Traumatic hematoma-based pseudoaneurysm of the superficial temporal artery in a 7-year-old boy: a case report

The superficial temporal artery (STA), the terminal branch of the external carotid artery, is divided into the frontal (anterior) and parietal (posterior) branches. The frontal branch of the STA is located superficially on the anterior region of the scalp, making it especially susceptible to trauma. Here, we report a traumatic pseudoaneurysm of the STA in a 7-year-old boy who was injured in a minor car accident. A physical examination showed only a small bruise on the patient’s forehead, and all vital signs were stable at the emergency room of our medical center. A facial computed tomography scan showed no significant findings. However, the boy later re-visited the hospital with slight swelling on the right forehead, and an ultrasonography scan revealed a hematoma near the right temporal artery. The resected hematoma (approximately 2 cm) was diagnosed as a traumatic pseudoaneurysm. Awareness of the possibility of a traumatic pseudoaneurysm in the STA may prevent a circumspect diagnosis in the future.

Treatment of primary cutaneous anaplastic large cell lymphoma

Primary cutaneous anaplastic large cell lymphoma (C-ALCL) is a rare subtype of primary cutaneous lymphoma with a favorable prognosis. Primary cutaneous CD30+ lymphoproliferative disorders, which include C-ALCL and lymphomatoid papulosis, are the second most common group of cutaneous T-cell lymphomas. C-ALCL is comprised of large cells with anaplastic, pleomorphic, or immunoblastic cytomorphology, and indeed, more than 75% of the tumor cells express the CD30 antigen. C-ALCL clinically presents with solitary or localized reddish-brown nodules or tumors, and sometimes indurated papules, and they may be with ulceration covering with dark eschar. Multifocal lesions are seen in 20% of the patients. Extracutaneous dissemination, which mainly involves the regional lymph nodes, occurs in 10% of patients. A 69-year-old man noticed a mild elevated cutaneous lesion containing central ulceration covering with brownish black necrotic tissue on the right lower lip, and the lesion was surgically removed. After the first operation, another skin lesion was developed and the histological examination confirmed the diagnosis, C-ALCL. Eight specimens were excised during the 7-month follow-up period. The patient started the treatment with low-dose oral methotrexate (15 mg/wk) and there was no recurrence for 11 months.

Treatment of the wide open wound in the Ehlers-Danlos syndrome

Ehlers-Danlos syndrome (EDS) is an inherited disorder of collagen biosynthesis and structure, characterized by skin hyperextensibility, joint hypermobility, aberrant scars, and tissue friability. Besides the skin, skeleton (joint) and vessels, other organs such as the eyes and the intestine can be affected in this syndrome. Accordingly, interdisciplinary cooperation is necessary for a successful treatment. Three basic surgical problems are arising due to an EDS: decreased the strength of the tissue causes making the wound dehiscence, increased bleeding tendency due to the blood vessel fragility, and delayed wound healing period. Surgery patients with an EDS require an experienced surgeon in treating EDS patients; the treatment process requires careful tissue handling and a long postoperative care. A surgeon should also recognize whether the patient shows a resistance to local anesthetics and a high risk of hematoma formation. This report describes a patient with a wide open wound on the foot dorsum and delayed wound healing after the primary approximation of the wound margins.

Sepsis Leading to Mortality after Augmentation Rhinoplasty with a Septal Extension Graft and Fat Grafting

No abstract available.

Comparison Study of the Use of Absorbable Materials as Internal Splints with Airway Silicone Splint and Absorbable Materials as Internal Splints Alone

BACKGROUND: Packing after closed reduction of nasal fracture causes uncomfortable nasal obstruction in patients. We packed the superior meatus with synthetic polyurethane foam (SPF) to support the nasal bone, and packed the middle nasal meatus with a nasal airway splint (NAS) and SPF. The aim of this article is prospectively to compare the subjective patient discomfort of SPF (Nasopore Forte plus) packing alone and SPF with NAS. METHODS: We compared the prospectively subjective patient discomfort of SPF packing alone (group A) and SPF with NAS (group B) via visual analog scale (VAS; 0, no symptom; 100, most severe symptom). RESULTS: At first postoperative day group B showed significant lower scores in dry mouth, sleep disturbance, conversation difficulty. However at third postoperative day, VAS scores of each group had no statistically significant differences. Moreover at fifth postoperative day group A had statistically significant lower scores for nasal pain, dry mouth than the group B. CONCLUSION: Combination method of using NAS and SPF have some advantage on the patient comfort from first postoperative day to third postoperative day.

Telecanthus Associated with Blepharoptosis

PURPOSE: Blepharoptosis is often associated with telecanthus and the presence of epicanthal fold in telecanthus is one of unique features in Asian eyelids. The purpose of this article is to define telecanthus and pseudotelecanthus, and to determine optimal surgical procedure depending on classification of telecanthus. METHODS: Among 187 patients with blepharoptosis who had the advancement procedure of the Muller's muscle-levator aponeurosis composite flap for ptosis, 55 patients underwent Flowers' split V-W plasty concomitantly with shortening the medial canthal tendon for correction of telecanthus from September 2003 to January 2011. Among them, 52 patients were followed up for 16 months. We newly defined telecanthus because Mustarde ratio is inaccurate to measure in certain cases and then made a definition of pseudotelecanthus. Besides, we also classified telecanthus into mild, moderate and severe types based on its severity. RESULTS: Telecanthus is defined when the ICD (inner canthal distance) is greater than 110% of normal ICD. Pseudotelecanthus is a telecanthus like a wide skin bridge formed between the eyes because of the epicanthal fold in the normal ICD. Flowers' split V-W plasty combined with shortening medial canthal tendon was very effective in mild and moderate telecanthus with almost invisible scar and no recurrence occurring. In severe types, however, it showed high incidence (28%) of incomplete correction of telecanthus. CONCLUSION: New definition of telecanthus can be easily applied to any case and we think the classification of telecanthus is useful to select an appropriate operative procedure. Split V-W plasty with shortening of medial canthal tendon is a very effective procedure in mild and moderate telecanthus. Besides, it is also effective in improving the treatment outcomes of ptosis in cases of blepharoptosis associated with telecanthus.

Treatment of Blepharoptosis by the Advancement Procedure of the Muller's Muscle-Levator Aponeurosis Composite Flap

PURPOSE: Even in a small levator resection for blepharoptosis, 10-13mm of Muller's muscle and levator aponeurosis is resected. To solve the problem, Muller's muscle was detached from the superior tarsal border and conjunctiva, and the muscle with overlying levator aponeurosis was advanced on the upper tarsus as a composite flap. The purpose of this study is to evaluate the effectiveness of the Muller's muscle-levator aponeurosis complex advancement technique for the correction of blepharoptosis. METHODS: From 2003 to 2008, 107 patients(183 eyes) underwent the advancement procedure of the Muller's muscle-levator aponeurosis composite flap for blepharoptosis. The advanced composite flap was fixed 3 mm below the superior tarsal border and 2-3mm of distal flap stump was left after trimming up to 5mm. The results of the operations were evaluated. RESULTS: The mean age of the patients was 35.2 years and 83 patients(145 eyes) were followed up for a mean of 16.7 months. 128 eyes(88.3%) showed a normal level of upper eyelid margin(MRD1 4.1-5.0mm) or less than 1mm ptosis(MRD1 3.1-4.0mm). 10 eyes(6.9%) showed 1-2mm ptosis(MRD1 2.1-3.0mm). 7 eyes(4.8%) showed more than 2mm ptosis which required secondary correction. About 80% of the 183 eyes needed no trimming of the flap stump with 5-6mm of composite flap advancement and 20% had about 3mm of the flap stump trimmed with 8-9mm of composite flap advancement (shortening of the levator complex). CONCLUSION: Muller's muscle-levator aponeurosis complex advancement technique offers several advantages: There is no, or minimal, sacrifice of the normally functioning Muller's muscle; it is more physiological; it is reproducible and it is predictable-with gratifying results for blepharoptosis.

The Comparative Study between PLGA and Chitosan Scaffolds for Cartilage Tissue Engineering

Clinical application of the cartilage formed by tissue engineering is of no practical use due to the failure of long-term structural integrity maintenance. One of the important factors for integrity maintenance is the biomaterial for a scaffold. The purpose of this study is to evaluate the difference between polylactic-co-glycolic acids (PLGA) and chitosan as scaffolds. Human auricular chondrocytes were isolated, cultured, and seeded on the scaffolds, which were implanted in the back of nude mice. Eight animals were sacrificed at 4, 8, 12, 16, and 24 weeks after implantation respectively. In gross examination and histological findings, the volume of chondrocyte-PLGA complexes was decreased rapidly. The volume of chondrocyte-chitosan complexes was well maintained with a slow decrease rate. The expression of type II collagen protein detected by immunohistochemistry and western blots became weaker with time in the chondrocyte-PLGA complexes. However, the expression in the chondrocyte-chitosan complexes was strong for the whole period. Collagen type II gene expressions using RT-PCR showed a similar pattern. In conclusion, these results suggest that chitosan is a superior scaffold in cartilage tissue engineering in terms of structural integrity maintenance. It is expected that chitosan scaffold may become one of the most useful scaffolds for cartilage tissue engineering.

Muller's Muscle-Levator Aponeurosis Advancement Procedure for Blepharoptosis

Muller's muscle-levator aponeurosis advancement procedure was performed to correct mild to moderate congenital blepharoptosis with moderate to good levator function and to correct severe aquired blepharoptosis with poor levator function. Through the blepharoplasty incision, the upper half of the tarsal plate was exposed and the orbital septum was opened to show the levator aponeurosis. The Muller's muscle was dissected from the superior margin of the tarsal plate and from the posteriorly located conjunctiva with sharp scissors. The Muller's muscle and levator aponeurosis were advanced on the anterior surface of the tarsal plate as a composite flap and fixed approximately 3 to 4mm inferior to the upper edge of the tarsal plate with three horizontal 6-0 nylon mattress sutures. The amount of advancement of the composite flap was controlled by the location of the upper eyelid margin 2mm below the upper limbus in primary gaze after the first suture in the middle portion of the flap. The excess flap was trimmed off with scissors, but trimming was usually not necessary in cases of mild to moderate ptosis. Nine cases underwent this Muller's muscle-levator aponeurosis advancement procedure from September 2003 to September 2004. Five cases were congenital blepharoptosis with 2-4mm ptosis and more than 5mm of levator function, but three of the four acquired ptosis cases had more than 4mm ptosis with poor levator function. The age of the patients ranged from 7 to 81 years. In operative results, all patients except one traumatic case were within 1mm of the desired eyelid height in primary gaze. This procedure can provide not only tightening of the Muller's muscle but also advancement and firm fixation of the levator aponeurosis to the tarsal plate, yielding predictable results.

A Case of Malignant Proliferating Trichilemmal Tumor with Spindle Cell Carcinoma

Proliferating trichilemmal cyst(proliferating trchilemmal tumor, PTC) most commonly occurs in the scalp and is generally benign. Malignant transformation of PTC is rare, and the appearance of a spindle cell(sarcomatoid) carcinoma is extremely rare. The authors experienced a case of malignant proliferating trchilemmal tumor with spindle cell carcinoma on the scalp in a 41-year-old male. The tumor was widely resected and covered with split thickness skin graft after Terudermis(R) graft. Imaging studies and fine needle aspiration cytology showed no regional lymph node involvement or distant matastasis.

Wound Healing Effect of the Chitosan Sponge

Chitosan is a polysaccharide obtained by deacetylating chitin which is the major constituent of the exoskeleton of crustaceous water animals. Chitosan has many useful biological properties such as biocompatibility, biodegradability, hemostatic effect, antimicrobial activity and the ease of chemical modification. In order to evaluate the efficacy of chitosan as a wound dressing material, authors prepared chitosan as a sponge form and compared it with ointment dressing material, amniotic membrane and hydrocellular dressing material through the animal experiment. Four round( 3 cm) full thickness skin defect were made bilaterally on the dorsolateral aspect of the New Zealand white rabbit's trunk and four groups of dressing material -chitosan sponge, ointment dressing material, amniotic membrane and hydrocellular dressing material-were applied on the wound and evaluated grossly and histopathologically. We compared gross finding by means of percentage of wound contraction, percentage of wound epithilization and percentage of wound healed by tracing the remained wound area every week and wound biopsy were performed every other day. Chitosan sponge group and amniotic membrane group show statistically higher percentage of wound contraction and higher percentage of wound healed than the other groups (p < 0.05). Hydrocellular dressing material group shows statistically lower percentage of wound epithelization than the others(p < 0.05). During the inflammatory phase (postwounding day 1-5) chitosan sponge group and amniotic membrane group absorbed exudate effectively and demonstrate less inflammatory cell infiltration, which induce faster angiogenesis and fibroblast proliferation than the other groups. This study suggest chitosan has a potential as a new dressing material because of high absorbency of exudate, promotion of wound contraction and reduction of inflammatory reaction during the inflammatory phase of wound healing.

Digital Photography in Plastic Surgery

Photography is essential for facial plastic surgery practice and has been used for documentation of patients, assessment of operative result, research, education, publication and medicolegal defense. With rapidly advancing technology, digital photography is emerging as a standard method for patient documentation in clinical setting. Digital photogrphs are captured on CCD(charged coupler device) of camera, and stored in flash memory in camera such as Compact Flash and Smarta Media card and transferred to a computer. The image may be immediately viewed on LCD(liquid crystal display) screen of the camera and reshot if necessary, and may be manipulated using photo-editing software programs, easily incorporated into digital presentation. The advantage of long-term storage, easy retrieval, and database organization make digital photography even more appealing. The authors intend to discuss considerations in selecting digital camera and photographic methods to acquire better image in plastic practice, and recommend digital photography as a new standard for conventional 35-mm film photography for general use in plastic surgery.

The Effects of New Recombinant Protein of Fibronectin and beta ig-h3, T-CAM(Tetra Cell Adhesion Molecule) on Wound Healing

T-CAM(Tetra cell adhesion molecule) is new recombinant mixture of fibronectin and beta ig-h3. Fibronectin and beta ig-h3 are extracellular matrix protein involved in each phase of wound healing and sum of these materials may play synergistic effect on the wound healing. In order to evaluate wound healing effect of T-CAM on open wound in rabbit, we made four round full thickness skin defects, 3 cm in diameter, bilaterally on the dorsolateral aspect of New Zealand white rabbit's trunk. We divided the wound into four groups, according to the content of topocally applied onitments: Group A treated with ointment base only; Group B with ointment containing fibronectin microgram/ml; Group C with ointment containing beta ig-h3 300 microgram/ml; Group D with ointment containing T-CAM 300 microgram/ml. These ointments were applied daily on the wound. We compared each group with gross findings by means of percentage of wound contraction, percentage of wound epithelization and percentage of total wound healed area with surface tracing the remained wound area on the 0, 6,th 12th, 18th day after wound formation and wound biopsy were performed on the 3rd, 6th, 10th, 14th, and 21st day after wound formation.The T-CAM group shows statistically significant (p < 0.05 ANOVA test and Scheffe's test) in wound contraction and totalwound healed area than other groups on the 6th day after wound formation, and equally significant on the 12th and 18th day after wound formation except in group C. In histological examination, T-CAM group shows less inflammatory cell infiltration, faster angiogenesis and marked fibroblast proliferation than other groups in early inflammatory period, and more matured, thickened reepithelization and regularly aligned collagen formation on the 14th and 21st day. This study suggest recombinant T-CAM shows synergistic effect on wound healing, and is expected as new potent material for treatment of wound healing.

Effect of Growth Hormone on Early Bony Regeneration in Distraction Osteogenesis

The purpose of this project was to study the effect of growth hormone on early bony consolidation in distraction osteogenesis of a dog mandible. Sixteen dogs were used for this study. An external distraction device was applied to the mandibular body and the mandibular distraction was started five days after the operation at a rate of 1 mm per day up to a 10-mm distraction. Dogs in the growth hormone group received a daily subcutaneous injection of 1 IU of recombinant human growth hormone per kilogram of body weight per week. Normal saline was injected in the control group. Bone mineral density was higher in the growth hormone group than the control group in the whole period. Bone mechanical strength was 300% higher in the growth hormone group than that in the control group. However, results were more suggestive than conclusive. Upon histological examination, the formation of a substantial amount of active woven bone was observed throughout the distracted zone in 6 weeks in the growth hormone group. In the control group, new bone was generated from the edge to the center of the distracted zone. But, the most central area of the distracted zone was filled with fibrous tissue in 6 weeks. In conclusion, growth hormone appears to be effective in early bony consolidation in distraction osteogenesis.

The Treatment of Palpebral Bags by Repositioning of Orbital Fat into a Subperiosteal Pocket

Baggy eyelids or palpebral bags of the lower eyelids are mainly caused by weakening of the orbital septum, atrophy of the orbicilaris oculi muscle and slackness of the skin. These palpebral bags are usually combined with a depression along the inferior orbital rim which is called a tear trough groove and a tear trough groove can be divided into a nasojugal groove and a palpebromalar groove. Excision of the protruded orbital fat as a treatment for palpebral bags may contribute in the long term to the senile enophthalmos due to a volume reduction of the intraorbital adipose tissue. Authors treated palpebral bags and tear trough grooves by reposition of orbital fat flaps into a subperiosteal pocket of the inferior orbital rim. Myocutaneous flaps from the lower eyelids were elevated through subciliary incisions to expose the inferior orbital rim and subperiosteal pockets were made on the orbital rim. The orbital fat flaps protruded through the incised orbital septum near the arcus marginalis were repositioned into the subperiosteal pockets by two or three horizontal mattress sutures. Nine patients with palpebral bags and tear trough grooves were operated with this technique and follow-up range was between 6 to 14 months(an average of 11 months). Palpebral bags and tear trough grooves were corrected well and youthful looking eyes were obtained. The main advantages of this technique are that; the first, we can get wide operative field and easy repositioning of orbital fat into the subperiosteal pocket through the transcutaneous approach than the transconjunetival approach, the second, subperiosteal repositioning of the orbital fat can make more even and smooth skin surface over the periorbital region than the supraperiosteal repositioning of the orbital fat due to coverage of the irregular fat lobules by the periosteum and the third, lower blepharoplasty can be combined with this technique.

Effect of Injectable Calcium Sulfate on Early Bony Consolidation in Distraction Osteogenesis of Facial Bone

The purpose of this project was to study the effect of calcium sulfate on early bony consolidation in distraction osteogenesis. In the control group, a total of 17 patients were treated between December 1997 and December 1999. The age of patients ranged from 2 to 45 years. The follow up period was 6 to 24 months(mean 15.3 months). In experimental group, a total of eight patients with craniofacial microsomia were treated between April 2000 and February 2001. The age of patients ranged from two to 40 years old. All patients were male. The follow up period was 3 to 15 months. The operative procedure in adult was based on the Ortiz Monasterio's simultaneous mandibular and maxillary distraction technique. The authors modified the original Ortiz Monasterio's method by using Le Fort I osteotomy with complete separation of both pterygomaxillary junction and mandibular osteotomy to avoid the resistance during distraction. In child, the osteotomy of the mandible was performed to distract. In the control group, in adults, after 5 days of latent period, distraction was performed at a rate of 1 mm per day. After 6 to 8 weeks of consolidation period, intermaxillary fixation and distraction device were removed. In children, the distraction was started at a rate of 1 mm per day without latent period. The consolidation period was 4 to 6 weeks. In the experimental group, after 5 days of latent period, distraction was performed at a rate of 1 mm per day in 2 adults. However, in children distraction was performed at a rate of 1 mm per day in 2 patients and 2 mm per day in 4 patients without latent period. On the completion of distraction, the calcium sulfate mixed with carboxymethyl cellulose was injected into the distracted zone. Radiographs showed bony consolidation in 4 weeks in 1 child, 5 weeks in 1 child with distraction rate of 1 mm per day, in 5 - 7 weeks in 4 children with distraction rate of 2 mm per day and in 5 weeks in 2 adults with distraction rate of 1 mm per day after injection of the calcium sulfate. The consolidation period in adult was statistically significant compared with that of the control group using Mann-Whitney U test.In conclusion, these findings suggested that injectable calcium sulfate is effective for early bony consolidation in distraction osteogenesis in adult.

Correction of Cleft Lip Nasal Deformity using Refined Reverse-U Incision and V-Y Plasty

Forty-five patients with cleft lip nasal deformities were operated on between September 1997 and December 1999. Thirty-five were followed up. Among them, 31 patients had unilateral cleft lip nasal deformities and 4 had bilateral cleft lip nasal deformities. The age range of the patients was from 3 to 56 years old. Reverse-U incision and V-Y plasty were used in 20 patients with mild to moderate unilateral cleft lip nasal deformities. An open rhinoplasty incision combined with the reverse-U incision and V-Y plasty was used in 11 patients with severe unilateral cleft lip nasal deformities. Bilateral reverse-U incisions and transcolumella incisions were used in 4 patients with bilateral cleft lip nasal deformities. After advancement of the mucochondrial flap, alar transfixion sutures were performed to make firm contact between the nasal skin and the redraped reverse- U flap. Ancillary procedures included correction of the laterally displaced alar base, lip scar revision, cartilage graft for tip augmentation, iliac bone graft for correcting hypoplasia of the maxilla or an alveolar cleft, corrective rhinoplasty, and composite graft for columella lengthening. A self-made nasal retainer was applied for 6 months in all patients to maintain the corrected contour of the nostril. The follow-up period ranged from 11 to 26 months, with an average of 18 months. Final results were evaluated based on the degree of symmetry of both nostrils, conditions of the redraped alar-columella web, and exposure of the nostril. Good results were obtained in 29 patients where alar-columella web deformities were either absent or minimal and a satisfactory symmetry of the nostrils was acquired. Four patients showed fair results, and 2 poor. In conclusion, these results suggest that the reverse-U incision and V-Y plasty are useful methods for creating a symmetry of the nostrils in cases of cleft lip nasal deformities in Orientals. In addition, this technique provides ample advancement and repositioning of the mucochondrial flap and simultaneous correction of the nasal vestibular web.

Surgical Correction of the Prominent Ear using the Posterior Approach

In prominent ears, major common deformities are a poorly developed antihelical fold and the formation of excessive conchal cartilage, in particular the posterior conchal wall. Goal of the surgical correction of prominent ears is narrowing of the conchoscaphal angle by folding of the antihelix and reduction of the concha. In this study, cartilage sparing otoplasty is refined by the addition of minimal dissection of the medial and lateral margin of the medial and lateral cut cartilage through the posterior approach and horizontal mattress sutures between two margins. A total of 9 patients were operated between 1999 and 2001. Among them, 4 patients were bilateral and 5 patients were unilateral. There were no hematomas. There was mild recurrence of the upper antihelical fold in one patient who requested further surgery. Two patients developed suture extrusion. This technique is a simple and safe procedure with reliable results and does not cause anterior scarring or skin necrosis.

Combination Treatment of Osmidrosis by Liposuction and Endoscopic Shaver

Many surgical procedures have been introduced for treatment of axillary osmidrosis, but some complications, such as symptom recurrence, hematoma, seroma, delayed wound healing, skin flap necrosis and scarring, are not solved yet. Recently introduced liposuction method has several advantages over previous surgical methods, such as increased skin flap vascularity, minimal scarring and bleeding, etc, but the sympton recurrence rate has been reported 10-30%. Liposuction method could remove apocrine glands in subcutaneous tissue effectively, but the glands firmly seated in subdermis remain as the cause of sympton recurrence. For this reason, we employed combination treatment of liposuction and endoscopic subdermal shaving method. From March 1997 to February 2001, a total 71 patients (24 men and 47 women) had been treated with this procedure for bilateral axillary osmidrosis. In our procedure, apocrine glands in subcutaneous tissue were removed by liposuction method and the glands in subdermis were removed by using 4.5 mm incisor blade of endoscopic shaver. Follow-up evaluation period was from 3months to 24 months, and the results were satisfactory. No one suffered from sympton recurrence. Postoperative scar was negligible (below 0.5 cm) and other complications were minimal.

The Effect of the Periosteum for the New Bone Formation into Bone Substitutes

To investigate the effect of the periosteum for the new bone formation into bone substitutes, artificial full thickness calvarial bone defects were made in diameter of 6mm in 45 New Zieland white rabbits and the defects were filled with Medpor(R) and Biocoral(R) as bone substitutes and with Surgicel(R) as control material. Each group was then divided into three sub-groups: non-periosteal group, periosteal flap group and periosteal graft group. Bone formation was investigated morphologically, radiologically and histologically and the degree of bone formation was calculated with scanner(Scanmaker III, Microtek Co.)and image processing program. In the non-periosteal group, there was no bone formation in all artificial bone substitutes 10 days after experiment. The amount of bone formation in Biocoral(R), Medpor(R) and Surgicel(R) was 3.58 +/- 1.70%, 0.00%, 2.11 +/- 1.73% respectively 6 weeks after experiment, and 27.43 +/- 11.92%, 15.72 +/- 5.47% and 3.59 +/- 2.18% respectively 3 months after experiment. In the periosteal flap group, there was no bone formation in Medpor(R) and Surgicel(R) but 6.84 +/- 3.21% of the bone formation in Biocoral(R) 6 weeks after experiment. The amount of bone formation in Biocoral(R), Medpor(R) and Surgicel(R) was 41.83 +/- 11.32%, 20.72 +/- 6.53% and 22.32 +/- 5.85% respectively 3 months after experiment. In the periosteal graft group, there was cartilage formation in Biocoral(R) and Medpor(R) 10 days after experiment. The amount of bone formation in Biocoral(R), Medpor(R) and Surgicel(R) was 25.38 +/- 6.49%, 17.16 +/- 4.03%, 7.95 +/- 3.17% respectively 6 weeks after experiment and 80.87 +/- 11.24%, 41.20 +/- 8.87%, 44.93 +/- 16.48% respectively 3 months after experiment. In conclusion, the periosteum played an important role for the bone formation into bone substitutes of Biocoral(R) and Medpor(R). The amount of bone formation was the greatest in the periosteal graft group among three groups and greater in Biocoral(R) than in Medpor(R).