The Correction of Inverted Nipple by Modified Elsahy and Broadbent-Woolf Methods

An inverted nipple may have both functional and aesthetic problems such as loss of lactability and hygiene. The inverted nipple may be congenital or caused by trauma, mastitis, mammmoplasy and breast cancer. Many procedures have been described for creating the normal anatomic configuration of the retracted nipple. For correcting the inverted nipple, the authors choose surgical procedure according to the grade of inverted nipple and the need of lactation. A total 37 nipples in 20 patients were operated on from February of 2001 to February of 2005. The patients were classified into 3 grades according to Han and Hong's grading system of inverted nipple. We applied modified Elsahy method to the group of patients in Grade I and patients in Grade II with need of lactation, and we applied Broadbent-Woolf method to the group of patients in Grade III and Grade II with need of lactation. Recurrence was found in 1 case corrected by modified Elshay method and no recurrence was found in those corrected by Broadbent-Woolf method. The patients' satisfaction score was 4.6 points in 5 points perfect score system. We prevented recurrence of inverted nipple with patients' satisfaction by applying different operative procedures according to the grade and patients' need of lactation.

The Clinical Use of High Density Polyethylene Implants (MEDPOR(R)) in Rhinoplasty after Foreign Body Removal

The materials used in rhinoplasty can be divided into autogenous and alloplastic one. The advantages of autogenous materials such as bone, cartilage, dermofat are no postoperative rejection and good adaptation. They are also economical. But they are often limited in harvesting which entails additional morbidity. Many synthetic materials have been introduced in rhinoplasty. Silicone is popular material for augumentation, but that has disadvantage, such as infection, protrusion, foreign body reaction and showing. Porous high density polyethylene implant (Medpor(R)) present an alternative to autogenous material as they allow of fibrovascular ingrowth, leading to stability of the implant and decreased rates of infection. We reviewed the data from 10 consecutive patients with foreign body injection on the nose who were operated in Dong-A University Hospital from May 2001 to July 2003. Our application is that the necessity of enough rigidity to provide structural support and enough volume to provide augumentation. Patient follow-up ranged from 1 month to 2 years. We can achieve 7 good satisfaction patients and 3 fair satisfaction patients. No complications were reported, such as infection, secondary deformity and exposure of implants. Medpor(R) is useful in corrective rhinoplasty, especially in the cases with foreign body injection, because it can provide structural support and augumentation with enough rigidity.

The Effect of Botulinum Toxin A on Calf Reduction

Botulinum toxin type A is widely used for anti-wrinkling therapy, and correction of the square face. The toxin ultimately prevent the release of membrane-bound acetylcholine at the neuromuscular junction of striated muscles and thus produce chemical denervation and paralysis of the muscles. Our purpose of study is to know if application of botulinum toxin type A on calf reduction is effective, how much dosage is effective, and what are the possible complications. We reviewed data of 30 consecutive patients subjected to calf reduction in Dong-A University Hospital from February 2003 to April 2003. We injected normal saline 2cc on both calves region in 15 control group patients, and the other patients was divided 3 group. Group 1, Group 2, Group 3 was injected 50U, 100U, 150U botulinum toxin A on each calf region and followed up for 6 month. Maximal circumference of calf was not changed in the control group but an average of 0.7 cm reduction was noted in group 1, average 1.34 cm (right calf) and 1.26 cm(left calf) in group 2, average 1.44 cm(right calf) and 1.58 cm(left calf) in group 3. Maximal area of calf was not changed in the control group but average reduction of 12.5%(right calf) and 12.7%(left calf) was obtained in group 1, average 19.4% (right calf) and 19.9%(left calf) in group 2, average 24.8%(right calf) and 21.07%(left calf) in group 3, as measured on CAT scan. Total fat amount and fat amount in the lower extremity was no change in all the groups, but lean body mass was decreased average 1.27%(right calf) and 1.15%(left calf) in group 1, average 3.47%(right calf) and 2.98%(left calf) in group 2, average 3.58%(right calf) and 3.95%(left calf) in group 3. Photography of the preoperative and postoperative 6 month state revealed higher satisfaction in Group 2, 3 compared to Group 1. Use of botulinum toxin type A in calf reduction is a very simple, safe, non-invasive method and effective in terms of calf contouring rather than reduction of calf circumference.

Urethroplasty in Male Pseudohermaphroditism

Male pseudohermaphroditism is individuals with Y chromosome whose external appearances fail to develop as expected as a normal male. Cytogenetic form of male pseudohermaphroditism was 46XY but external genital forms were variable. We reviewed data from 7 patients with male pseudohermaphroditism operated in Dong-A University Hospital from January 1996 to August 2002. They all had severe form of hypospadias (pseudovaginal perineoscrotal type). Only 1 of 7 cases was operated urethroplasty by one stage method, and all others by two stage method. Patients with mild chordee were operated by one stage method and patients with severe chordee were operated by two stage method. Complete chordee release was done by Z-plasty or FTSG on the first stage and posterior urethroplasty was done at level of mid-dorsum of shaft at the same time. Anterior urethroplasty was done completely on the second stage. Results were good from the viewpoint of shape and urination. Urethral fistula occurred in two cases, but other complications (infection, urethral stricture, etc.) didn't occur. In conclusion, two stage method was compatible to correct hypospadias in male pseudohermaphroditism, because hypospadias in male pseudohermaphroditism is in severe form.

The Efficiency of Fibrin Glue at Bicoronary Approach in Facial Surgery

Fibrin glue has been widely used as an adhesive in plastic and reconstructive surgery. It is effective in hemostasis, sealing anastomosis sites, promoting wound healing and tissue adhesion. The aim of this study is to establish that fibrin glue is effective at bicoronary approach in facial surgery in direction of hemostasis and wound healing. We reviewed the data from 40 consecutive patients with medial orbital wall fracture who were operated by bicoronary approach in Dong-A University Hospital from May 2001 to August 2002. We used Fibrin glue(Tisseel(R)) in 20 patients and the others were control. We analized the data from the view point of operation time, amount of Hemo-vac(R) count duration until removal of Hemo-vac(R), facial edema status, duration of admission. Statistical analysis was done with student's t-test(p <0.05). The results were as follow; Operation time was reduced by average 15 minutes in group using fibrin glue. Amount of Hemo-vac(R) at postoperative 1st day was reduced by average 31cc in group using fibrin glue significantly. Duration until removal of Hemo-vac(R) was reduced by average 2.7 day in group using fibrin glue significantly. Facial edema status from the viewpoint of patient & third party was recovered by average 1.7 day earlier in group using fibrin glue. Duration of admission was reduced by average 4 day in group using fibrin glue significantly. In conclusion, our clinical experience demonstrates several advantages of fibrin glue; Hemostasis, early adherence and wound healing are improved. The comfort of the patients is remarkably increased over the healing period. The comparatively small additional costs incurred seem very much worthwhile for these operation, because the duration of admission was reduced.

Classification of Nasal Bone Fracture; Types and Secondary Deformities

The nose is the most prominent and chracteristic feature of the human face, and nasal bone fracture is the most common facial bone fracture, resulted from less force others fractures. Although nasal fracture is often discussed as minor injury, the incidence of posttraumatic nasal deformity remains high. We reviewed the data from 380 consecutive patients with nasal bone fracture treated in Dong-A University Hospital from Jannuary 1995 to December 2001 to analysis. We classified the nasal bone fracture according to the severity of fracture. Type I is simple and unilateral nasal bone fracture, Type II is simple and bilateral, Type III is communited, Type IV is complex (nasal & septal disruption), Type V is associated with NEO fracture and midface fracture. and then we did follow up after correction and estimate the incidence of secondary deformity in classification of nasal bone fracture. The follow-up period of patients ranged from 3 months to 5 years with a mean of 2.7 years. The results were as follow. First, in Type I, II, IV, the rate of incidence of depression and hump formation after operation was lower than in Type III, V. Second, in Type III, the rate of incidence of depression and hump formation was higher than in type IV, because we had corrected nasal bone fracture with more aggressive approach in Type IV. Third, in Type IV, the rate of incidence of deviation was highest due to septal disruption. Forth, in Type V, the rate of incidence of depression and hump formation was the highest, but the rate of incidence of deviation was lower than that in Type IV. Fifth, it was highest rate of incidence of deviation of C-shape nasal bone fracture preoperatively and C-shape deformity postoperatively in type IV. Sixth, a deviated shape of nasal bone fracture was tend to be the same deviated shape of secondary deformity and It's tendency was higher in S-shape nasal bone fracture in Type IV. Seventh, it was considered that the more accurate reduction of nasal bone fracture by open approach was advisable in severe cases to reduce the incidence of postoperative secondary deformity.