Augmentation Rhinoplasty Combined with Tip Plasty Using AlloDerm(R)

Because the Korean nose has a flat dorsum and depressed tip, tip projection procedure has frequently been performed as an ancillary procedure of dorsal augmentation. Although various materials have been used for tip plasty, an ideal technique has not yet been described. The authors performed classic augmentation rhinoplasty using a silicone implant to correct flat dorsum. Alloderm(R)(Life Cell Corporation, the Woodlands, Texas), acellular human dermis, was used for soft and smooth projection of the nasal tip. From January of 2000 to August of 2003, 20 patients underwent this procedure in Department of Plastic and Reconstructive Surgery. The patients were followed up for 2 to 26 months. Postoperative course was uneventful. Although partial graft resorption was noted in 3 patients, long-term follow-up showed good results. Alloderm(R) usage for tip plasty allows natural contour of the nasal tip, decreases donor site morbidity, and obviates time consuming procedures for graft harvesting. In conclusion, Alloderm(R) graft could be an appropriate alternative in tip projection procedure.

A Retrospective Study for Method and Timing of Reconstruction Using Free Latissimus Dorsi Muscle Flap at Foot in Electrical Burn Patients

High-voltage electrical injury results in progressive deep tissue necrosis, often resulting in amputation when foot is involved. Complete surgical debridement and coverage with a vascularized free flap, when local flaps and skin graft are unsuitable, may protect partially devitalized structure, preserve function, and reduce the incidence of amputation. The free latissimus dorsi muscle flap for coverages of extensive soft tissue defect of foot has advantages over the musculocutaneous flap or perforator flap. The flap is less bulky, flexible, contoured easily, long pedicle and less donor morbidity. Well- vascularized muscle may be effective in getting under control infection. Vein anastomosis was performed to the venae comitantes and thoracodorsal vein, because electrical current produces tissue damage accompanied by valve fibrosis and coagulation of superficial blood vessel. The timing of surgical debridement remains controversial. Thus, we compared result of flap survivor with operation less than 3 weeks after injury and operation more than 3 weeks after injury, anastomosis of recipient vein that venae comitantes and saphenous vein from January 1997 to April 2002, 21 patients injured by electrical burn of foot treated reconstruction using the free latissimus dorsi muscle flap with meshed split- thickness skin graft coverage. As a result, we think that delayed debridement(more than 3 weeks after electrical burn injury) may result in increased saving of free flap, because it relatively makes demarcation of devitalized tissues and selection of uninjured recipient vessel clear. We suggest that using delayed operation and anastomosis of venae comitantes in electrical burn injury increase of survival rate free latissimus dorsi muscle flap.

The Management of Pediatric Steam Burn Caused by Electric Rice-cooker

The steam burn caused by electric rice-cooker is a unique mode of burn injury in Korea. This type of burn injury is characterized by first, a predilection for the volar aspect of the hand in toddlers younger than 2 years old age second, The depth of burns are normally deep second degree to third degree and usually need operation at the time of injury, third, Flexion contractures of multiple finger joints and web space contracture are common sequelae. We hypothesized that primary FTSG would give more reliable results and eliminate the late reconstructive procedures. Between Jan. 1997 and Jan. 2002, 65 patients underwent primary FTSG, and the results of this primary FTSG group were compared with 124 patients who were treated with STSG(79/124, 63.7%) or by conservative management(45/124, 36.3%), and readmitted for the correction of hand deformities between Sep.1995 and Sep.1999. In the primary FTSG group, 9.2%(6/65) of mild web contractures and 6.1% (4/65) of finger joints contractures were documented and one patient was received the reconstructive procedure during a follow up period of 9.7+/-6.3 months. In 124 patients of the primary STSG or conservative group, the mean time interval to reoperation was 8.9+/-4.0 months and all patients received FTSG for correction of late hand deformities. In a retrospective study of the primary STSG group, 42 of 53 patients(79.2%) received reconstructive procedure. In this report, we propose that primary FTSG may be a reliable method for the treatment of this more severe type of acute burn in pediatric patients.