Cadever dissection and Dynamic CT for Vascular Anatomy of Rectus Abdominis Muscle

PURPOSE: Pedicled transverse rectus abdominis myocutaneous(TRAM) flap has been a gold standard for breast reconstruction and one of surgical techniques preferred by many surgeons. The authors examined the course of deep epigastric artery focusing on distance from margins of rectus abdominis to pedicle and location of choke vessels to get minimal muscles during pedicled TRAM flap operation. METHODS: Eleven rectus abdominis muscle from nine cadavers were used in this study. Rectus abdominis was separated from the cadavers, deep inferior and superior epigastric artery were isolated and then 8 anatomical landmarks in medial and lateral margins of rectus abdominis were designated. Distance to a pedicle meeting first horizontally was measured and vertical location from umbilicus to choke vessel was determined. In addition, 32 rectus abdominis images of 16 women(average age: 37.2 years old) from 64 channel abdomen dynamic computerized tomography were also examined with the same anatomical landmarks with those of cadavers. RESULTS: Average distance from four landmarks on lateral margin of rectus abdominis to pedicle was 1.9-3.4cm and 1.8-3.8 cm on medial margin. Choke vessel was located between middle and inferior tendinous intersection in all cases and average distance between two tendinous intersection was 6.7-7.0cm on medial margin and 6.2cm on lateral margin. Location of inferior tendinous intersection was on umbilicus or superior of it in all cases and its average distance from umbilicus was 1.8-5.6cm on medial margin and 2.7-6.2cm on lateral margin. CONCLUSION: Distance from medial and lateral margins of rectus abdominis muscle to pedicle was the shortest in inferior tendinous intersection and that was averagely 1.8cm on medial margin and 1.9cm in average on lateral margin. All choke vessels were located between middle and inferior tendinous intersection.

A New Method for Correcting the Gummy Smile: Cinching of the Upper Lip Elevators

For decades, many surgical techniques have been devised for correction of the gummy smile including mucosal resection, myectomy, the implant spacer technique, and osseous shortening of the alveolar-maxillary complex in case of vertical maxillary excess. However there are several problems in those techniques: the mucosal resection and the myectomy tends to recur, there would be the morbidity of the implant in the implant spacer technique, and the osseous shortening of the alveolar-maxillary complex is a procedure for the long face syndrome. Our technique is freeing the levator labii suprioris muscles and cinching them to the anteroinferior nasal septal cartilage for loss of muscle action. Seventeen patients(14 females and 3 males; mean age, 24 years) underwent operations. Preoperative photogrammetric analysis indicated the range of gum exposure when smiling was 2.0 - 9.0 mm(mean, 3.8 mm) and the maxillary lip length in repose was 17.0 - 29.0 mm(mean, 23.1 mm). Three to 31 months(mean, 12 months) after the operation, the results were analysed using the Wilcoxon signed ranks test. The postoperative gum exposure was ranged 0.0 - 4.0 mm(mean, 0.4 mm) (-3.4 mm, p< 0.05). And the maxillary lip length was elongated about 4%(+1.0 mm, p< 0.05). Results were also analyzed clinically by the ordinary scale method. The gum exposure when smiling was excellent and the nature of the smile was good. Upper lip stiffness developed in all patients, but resolved completely within 1 month after the operatio. Hypesthesia of the upper lip was noted in 8 cases, but also disappeared within 2 months. Additionally, this technique resulted in narrowing of the interalar distance. Our technique is effective in correcting a gummy smile, but would not be recommended for patients with an abnormally narrow interalar distance.

A Correction Of Unilateral Cleft Lip Nose Deformity using Porous High-density Polyethylene Columellar Strut

Even though many surgical techniques have been reported to correct the unilateral cleft lip nose deformity, it is very difficult to achieve optimal results. The authors used the porous high-density polyethylene(Medpor(R)) sheet as a columellar strut for alar cartilage repositioning and the triangular transposition flap based on the superior columella for correction of excess skin of alar web. A silicone implant was used for nasal dorsal augmentation. Additional techniques including segmental resection of the excessive alar cartilage on the normal side, freeing of the septal cartilage from the vomer, the nasal osteotomies, a Z-plasty on the afftected plica vestibularis, alar advancement of denuded alar base flap or an interalar cinch, and subcutaneous reduction of the external lateral triangle were also used to repair individual differences of the nasal deformities. Twenty-four patients (11 females and 13 males; mean age, 24 years) were included in this study. From six to thirty-four months(mean fifteen months) postoperatively, the patients were evaluated by the ordinary scale method and the anthropometric analysis using preoperative and postoperative nasal cast models. The analysis of the result was conducted by Paired samples T test. All the patients showed uneventful healing except three cases of columellar strut protrusion. By the ordinary scale method, "good" aesthetic results were noted. By the postoperative anthropometric analysis, the alar length of the normal side, the columellar length and the tip projection of both normal and affected sides were significantly increased. The nostril floor width of the affected side and the nose width were significantly decreased. In conclusion, this technique is valuable in the correction of unilateral cleft lip nasal deformity. But in cases of severe deformity, residual septal deviation, those who have received the operation several times, the porous high-density polyethylene sheet must be used carefully because of the protrusion.

Mutation Analysis in Fibroblast Growth Factor Receptor 3 Gene in Korean Children with Simple Craniosynostosis

The C749G(Pro250Arg) mutation in the gene for fibroblast growth factor receptor 3 (FGFR3) has been found in patients with various types of craniosynostosis. In this study, the blood of 9 Korean children with non-syndromic craniosynostosis were collected and mutation analyses were performed to screen whether this Pro250Arg mutation is also prevalent in Korean population. The genomic DNA samples were analysed by PCR amplification to amplify exon 7 and flanking intron sequence of FGFR3 (341 bp). Restriction digests were analysed by gel electrophoresis. There were no heterozygous for Pro250Arg mutation. No mutations in restriction enzyme digestion were confirmed by direct DNA sequencing. In this study, only 9 patients with simple craniosynostosis were subjected to mutation detection. Therefore, it is necessary to study a large number of patients in order to understand the proportion of non-syndromic craniosynostosis attributalbe to FGFR3 mutation. The epidemiologic study of this disease should be also combined in addition.

Mutation Analysis in Fibroblast Growth Factor Receptor 3 Gene in Korean Children with Simple Craniosynostosis

The C749G(Pro250Arg) mutation in the gene for fibroblast growth factor receptor 3 (FGFR3) has been found in patients with various types of craniosynostosis. In this study, the blood of 9 Korean children with non-syndromic craniosynostosis were collected and mutation analyses were performed to screen whether this Pro250Arg mutation is also prevalent in Korean population. The genomic DNA samples were analysed by PCR amplification to amplify exon 7 and flanking intron sequence of FGFR3 (341 bp). Restriction digests were analysed by gel electrophoresis. There were no heterozygous for Pro250Arg mutation. No mutations in restriction enzyme digestion were confirmed by direct DNA sequencing. In this study, only 9 patients with simple craniosynostosis were subjected to mutation detection. Therefore, it is necessary to study a large number of patients in order to understand the proportion of non-syndromic craniosynostosis attributalbe to FGFR3 mutation. The epidemiologic study of this disease should be also combined in addition.