ABSTRACT
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.
Subject(s)
Adult , Humans , Amputation, Surgical , Cosmetics , Fingers , Nails , Necrosis , Replantation , TransplantsABSTRACT
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.
Subject(s)
Humans , Cicatrix , Cicatrix, Hypertrophic , Comprehension , DNA, Complementary , Gene Expression , Gene Library , Heat-Shock Proteins , Hot Temperature , Keratinocytes , Pyruvate Kinase , Rejection, Psychology , RNA , Shock , Skin , Wound HealingABSTRACT
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.
Subject(s)
Female , Humans , Young Adult , Anesthesia , Cardiomyopathies , Echocardiography , Electrocardiography , Epinephrine , Hemostasis , Hypokinesia , Hypotension , Lidocaine , Nasal Septum , Nose , Prognosis , Rhinoplasty , Skin , Surgery, Plastic , Tachycardia, SinusABSTRACT
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
Subject(s)
Humans , Cartilage , Cicatrix , Hand , Imidazoles , Incidence , Nitro Compounds , Nose , Rhinoplasty , Succinates , Sutures , Tissue Donors , TransplantsABSTRACT
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
Subject(s)
Humans , Cartilage , Cicatrix , Hand , Imidazoles , Incidence , Nitro Compounds , Nose , Rhinoplasty , Succinates , Sutures , Tissue Donors , TransplantsABSTRACT
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.
Subject(s)
Humans , Apocrine Glands , Cicatrix , Follow-Up Studies , Hematoma , Lipectomy , Necrosis , Postoperative Complications , Recurrence , Seroma , Skin , Social Problems , Subcutaneous Tissue , Transplants , Wound HealingABSTRACT
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.