nerve injury in Sprague-Dawley rats. Experimental animals were divided into 3 groups: intact sciatic nerve as a control group, surgical repair alone, and surgical repair with ALCAR treatment. Toe-spreading response, pinprick response, and compound action potential were measured to evaluate the recovery of sciatic nerve injury. Recovery of behavioral function and electrophysiological function both improved in the surgical repair with ALCAR treatment group. Weak basal expression of Jun was shown in the ventral horn the of spinal cord in the control group. In the surgical repair alone group or the surgical repair with ALCAR treatment group, Jun expression persisted until 28 days after injury in the ventral horn of the spinal cord. Moreover, the surgical repair with ALCAR treatment group showed more increased expression of Jun than the surgical repair alone group. These results suggest that ALCAR facilitates the functional recovery after peripheral nerve injury.

A Case Report of Pseudoxama Elasticum of the Neck: Surgical Excision and The Effect of Laserbrasion

Pseudoxanthoma elasticum (PXE) is an uncommon heritable disorder of elastin characterized by cutaneous, ocular and vascular abnormalities. Typical skin lesion shows yellowish papules and redundant skin folds on the neck, axilla and groin due to degeneration and calcification of elastic fibers in deep dermis. As in all heritable disorders of connective tissue, no curative therapy is presently know. Redundant and unsightly skin folds about the neck can be improved by surgery, but irregular papular lesion on skin does not improved by surgery. A-44-year-old female who had a skin lesion and angioid streak was treated as follows: Skin folds on the neck were excised successfully without any significant problem such as intraoperative bleeding, wound dehiscence or hypertrophic scar formation. To evaluate whether we could smooth the irregular skin surface due to multiple papules, laserbrasion with a SLT contack Nd:YAG laser system was performed experimentally on a limited area which was located on the right supracla-vicular area about 2 x 3cm in size. An acceptable aesthetic appearance was achieved with surgical excision 12 months after the operation. Biopsy of the laserbrasion site revealed disappearance of the calcium deposit. This study emphasizes the possibility of using laserbrasion in solving troblesome skin lesion of the PXE.

Lacrimal canalicular repairing using silicone intubation

Repairing of lacrimal canalicular laceration has some controversies on the golden time of surgery, the suture method, and the materials for stent. Recently, intubation of silicone tubes has become popular for repair of lacrimal canalicular injuries. Thirty-two cases of injured lacrimal canaliculi were repaired with use of silicone tube stents. The surgery can be done with monocanalicular(10 patients) or bicanalicular(22 patient) methods. The follow-up period was from two to eighteen months(mean ten months). Seven cases using the monocanalicular method and nineteen cases using the bicanalicular method were successful. Three cases of monocanalicular method had epiphora with canalicular obstruction due to early loss of the silicone tube. In monocanalicular method, postoperative complications were punctal granuloma(1 case), punctal slits(2 cases), and early loss of the silicone tube(3 cases). In bicanalicular method, postoperative complications were persistent epiphora during the period of intubaion(4 cases), conjunctival irritation sign(3 cases) and loop retraction(1 case). In conclusion, the success rate of bicanalicular stents were higher than that of monocanalicular stents for canalicular laceration. But the bicanalicular stent had some complications including cosmetic problem, possibility of injuries to the normal canaliculus during intubation, conjuntival irritation sign, and loop retraction.

The effects of compound madecassol on the wound healing

This study was designed to assess the effects of compound madecassol(madecassic acid with neomycin sulfate and hydrocortisone acetate) on the wound healing. Madecassol is a titrated extract of centella asiatica and the clinical effects of madecassol are stated to the enhancement of wound healing and the prevention and relief of excessive scar formation. Compound madecassol is composed of madecassol and neomycin sulfate and hydrocortisone acetate. Neomycin sulfate has antibiotic effect and hydrocortisone acetate has antiinflammatory and antiallergic effects. So, compound madecassol has a synergistic effect of madecassol as well as neomycin sulfate and hydrocortisone acetate. Using 54 rats, we compared the effect of compound madecassol on wound healing at 3rd, 7th, 14th, and 21th postoperative days. This study examined the histologic findings and the gross findings which were wound size, epithelization and quality of granulation tissue. In this study, compound madecassol showed lower degree of inflammatory infiltration, shorter inflammatory phases and less wound contraction. The number of the myofibroblast in the group of compound madecassol were fewer than other groups. Granulation tissue of the compound madecassol was relatively healthier than others. There were no significant difference of re-epithelization between compound madecassol and other groups. In conclusion, compound madecassol can reduce excessive wound contraction and promotes wound healing process.

RECONSTRUCTION OF CANALICULAR INJURY WITH MONOCANALICULAR TUBE

No abstract available.