CO2 Laser Resurfacing in Skin Tumor Surgery

PURPOSE: The prevalence of skin cancers and cutaneous premalignant lesions are increasing recently. It is necessary to treat cutaneous premalignant lesions, because these can progress to invasive skin cancers. We conducted a retrospective study to evaluate the usefulness of CO2 laser resurfacing in skin tumor surgery. METHODS: From 2005 to 2008, 14 patients with skin cancers, photodamaged skin and cutaneous premalignant lesions were treated with skin cancer excision, immediate reconstruction, and CO2 facial laser resurfacing. Mean average follow-up period was 15.6 months(5 months-36 months). Biopsy and clinical photograph were taken preoperatively, intraoperatively and through follow-up period to assess the effectiveness of laser resurfacing. Recurrence and side effects were evaluated through follow-up period. RESULTS: Histologic examination shows the abolition of actinic atypia, regeneration of epidermis and normalization of cellular differentiation after laser resurfacing. Clinical photographs shows elimination of keratoses and spots, and the homogeneous, smoothening change of skin surface, indicating healthy and younger faces. All patients had remained free of skin cancers and premalignant lesions in laser-treated field through follow-up period. CONCLUSION: CO2 laser resurfacing in skin tumor surgery can treat not only premalignant lesions but also subclinical lesions of photodamaged skin. Moreover it may be helpful in prophylaxis against skin cancers and premalignant lesions, providing rejuvenation and cosmetic improvement.

Minimal-incision Tenorrhaphy in Flexor Tendon Injury

PURPOSE: To retrieve the retracted flexor tendon, additional incision and wide dissection are conventionally required. We introduce minimal-incision tenorrhaphy using 1cm-long incision and minimal dissection. METHODS: Transverse incision about 1cm in length is made over the level of retracted tendon. Nelaton's catheter is advanced into tendon sheath from distal primary laceration wound to emerge proximally through the incisional wound. A catheter is sutured to proximal tendon in end-to- end fashion. By gently pulling the catheter, retracted tendon is delivered to distal wound. Tenorrhaphy with core suture and epitendinous suture is then carried out. RESULTS: This retrieving technique provides minimal incision, minimal dissection, minimal bleeding, minimal injury to tendon end, and shorter operation time with preservation of vincula tendinum and pulley system. CONCLUSION: In case of flexor tendon rupture with retraction, this operative method is believed to allow reliable and effective tenorrhaphy and excellent postoperative outcomes.

Reattachment of Amputated Auricle using Postauricular Subcutaneous Pocket

PURPOSE: There are several modalities to reattach the amputated auricle. Although microvascular replantation can achieve the best outcome, it is technically difficult. Conventional composite graft is technically easy, but uniformly unsuccessful. Our successful experience of reattachment using postauricular subcutaneous pocket is presented. METHODS: The amputated tissue was placed in its anatomical position with buried sutures. The amputated part is dermabraded to remove the epidermis and outer layer of dermis(Fig. 1, Center, left). Postauricular skin flap was then raised and the reattached dermabraded ear was buried beneath the flap(Fig. 1, Center, right). Two weeks after the original surgery, the buried ear was removed from its pocket(Fig. 1, Below, left). RESULTS: The ear was reepithelialized spontaneously in 7 days. In 3 months, the reattached ear shows satisfactory appearance without contour deformity(Fig. 1, Below, right). CONCLUSION: This technique provides increase in contact surface between the amputated segment and the surrounding tissues which supply blood, serum, oxygen and nutrients, maximizing the probability of "take". Minimally injured dermis can be healed from spontaneous reepithelialization and provides minimal contour deformity. We have used this non-microsurgical technique with very satisfying outcome.

Comparison Study of Open Reduction and Closed Reduction in Treatment of Mandibular Subcondylar Fractures

PURPOSE: The choice of open versus closed reduction for mandibular subcondylar fracture is a debatable issue. To evaluate the advantage of open approach to closed method with IMF(intermaxillary fixation), we conducted a retrospective study to compare the outcomes of each method. METHODS: From 2002 to 2006, 29 patients with mandibular subcondylar fractures were treated by open or closed reduction. 17 patients were treated by open reduction and 12 patients by closed reduction and IMF. Each group was assessed for duration of mandibular immobilization, incidences of buccal palsy, malocclusion, TMJ(temporomandibular joint) pain, and deviation of the mandible on mouth opening. RESULTS: All cases showed accurate reduction in anatomical position, no significant displacement and no deviation on mouth opening during the follow-up period. IMF period is statistically shorter in open reduction (p<0.05). Differences in incidence of other complications were not significant statistically. CONCLUSION: As there are significant independent morbidities associated with IMF which requires postoperative rehabilitation, prolonged temporomandibular immobilization should not be overlooked. Some patients with poor compliances will not tolerate IMF in nonsurgical treatment. In the aspect of patient's convenience and early recovery by short IMF period, open reduction would be recommended as a better treatment method.