In 1998, we reported on 120 fingers in 110 consecutive patients who were treated with reverse digital artery island flaps for fingertip reconstructions. The purpose of this follow-up study is to emphasize a couple of changes in our procedures since the original study. First, we do not employ sensate flaps any more. Second, digital artery is separated more distal than the original report, to the level of distal interphalangeal joint in some cases. Lastly, flap design in a stellate shape is recommended to avoid scar contracture. Twenty-eight additional patients(fingers) during the period from September of 1999 to August of 2002 were added in this study and long-term follow up was performed in 11 cases for 1 to 2 years after operation with insensate and stellate shaped flaps. Extensive digital artery dissections were performed in 9 fingers. Survival of the flaps and postoperative sensory recovery was successful in all 28 fingers. The static two-point discrimination ranged from 8mm to 4mm, with an average of 6.6mm. No patient showed severe discomfort for their sensory perception and, was required an additional operation for further improvement of the finger shape. We still think that the reverse digital artery island flap is an excellent choice for coverage of fingertip defects and are convinced that a couple of technical changes in this study contribute to the improvement of the procedure and its final outcome.
Arteries* ; Cicatrix ; Contracture ; Discrimination (Psychology) ; Fingers ; Follow-Up Studies* ; Humans ; Joints ; Surgical Flaps

The augmentation rhinoplasty using silicone implant is one of the most popular cosmetic procedure in Asians. But complications such as deviation and extrusion are often noted. For prevention of these problems, we discussed and assessed the effectiveness of augmentation rhinoplasty through unilateral infracartilaginous incision and fixation of the silicone to the septal cartilage. Among 121 patients who underwent closed rhinoplasty using anchoring suture in silicone fixation and covering the silicone tip with medial border of lateral crus in both alar cartilage by intercrural suture, we analyzed 47 patients. No other procedures were used. The average follow-up period was 11 months. This technique showed good results without deviation or extrusion of silicone implants. In addition, this procedure yields good nasal tip projections. Herein, this treatment will be a future promising treatment modality for reducing complications with high level of patient satisfaction
Asian Continental Ancestry Group ; Cartilage ; Follow-Up Studies ; Humans ; Patient Satisfaction ; Rhinoplasty* ; Silicones* ; Sutures*

Mandibular anterior segmental osteotomy, is an alternative surgery for patients with pseudoprognathism who do not tolerate orthodontic treatment. When genioplasty is required as a concomitant procedure, this is easily accomplished without the deformation of occlusion by leaving a horizontal bony bar. However, for patients with a short chin, there is no space to leave a bony bar. Hence, a complete osteotomy is required to separate the mandible into several pieces, which include anterior dentoalveolar segment, mentum and two mandibular bodies, leaving no structural continuity of the mandible. In this case, it is essential to consider the occlusion, to use a wafer splint, and to proceed with a long duration of intermaxillary fixation. The authors describe a modified procedure from the one described above for mild pseudoprognathism and a short chin. An 18-year-old female was concerned about her asymmetric lower facial appearance and anterior cross-bite with protruding short chin. After mandibular anterior segmental osteotomy and setback reposition, we made an angulated bony bar. Another horizontal osteotomy was performed 2mm apart from the previous osteotomy line and angulated 30 degree leaving about 8mm on the posterior cortex. The movable chin segment was repositioned posteriorly and fixed to the bony bar using two 11-mm screws. The long-term result was satisfactory both functionally and aesthetically.
Adolescent ; Chin* ; Female ; Genioplasty* ; Humans ; Mandible ; Osteotomy* ; Splints

Osteochondroma is a relatively common benign tumor of skeleton, occurring most often in the metaphyseal region of long bone. However, it is very rare in the facial bone, expecially in the mandible body. We report a case of osteochondroma on the left mandible body in a 9-years-old male, which has been present for 2 years. It was successfully removed by surgery. On pathologic examination, it was diagnosed as osteochondroma consisting of bony structures covered with a cartilaginous cap, the typical composition of osteochondroma.
Facial Bones ; Humans ; Male ; Mandible* ; Osteochondroma* ; Skeleton

Psoriasis is a common and unpredictable chronic immune mediated disease charcterised by skin lesions and associated with arthritis. Complete remission is very rare. Prevention of acute exacerbation is mainstay of the treatment. At present, risk of surgery in psoriasis patient is uncertain although some dermatologic literatures reported that well controlled psoriasis is usually not cause surgical complications. We experienced a case of wide necrosis of flap in chronic psoriasis patient after immediate breast reconstruction with pedicled transverse rectus abdominis flap. Psoriasis is well known to have chronic skin damage from characteristic histopathologic findings of Munro's micro abscess, dermal arteriolar tortursity and hyperplasia. Such pathologic feature may induce congestion of flap and wide necrosis of flap.
Abscess ; Arthritis ; Breast* ; Estrogens, Conjugated (USP) ; Female ; Humans ; Hyperplasia ; Mammaplasty* ; Necrosis ; Psoriasis* ; Rectus Abdominis ; Skin

The purpose of this study is to evaluate the effect of the presurgical infant orthopedics and the nasoalveolar molding in unilateral complete cleft lip and palate by the analytic system using standardized photographs. This study involved 34 patients with unilateral complete cleft lip and palate(24 male, 10 female, mean age 4.9 years) who underwent a rotation-advancement flap repair between 1995 and 1998 by single surgeon. Follow-up photographs were taken at a time average 3.8 years(2-7ears) after surgery. The patients were divided into three groups Group I(9 patients) consists of those who underwent cheiloplasty and primary rhinoplasty without presurgical infant orthopedics. Group II(10 patients) consists of those who underwent cheiloplasty and primary rhinoplasty with presurgical alveolar molding alone without nasal molding, and Group III(15 patients) consists of those who underwent presurgical alveolar molding with nasal molding without primary rhinoplasty. Facial proportions and angles were measured on standardized photographs using defined anthropometric points. All linear parameters were converted to the percentage values. In addition, the qualitative measurements were performed on scar quality, nostril symmetry and alar symmetry. Comparisons between group I and II and those between group II and III were made in all parameters. Results were analyzed by Mann-Whitney/ Wilcoxon rank sum test. Between group I and II, there was a significant increase in upper lip height symmetry in group II(p= 0.014). Between group II and III, upper lip height symmetry and Cupid's bow length symmetry significantly increased in group II(p=0.002, p=0.012). The other quantitative and qualitative parameters didn't make the difference between groups. In conclusion, the infant orthopedics increases upper lip height of cleft side and has the effect to obtain the upper lip symmetry. But the nasoalveolar molding has no effect to increase the nasal symmetry. So the nasoalveolar molding alone appears to be insufficient to replace the infant orthopedics with primary rhinoplasty.
Cicatrix ; Cleft Lip* ; Female ; Follow-Up Studies ; Fungi ; Humans ; Infant* ; Lip* ; Male ; Nose* ; Orthopedics* ; Palate* ; Rhinoplasty

The human acelluar allogenic dermis has been used for soft tissue augmentation of sunken areas. Because of high price, extra-acelluar allogenic dermis is resterilized after being used. The purpose of this experiment is to evaluate the safety and efficacy of ethylene oxide (E.O) gas sterilized acellular allogenic dermal graft(Sure Derm(R)). Twenty-four white rats, weighing about 200 grams and of 5 weeks of age were divided into 3 groups. The prepared SureDerm(R) sheets(10x10mm sized , each 1 mm in thickness) were implanted into the pockets of back area. Biopsy specimens were taken after 4, 8 and 12 weeks and examined histologically for inflammatory reaction, neocollagen synthesis. The initial volume of the graft was measured by immersing it in a 2cc of normal saline and the volume of fluid displaced was checked. The changes in graft volume were measured by the same method. There was a tiny decrease in the volume of the E.O. gas sterilized graft. However, there was no significant difference in the survival rate among the groups(p<0.05). Histological analysis demonstrated progressive monocytes and fibroblast infiltration, sparce collagen bundle organization with time in E.O. gas sterilized grafts. Our experimental study suggests that E.O. gas re- sterilized SureDerm(R) might not be a safe material to use as an implant.
Animals ; Biopsy ; Collagen ; Dermis* ; Ethylene Oxide* ; Fibroblasts ; Humans ; Monocytes ; Rats ; Survival Rate ; Transplants

Endothelial cells are most sensitively affected by ischemic-reperfusion injury, and also the endothelial cells have very important role in immune reaction of organ transplantation and preservation of the organ. To improve the survival rate of a flap, and also to reduce the possibility of flap necrosis, the protection and preservation of the endothelial cells are very important. Because reactive oxygen species(ROS) are thought to be an important cause of ischemic reperfusion injury, we studied the cytotoxicity of ROS on endothelial cells. We performed an in vitro study to document whether green-tea polyphenol pretreatment play an important role in preventing cytotoxic damage from ROS. Neonatal Dermal Microvascular Endothelial Cells were cultured in EGM-2 MV BulletKit. Endothelial cell suspension in concentration of 4x104, was distributed into the wells of 24-well plate, cultured for 1, 3, 5, 7 days and the growth rates of the cells were measured with ELISA reader. Green-tea polyphenolic compounds(GtPP) were administered on L929 mouse fibroblasts and the possible cytotoxicity was measured with ELISA reader. Cultured endothelial cells in the concentration of 2x105 cells were treated with 0.1mM, 1mM, 10mM H2O2 and also with 0.25mM xanthine and 0.1U/L, 1U/L, 10U/L xanthine oxidase to induce oxidative stresses. Then the morphological findings of the endothelial cells were observed under the light microscope and the growth rate was analyzed with flow cytometry. To evaluate its protective effect, 0.25, 1, 10, 100microgram/ml of GtPP were administered to endothelial cells in the concentration of 2x105cells, one hour before administration of the oxidative agents, and then the cells were cultured for 24 hours. Afterwards, the morphology of endothelial cells were observed under the light microscope and the growth rate was analyzed with flow cytometry. The results are as follows: The growth of human endothelial cells were normal, and polyphenol of each concentration administered in this study did not show cytotoxicity. As a result of oxidative stress induced by H2O2 or xanthine oxidase(+0.25mM xanthine), the endothelial cell viability decreased by more than 25%, thus confirming the effects of ROS to endothelial cells. The GtPP pretreatment before H2O2 or xanthine oxidase(+0.25mM xanthine) administration, resulted significant protective effects for endothelial cells in morphology and growth rate study. Through these studies, the authors confirmed the protective effects of polyphenol against ROS. We also conceived that the polyphenol can possibly be implemented as an agent for organ or tissue preservation.
Animals ; Endothelial Cells* ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts ; Flow Cytometry ; Humans* ; Mice ; Necrosis ; Organ Transplantation ; Oxidative Stress ; Oxygen ; Reactive Oxygen Species* ; Reperfusion Injury ; Survival Rate ; Tissue Preservation ; Transplants ; Xanthine ; Xanthine Oxidase

The purposes of this study are to establish standard model in which endothelial cell proliferations are induced by DMH stimulation in vitro, and to analyze the gene expressions of proliferative HUVECs using DNA chip technique which could evaluate the mechanisms of angiogenesis, and the development of vascular tumors. To perform the MTT assay in 96-well microplates, 104 cells were seeded in each well which were cultured in medium. On the third day, the cells were treated with 5 different concentrations of diluted DMH from 10 to 10-3 ng/ml. Five DMH-treated groups were compared with the control group which was not treated with DMH. The optical densities in each group were measured at the time of 0, 6, 12, 24, 36, 48, and 72 hours after DMH treatment. The same experiment was repeated 9 times. Statistically significant cell proliferations were observed in 1 and 10-1ng/ml group. The RNAs were isolated from HUVECs of control group and 1ng/ml DMH-treated group, and they were used to analyze the gene expressions using DNA chip technique. One hundred and seventy-seven genes(142 of up-retulated genes and 35 down-regulated genes) were identified, and several genes were associated with VEGF and FGF production. Also DMH could affect expression of genes that involve oncogenesis. Further study should be performed to evaluate the processes of angiogenesis and morphogenesis of vascular tumors, which could be utilized in the development of new therapeutic approaches.
Carcinogenesis ; Dimenhydrinate ; Dimethylhydrazines ; Endothelial Cells ; Gene Expression Profiling* ; Gene Expression* ; Human Umbilical Vein Endothelial Cells* ; Humans* ; Morphogenesis ; Oligonucleotide Array Sequence Analysis ; RNA ; Umbilical Veins ; Vascular Endothelial Growth Factor A

This study was carried out on 80 New Zealand white rabbits, each weighing 3-3.5kg. Twenty rabbits were allocated into each of the four groups. After a 1cm sized ostectomy was made on the tibial body with the periosteum preserved, artificial bone substitutes were implanted. Except for control group(I), manufactured chitosan pellets were implanted in group II, Osteoset(R)(calcium sulfate) in group III and manufactured calcium sulfate-chitosan composite pellets in group IV. Results were evaluated using radiographic study, bone mineral density test and histologic examination in 2, 4, 6 weeks and three point bending test in 6 weeks after implantation. In the radiographic study, the formation and corticalization of callus were similar in groups III, IV and this was much earlier than in groups I, II. In the bone mineral density test and three point bending test to contralateral normal tibia in 6 weeks, the values in groups III and IV were statistically significantly higher than in groups I and II(p<0.05). In histologic examination, groups III and IV have more abundant and faster new bone formation than groups I and II. In conclusion, the synergistic effect between calcium sulfate and chitosan in group IV is considered to facilitate new bone formation as effectively as Osteoset(R) does.
Bone Density ; Bone Substitutes ; Bony Callus ; Calcium Sulfate ; Calcium* ; Chitosan ; Osteogenesis* ; Periosteum ; Rabbits* ; Tibia