Comparison Between the Digital Artery Perforator Flaps and the Distant Flaps within Hand

PURPOSE: The digital artery perforator flap was recently introduced and has been proven to be useful for reconstruction of various finger defects. Short operative time, less invasive surgery, and reliable flap circulation are the major advantages of this flap. The authors presented the clinical cases of the digital artery perforator flap and compared them with the distant flaps within a hand (thenar and hypothenar flaps) to reveal their differences. METHODS: From May of 2006 to February of 2009, the authors performed reconstructions of finger defects with the digital artery perforator flaps in 10 patients as with the distant flaps within hand in 9 patients (7 thenar and 2 hypothenar flaps). In these two groups of the patients, flap size, use of skin graft, length of stay in hospital, healing time, complications were reviewed retrospectively and compared with statistical analysis (Student's t-test). RESULTS: All flaps survived completely. The mean size of the perforator flap was 0.9 x 1.9 cm and the mean distant flap within a hand was 1.9 x 2.0 cm. The use of skin graft was reduced in the perforator group because the donor site of the flap was closed primarily. The hospitalization period and healing time also reduced significantly in the perforator group. Minor complications (partial flap loss) were noted in small percentages in both groups but resolved with conservative management. Mean follow-up period was about 6 weeks. CONCLUSION: The digital artery perforator flap was smaller than the distant flap but its reconstruction of finger defects was reliable and comparable to the conventional distant flaps within a hand. This flap would be not only an alternative method but very useful in the management of various finger defects, because of ease of operative technique, less invasive surgery, decreased need of skin graft, and shorter period of hospitalization and healing time.

Clinical Effect of Immediate Cooling on Superficial Second Degree Thermal Burns

PURPOSE: Numerous experimental studies have shown the benefits of treating thermal burns by cooling. Nevertheless, few studies have shown the clinical effect of cooling therapy on thermal burns. This study aimed to identify the clinical effect of immediate cooling therapy. METHODS: The research was conducted as a retrospective, case-control study. All patients had thermal injuries characterized as a superficial second-degree burn. In the cooling group, 14 patients had first-aid cooling therapy delivered by either parents, caregivers, general practitioners, local hospitals, and/or Myongji hospital. Included in the study were 22 control patients who were not treated with any cooling therapies. Other clinical factors, such as age, sex, cause of burn injury, and burn area (Total Body Surface Area %), were taken into consideration. The duration of treatment was defined as the time from the occurrence of the injury to the presence of complete re-epithelialization, as confirmed by two surgeons. RESULTS: The duration of treatment in the cooling group was significantly less than that the control group (p < 0.05). CONCLUSION: Cooling therapy as an initial emergent treatment is clinically effective for superficial seconddegree burn injuries.

Nasal Tip Plasty on the Bulbous Nose Revisited

Correction of bulbous nasal tip in rhinoplasty is a difficult subject, particularly in Asian. Since first published an article on the correction of bulbous nasal tip in 1999, we have accumulated more experiences and improved our result in refining nasal tip. We had 17 patients for the correction of bulbous nasal tip. Age ranged from 20 to 39 years old (Mean age, 26.7 years old) and 6 males and 11 females. We were able to follow up from 1 month to 6 years. We classified our patients into three groups according to the shapes of nasal tip and surgical procedures implicated. Group 1: Simple bulbous nasal tip requiring excision of subdermal soft tissue and rearrangement. Group 2: Bulbous nasal tip with flat dorsum of nose, requiring augmentation of dorsum of nose with silicone implant and augmentation of nasal tip with onlay graft with conchal cartilage. Group 3: Bulbous nasal tip with short columella, requiring nasal tip plasty and lengthening of columella with composite graft using helix of ear. Open rhinoplasty technique was applied in all patients with excising subdermal fibrous tissue from nasal tip, and realignment and fixation of alar cartilage with interdomal sutures. Pressure splint was applied on 7th postoperative days and maintained for a couple of months. Proper preoperative diagnosis, subdermal soft tissue excision, realignment and fixation of alar cartilage, cartilage graft, augmentation of dorsum of nose, columella lengthening, postoperative splint and combinations of these are the key of successful results.

A Case of Tuberous Sclerosis with Multiple Fibroma on Scalp and Extremity

PURPOSE: Tuberous sclerosis is an autosomal dominant multisystemic neurocutaneous syndrome characterized by the development of multiple hamartoma distributed through the body, skin, brain, heart, kidney, and lung. The classic triad is seizure, mental retardation, and facial angiofibroma. We experienced a case of a tuberous sclerosis associated with the facial lesion and multiple masses on scalp, forehead, and right lower extremity. METHODS: This a 34-year-old male patient had subependymal giant cell astrocytoma in brain and multiple angiomyolipoma in both kidneys. Tangential excision with razor blade and dermabrasion were done on the centrofacial area. We excised other lesions and the mass on scalp was excised and covered with split thickness skin graft. RESULTS: The histopathological finding revealed that the facial lesion was angiofibroma and the others were multiple fibroma. CONCLUSION: In our case of tuberous sclerosis, we chose the tangential excision to remove the large nodules of angiofibroma, and then dermabrasion was used to smooth the final contour. The patient appeared to have a good results from this treatment modality. But, tuberous sclerosis is an disease that needs long term follow-up to check up the recurrence of skin problem.

Classification of the Lateral Orbital Wall Fracture and Its Clinical Significance

PURPOSE: The lateral orbital wall fractures have been previously classified by some authors. As there are some limitations in applying in their own classifications, we hope to present a refined classification system of the lateral orbital wall fracture and to identify the correlation between the specific type of the fracture and clinical diagnosis. METHODS: The facial bone CT scans and medical records of 78 patients with the lateral orbital wall fractures were reviewed in a retrospective manner. The classification is based on the CT scan. In type I, the fracture and its segments are away from the lateral rectus muscle and in type II, they are next to or slightly pushing the muscle in axial CT scan. In type III, the fracture segments compress and displace the longitudinal axis of the muscle or the optic nerve in axial view of CT scan. Type IV fracture includes multiple fractures found around the orbital apex or optic canal in coronal view of CT scans of the type I and type II fractures. RESULTS: The most common fracture pattern was type I(43.6%), followed by type IV(29.5%), type II(20.5%), and type III(6.4%). As diplopia and restriction of extraocular muscles were found in type I and II fractures, severe ophthalmic complications such as superior orbital fissure syndrome, orbital apex syndrome, and traumatic optic neuropathy were found in type III and IV fractures almost exclusively. CONCLUSION: We propose an easy classification system of the lateral orbital wall fracture which correlates closely with ophthalmic complications and may help to make further treatment plan. In Type III and IV fractures, severe ophthalmic complications may ensue in higher rates, so early diagnosis and treatment should be performed.

A Case of Giant Epidermal Inclusion Cyst

PURPOSE: The epidermal cyst is a very common skin lesion which usually occurs in the hairy regions. They are generally small but rarely reach more than 5 cm in diameter. We present a patient with a giant epidermal cyst on buttock area. METHODS: A 50-year-old man with a slowly enlarging, huge mass in his left buttock was examined. There was no history of trauma in this area. Physical examination revealed a soft, nontender, 15x15cm-sized mass in his left buttock. T1-weighted magnetic resonance images demonstrated a well-circumscribed, multilocular cystic lesion with homogeneous, slightly high signal intensity. On T2-weighted images the lesion had wide areas of high signal intensity. The mass was totally excised. RESULTS: A histopathological finding revealed that the cystic wall was lined with whole layers of stratified squamous epithelium. Keratin layers from the surface of the epithelium were seen to be sloughing into the cystic lumen. Multinucleted giant cells were found outside the cystic wall. CONCLUSION: Herein we report a rare case of giant epidermal cyst occurring on the buttock.

New Measuring Method of Breast Volume Using Polyethylene Bag and Plaster Molding

PURPOSE: Breast volume is one of the crucial measurements in preoperative planning and postoperative evaluation of the results in mammoplasty. There are several methods suggested by different authors, but there is still no commonly accepted standard methods for measuring breast volume. To help the surgeons to base their estimation on an objective evaluation, we developed a simple method using Polyethylene bag and plaster molding. METHODS: After Polyethylene bags were put in suitable size on both breasts of the patient in upright position, silk plaster was molded on the surface evenly. Then molds can be obtained after marking boundaries of breasts with a pen. Breast volume measurement can be done by filling water in the molds and measuring it. Moreover, postoperative design for natural skin brassier was possible using the molds. RESULTS: This method was applied to 2 patients for reduction mammoplasty and the breast volume measurement was simple, hygienic and accurate, done within 10 minutes. CONCLUSION: This method using Polyethylene bag and plaster molding has several advantages. 1.It is comparatively accurate regardless of the size and shape of patient's breasts in upright position. 2.Measurement time is short and inconvenience and shame of patients can be reduced by making molds after putting on Polyethylene bags. 3.It is relatively economical and uses easily available hygienic materials . 4.The postoperative shape and volume of breasts can be predicted by using molds preoperatively.

Plastic Surgery of the Breast

Plastic surgery of the breast includes; augmentation, reduction, reconstruction of the breast and correction of inverted nipples. For breast augmentation I herein introduce a technique of augmentation while preventing the occurrence of capsular contracture. For reduction surgery, I emphasize a short scar, preservation of nipple sensation and lactation. For reconstruction I suggest that a general surgeon should have a keen interest in reconstruction after mastectomy for better outcomes and improvement in quality of life of the patient. Finally I discuss correction surgery for inverted nipples, which is a challenging field in breast surgery because of its high recurrence rate and possibility of compromised breast-feeding after surgery.

Treatment of complications after augmentation mammoplasty

No abstract available.

The 585 nm Flashlamp-Pulsed Dye Laser of Treating Keloids and Hypertrophic Scars

Hypertrophic scars and keloids are difficult to treat. Currently numerous treatment modalities are available, but results are often hard to predict. We used the 585 nm flashlamp-pumped dye laser based on the principle that selective thermolysis of the increased vasculature in a scar may prevent scar hypertrophy through decrease in cellular function/nutrition within the scar. We treated 41 patients with hypertrophic or keloidal scars of more than 6 months duration. The number of treatments per person ranged from 1 to 8 (mean 3.7) and patients were treated every four weeks. Duration of follow-up ranged from 6 to 24 months. There was a significant improvement in appearance, texture and symptoms such as pain and pruritis. No recurrence or worsening of the scar was reported.

SUB-ORBICULARIS OCULUS FAT(SOOF) RESECTION IN AESTHETIC BLEPHAROPLASTY

The traditional aesthetic blepharoplasty has limitations in correcting the heaviness and bulkiness of the lateral orbital region. These limitation is due to presence of sub-orbicularis oculus fat(SOOF) which is defined as that layer of fibrofatty soft tissue deep to the orbicularis oculus muscle, superficial to orbital septum and orbital rim, and extending medially from supraorbital nerve and laterally to varying distance over the lateral upper orbit. Therefore authors performed resections of the SOOF in conjunction with aesthetic blepharoplasty in 15 patients, who visited the clinic with complaints of thickness and heaviness over their lateral eyebrow, often accompanied by tired or sad-looking appearance. We believe that in these patients the heaviness. bulkiness and fullness in the lateral upper orbital region were corrected effectively and smoothly in aesthetical aspect. No patients developed postoperative hematoma, dry eye syndrome, lacrimal gland injury and significant paralysis of the orbicularis oculus of corrugator muscle. Our department performed the SOOF resection to those who had bulkiness and heaviness in lateral upper orbital region. From this experience, the SOOF resection would appear to be a useful adjunct to standard blepharoplasty technique in selected patients. Since we achieved a satisfactory result aesthetically through this method on patients who showed proper indications, we are recording the indications, operative techniques and complications in addition to review of reference.

CLINICAL EXPERIENCES OF NASAL TIP PLASTY IN ORIENTALS

The nasal tips of Orientals are different from those of caucasians with are characterized by flat nose and bulbous nasal tip appearance because of its thick and tense skin, shory columella, flaring of nostrils, and restriction of nasal tip projection due to underdevelopement of medial crus of alar cartilage. For better nasal tip definition and projection, alar carilage must be realigned and tip might be augmented with autogenous cartilage onlay graft. Furthermore in patient with short columella, strut formation might be performed because the nostril comprises two-thirds of height of nasal tip. If the nasal tip is prjected without lengthening of columella, sometimes we noted unnaturally tented appearance of nasal tip may result. Also for the soft tissue lengthening in columella in proportion to the nasal tip projection, the short columella can be lengthened with columella based V-Y advancement. Surgical approach through alar rim incision or open rhinoplasty incision may be employed depending upon the severity of tip defomity. If flattening is severe to enough require lengthening of the columella, open rhinoplasty incision is the best choice. Through the incision, the alar cartilage is dissected freely from the skin and vestibulsr mucosa. Cartilage grafts are performed using carilage onlay graft or columella strut formation after transdormal fixation suture. This study presents clinical cases of various nasal tips in the view of nasal tip deformity which were corrected with various operative methods using combined technique of approximating the alar cartilage and a multilayered autogenous onlay cartilage graft on the nasal tip harvested from the auricular cartilage, also Silicone implant was used for augmetation of nasal dorsum and columella strut formation with columella base V-Y advancement. The ten years of our experience with nasal tip plasty in over one hundred patient showed excellent result and no complications were observed during post operative follow-up so we are reporting these cases with review of literature.

The Effect of Topical PGE4 (Prostaglandin E1) Analogue on Angiogenesis in the Hairless Mouse

An important aspect of plastic surgery is skin flap survival. Among the prostaglandins, PGE4 is used clinically to improve peripheral circulatory disturbances due to its action of augmenting blood flow by vascular smooth muscle relaxation and its strong inhibitory action of platelet aggregation. Clinically, many investigators found that the effect of PGE4 was prolonged for a long period even after short-term application. So a new hypothesis emerges that the prolonged effect of PGE4 may be due to neovascularization and not due to vasodilatation alone. This study was designed to clarify the mechanism of the prolonged effect of topical PGE4 with regard to angiogenesis. A total of 9 male hairless mice were treated with a topical application of PGE4 onitment (PGE4 powder mixed in hydrogen base) on the experimental side and only a hydrogen base on the contralateral control side of the back skin, respectively, for 7 days, once a day. Then they were divided into 3 groups. In group 1, specimens were obtained on the 7th day post-treatment using 3 mm size punch biopsy from both sides. In group 2, specimens were obtained on post-treatment 14th day. In group 3, specimens were obtained on post-treatment 28th day. The number of blood vessels were compared between the experimental side and control side with respect to neovascularization after PGE4 application using an image-analysis program under hemtoxyline-eosin stain. Treatment on the experimental side did not affect its contralateral mate, since there was no evidence of a systemic effect. From our experimental data, we could conclude that PGE4 may induce angiogenesis by topical application without systemic effect.

Nasal Tip plasty on the Bulbous Nasal Tip

Management of the bulbous nasal tip with inadequate projection and drooping is challenging aesthetic plastic surgery. The bulbous nasal tip is influenced by several factors; 1) thick, non-elastic oily skin, 2) soft tissue bulkiness due to supratip fibrous fatty tissue, and 3) a wide intercrural angle or increased interdormal distance. Another common factor among caucasians, hypertrophic alar cartilage, is seen less in orientals. These variable factors can be corrected with various surgical maneuvers for proper tip projection and refined alar shape. All these procedures are performed through open rhinoplasty incision. The fibromuscular fatty tissue on the nasal tip is resected with subdermal tangential excision without violating the detmal blood supply. The proximal part of the lateral crus, dome and the part of medial crus which was isolated from the skin and nasal mucosa are replaced and plicated in midline in the role of a new columellar strut and skeletal support. If more skeletal supports are desired, the new columellar is reinforced with a silicone strut and conchal cartilage onlay grafts are applied. And for lengthening of the columella, a V-Y advancement incision on the columellar base with open rhinoplasty is applied. The pressure splint on the upper third of the columella and nasal tip is applied on the 7th postoperative day and maintained for two months. All procedures are focused on the preservation of catilaginous integrity and in providing skeletal support. We performed nasal tip plasty on the bulbous nasal tip and its simple technique and predictability resulted in improved nasal tip projection and contour.

Simple Technique of Brow Lift

No abstract available.

The effect of decorinas an antagonist of tgf-betain fetal rat wound healing

Adult wounds heal with scar-tissue formation, whereas fetal wounds heal without scarring and with a lesser inflammatory and cytokine response. The unique fetal wound repair process is not dependent on the sterile, aqueous intrauterine environment. The differences between fetal and adult wound healing appear to reflect processes intrinsic to fetal tissue, such as the unique fetal fibroblast, a more rapid and ordered deposition and turnover of tissue components, and, particularly, a markedly reduced inflammatory infiltrate and cytokine profile. Among these cytokines, the transforming growth factor-beta(TGF-beta) is a growth factor which plays an important role in the regulation of cell growth and differentiation. The fibrosis characteristic of adult wound repair may be associated with TGF-betaexcess. Recent experimental studies have focused on the specific anti-TGF-beta strategies for scarless wound healing. Decorin, a proteoglycan, is known to regulate TGF-beta. This factor antagonizes the action of TGF-betain tissues. However, little is known about the functions of this factor in vivo. The objects of the present study were to analyze the effects of TGF-beta, an important regulatory molecule in adult healing events, and the effects of decorin, known inhibitor against TGF-beta, on the fetal tissue response following wounding. Fetal cellular and extracellular matrix response to injury were evaluated by treating the wound with TGF-beta and decorin in fetal rat at 14 days gestation (term = 21 days). Histologic response and histomorphometric analysis two to eight weeks later were compared between TGF-betaonly treated wound and TGF-betawith decorin treated wound.The histologic finding of the TGF-beta treated wound was characterized by an early acute inflammatory response : by week 6 fibroblasts and collagen were predominant. In contrast, TGF-beta with decorin treated wound had no remarkable histologic evidence of acute inflammation or fibroblast penetration and few collagen was deposited. These observations demonstrate that the fetal response becomes adultlike with fibroblast proliferation and collagen accumulation when TGF-betais added, thus documenting the responsiveness of the fetal system to adult repair signals. Such responsiveness thus suggests a critical difference in the fetal wound environment. Fetal repair may proceed in the absence of trophic factors like TGF-beta, thus accounting for optimal "healing" in the absence of excessive fibrosis. And these observations also confirmed the inhibitory action of decorin against TGF-beta in rat fetus model. We can suggest that the decorin minimize the inflammatory response and subsequent cellular proliferation in wound healing process, thus eventually prevent collagen deposition and scar tissue formation.

CORRUGATOR SUPERCILII MUSCLE RESECTION THROUGH THE BLEPHAROPLASTY INCISION

No abstract available.

BREAST RECONSTRUCTION WITH LATISSIMUS DORSI ISLAND FLAP IN ORIENTALS

No abstract available.

REGIONAL ANATOMY OF CORRUGATOR SUPERCILII MUSCLE, SUPRATROCHLEAR NERVE & SUPRAORBITAL NERVE

No abstract available.

FUNCTIONAL EFFECTS OF RADIAL FOREARM FREE FLAP USED FOR RECONSTRUCTION IN THE TONSILLAR REGION

Four consecutive patients underwent composite resection of tonsillar cancer and reconstruction with a microvascular radial forearm free flap. Three patients had postoperative assessments of speech at six to nine months respectively. One patient could not attend for the postoperative assessment. The speech assessment was examined by same speech therapist. All the patients had an good postoperative speech assessment. Compared to conventional local or regional myocutaneous flaps, the thin forearm free flaps offers better postoperative articulatory recovery.