Suitability of denervated muscle flaps as recipient sites for pancreatic islet cell transplantation.

BACKGROUND: Extensive research has been conducted on islet transplantation as a possible cure for diabetes. Islet transplantation in the liver via the portal vein has shown remarkable results, but numerous other recipient sites are currently being investigated. We aimed to show the effectiveness of using a muscle flap as a recipient site for islet transplantation. METHODS: Islet cells were harvested from 12 isogenic Lewis rats, and then diabetes was induced in another 12 isogenic Lewis rats by streptozotocin injection. In six rats, 3,000 islets were transplanted into gastrocnemius muscle flaps, and in the other six rats, the same number of islets were transplanted into the gastrocnemius muscle. The transplanted islet cell function between the two groups was compared by means of blood glucose tests, glucose tolerance tests, immunohistochemistry, and real-time reverse transcription polymerase chain reaction. RESULTS: In the muscle flap group, blood glucose levels significantly decreased after islet transplantation. Blood glucose levels were significantly different between the two groups at 3 weeks after transplantation. The muscle flap group showed nearly normoglycemic results upon the glucose tolerance test, whereas the muscle group was hyperglycemic. Immunohistochemical evaluation showed positive results against insulin and glucagon in biopsies of both groups, and the islet cell density was higher in the muscle flap group. There were no statistically significant differences between the two groups in real-time reverse transcription polymerase chain reaction results. CONCLUSIONS: Our results suggest that muscle flaps are promising candidates for islet cell transplantation.

Cleft Crossing Medial Mucosal Flap for Deepening of the Gingivolabial Sulcus in a Complete Cleft Lip Repair.

The aim of the present study is to introduce a method of which the medial mucosal flap is used in a deepening of the gingivolabial sulcus in a complete cleft lip repair. An incision was made on the lateral vestibular lining and the contracture was released. The defect produced was filled by transposing the lateral mucosal flap (l-flap). The transposed l-flap was sutured except for the proximal part of the lateral side. The medial mucosal flap (m-flap) was elevated with its base above on the alveolus. The m-flap was turned over and crossed over the cleft thereafter and the distal end of the m-flap was sutured to the proximal part of the lateral side of the l-flap. The width of the m-flap was 4 to 5 mm, and the length depended on the width of the cleft. The raw surface of the m-flap faced the outer side and was covered with the repaired muscle layer. Thereafter, the m-flap became a part of the deepened gingivolabial sulcus. A total of 12 patients (8 men, 4 women) with a unilateral complete cleft lip (left 9, right 3) were operated on using this technique and at least 2 mm deepening effect of upper gingivolabial sulcus was observed in 8 patients followed up. The authors think this cleft crossing medial mucosal flap technique may be of use in the primary repair of a unilateral cleft lip.

Correction of an alar web with a feather-edge rolled-in flap.

The aim of this study was to see the histological nature of the alar web and to introduce a featheredged rolled-in flap to reduce the alar web.On a cadaver, the perpendicular section of the alar web revealed a thickened dermis portion on both the skin side and the nasal side distal to the alar cartilage. According to histological results, we thought the thinning and rolling in of the distal margin of the end of the open rhinoplasty incision could reduce the alar web. An open rhinoplasty incision was made just distal to the hair-bearing vestibular skin and a V-Y shape incision created at the alar base. After the cartilage work, the skin of the distal end of the flap was featheredged to a 0.5-mm thickness. The distal margin was rolled in and sutured to the nasal lining. A bolster dressing was applied using a 4-0 nylon suture.Thirteen patients (8 males, 5 females) were operated on, and 8 patients were followed up for more than 12 months. Their preoperative and postoperative worm's eye views were compared. Four anthropometric distances were measured preoperatively and postoperatively. The columellar length increased significantly after the operation (P = 0.001 [independent 2-sample t test]) on the cleft side. Preoperatively, the alar width was significantly greater (P = 0.02 [paired-samples t test]) on the cleft side (0.17 ± 0.03 of an intercanthal distance) than the noncleft side (0.14 ± 0.03). After the operations, they became similar (0.16 ± 0.03 on cleft side, 0.16 ± 0.04 on the noncleft side; P = 1.00 [paired-samples t test]).We think this featheredged rolling-in flap might be a good method for the correction of an alar web since this technique increased the columellar length and decreased the alar width on the cleft side.

Burring and holes connecting ostectomy for the correction of prominent mandible angle.

The aim of this study was to introduce a safe ostectomy method for the correction of prominent mandibular angles via a "burring and holes connecting technique." A subperiosteal dissection was conducted, and the mandibular angle was exposed. Using a 7-mm-diameter burr, 3 to 5 holes were made on the predicted ostectomy line. The consecutive holes were connected using an oscillating saw. A bone fragment was removed, and irregularities were smoothened through light burring. Twenty-three patients (2 men, 21 women; mean age, 28.4 y) were operated on. The mean trace observation period was 11 months. Among the 23 patients, no subcondylar fracture or hematoma occurred. In x-ray comparisons, there was no excessive or insufficient reduction of the mandibular angle. We think this burring and holes connecting ostectomy might be a safe method for the correction of prominent mandible angles even for inexperienced surgeons.

Accelerated development of the first and second mandibular molars after distraction osteogenesis of the mandible in patients with hemifacial microsomia.

Although distraction osteogenesis of the mandible in patients with hemifacial microsomia (HFM) before the mixed dentition period is widely performed, long-term follow-up information on dental problems is limited. We evaluated the long-term effect of distraction osteogenesis on dental development by comparing Nolla's developmental stages of the first and second molars between the affected and unaffected sides of the mandible. Forty-five patients with unilateral HFM who received distraction osteogenesis of the mandible between the ages of 5 and 8 years and whose dental status was followed for more than 2 years were selected for this study. The patients were divided into 2 groups: group I (n = 28) consisted of patients with Pruzansky types I and IIA and group II (n = 17) consisted of patients with types IIB and III. Panoramic radiographs at T0 (1 month before distraction), T1 (6 months to 1 year after distraction), T2 (2-3 years after distraction) were reviewed. Nolla's stages for the first and second molars were compared at each of the abovementioned times between the affected and unaffected sides using Wilcoxon signed-rank test. In group I, there was no differences observed in Nolla's stages of the first and second molars in comparisons between the affected and unaffected sides of the mandible. However, in group II, at T0, there was a significant difference in Nolla's stage of the first and second molars in comparisons between the affected and unaffected sides. Over time, tooth development was accelerated, and eventually, there was no difference in Nolla's stage between the affected and unaffected sides at T1 and T2. Patients with severe HFM can benefit from distraction osteogenesis of the mandible. The results of this study showed that this procedure could normalize the delayed development and eruption of the first and second molars.

The use of bioabsorbable plate fixation for nasal fractures under local anaesthesia through open lacerations.

Nasal fractures are the most common facial fractures. The majority of nasal fractures have been discussed as minor injuries and managed by closed reduction and intranasal packing. However, in cases of a nasal fracture with open laceration on fracture site, the plates fixation may be accomplished with definite reduction through the open laceration. But, metallic reconstruction plates can sometimes produce palpable irregularity at the site of fixation in nasal bone fractures. We performed rigid fixation through open laceration wound with bioabsorbable plate and screws under local anesthesia. Satisfactory result was obtained in both functional and aesthetic aspect. Open reduction through external laceration and bioabsorbable fixation under local anesthesia is a reliable and useful method for the treatment of extensive and comminuted nasal fractures.

Functional reconstruction of the philtral ridge and dimple in the repaired cleft lip.

Our report describes a simple method of functional reconstruction of the philtral ridge in patients with repaired cleft lip. Philtral reconstruction was performed in 21 children with dehiscence of the orbicularis oris in repaired cleft lip. Prominent groove at the philtral column and lateral bulging during maximal "pucker" were the indications. First, the abnormally inserted orbicularis muscle is freed and realigned in a normal horizontal orientation. The muscle is vertically incised and repaired with vertical mattress sutures, spreading out the muscle to increase the thickness of the philtral ridge. The philtral ridge is accentuated by deepening the dimple with a dermal suture at the midline. Postoperative evaluation was performed at 8-18 months (mean; 13.1 months). The philtrum was evaluated by a panel using two visual scales. Eminence of the philtral ridge was scored by a five-point grading scale and the philtral dimple was scored by a three-point grading scale, both at resting and at maximal pucker. Preoperative scores showed the philtral ridge to be from "prominent groove" to "flat" at maximal pucker and at rest, respectively. Postoperative scores showed improvement of the philtral ridge to "less prominent than the normal philtral ridge" both at rest and at maximal pucker. The philtral dimple preoperative scores ranged from "no dimple" to "slight dimple" and postoperative improvement to "slight dimple" to "prominent dimple." This technique of functional reconstruction of the philtrum gave satisfactory results in formation of the philtral ridge and dimple, both at rest and at maximal pucker.