Tie-over dressing is commonly used in order to immobilize the skin graft. The classic method takes too much time and effort, and various apparatuses of the other modifications are somewhat large and bulky, especially in the surgery for hands, therefore, we have developed a simplified method for tie-over dressing. We placed several key stitches with absorbable suture material, and passed silk sutures from one margin of the graft to the opposite without tying. Then after putting saline-soaked cotton balls below and above the silk sutures, we tied the silk suture together applying appropriate pressure. This method has the following advantages: 1. speed of application 2. double compression 3. easy to remove
Bandages* ; Hand ; Silk ; Skin ; Sutures ; Transplants

In general, split thickness skin graft was done under general anesthesia. However, there was a difficulty to do general anesthesia in some cases due to poor general condition. The lateral cutaneous nerve block of the thigh(LCNBT) anesthesia the usual donor site of split-thickness skin graft in the thigh. Using 10 ml of 0.5% bupivacaine, LCNBT was used thigh for harvesting split-thickness skin in 42 patients. Patients age ranged from 18 to 62 years with mean 49 years. The onset of full anesthesia took between 12 and 21 minutes. The area anesthetised ranged from 200 cm2to 940 cm2with mean 551 cm2. The duration of full anesthesia was from 6 to 16 hours. In 6 patients, LCNBT was compared with previous lidocaine local anesthesia and all patients preferred to do LCNBT. In our experience, LCNBT is a safe, and simple method for harvesting split-thickness from the thigh and LCNBT provided good postoperative analgesia.
Analgesia ; Anesthesia ; Anesthesia, General ; Anesthesia, Local ; Bupivacaine ; Humans ; Lidocaine ; Nerve Block ; Skin* ; Thigh* ; Tissue Donors* ; Transplants*

Hypermastia has always been a serious problem for women, frequently causing physical pain and deformity as well as psychological disorders associated with self image. At present time, there are various techniques of reduction mammaplasty to help women's self esteem. Among these, inferior pyramidal dermal pedicle technique of reduction mammaplsty has some advantages including ease of performance and teaching, good preservation of the neurovascular supply to the nipple, applicability over a wide range of reduction size, and reliable reproducibility. We report ten patients with hypermastia and breast ptosis who underwent reduction mammaplasty and mastopexy using by our modified inferior pyramidal dermal pedicle technique, that is based on the concept of Courtiss & Goldwyn and Georgiade. In conclusion , inferior pyramidal dermal pedicle technique for hypermastia is a valuable technique for the reasons of time-tested simplicity and reliable reproducibility.
Breast ; Congenital Abnormalities ; Female ; Humans ; Mammaplasty* ; Nipples ; Self Concept

Microvascular surgery can provide the necessary soft tissue coverage from the remote donor areas by free flap transfer into the defect. Correct selection of the appropriate recipient vessels is difficult and remains the most important factor in successful free flap transfer. Recently, vascular anastomosis to recipient vessels distal to the zone of injury has been advocated and retrograde for flaps are well established in island flaps. Purpose of this study is to report our clinical experiences with lower extremity reconstruction in 9 patients. 9 patients with soft tissue defect below the knee underwent lower extremity reconstruction with distally based free flaps using retrograde arterial flow. For assessment of the retrograde flow, intraoperative retrograde arterial pressure was quantified and compared with systolic blood pressure taken at the same time. Suitable candidates had ben chosen with pulsatile retrograde flow and a diastolic retrograde arterial pressure of 60 mmHg. Three different free flaps were used. All flaps were successful. Retrograde flow anastomosis could not interrupting the major blood vessels which were essential for survival of the distal limb, the compromise of fracture or wound healing might be prevented. In cases wherein arteriography demostrates significant vascular flow interruption within the zone of injury, those are also candidate for retrograde arterial anastomosis.
Angiography ; Arterial Pressure ; Blood Pressure ; Blood Vessels ; Extremities ; Free Tissue Flaps* ; Humans ; Knee ; Lower Extremity ; Surgical Flaps ; Tissue Donors ; Wound Healing

A wide variety of free muscle or composite flaps have been used clinically for the reconstruction of soft tissue or compound tissue defects since introduction of the microsurgical technique but there were still difficulties in their application due to donor site morbidity and flap bulkiness. Free serratus anterior muscle flap and free composite flap, including serratus anterior muscle have been applied to 17 patients with small or medium sized tissue defects or large sized compound tissue defects from June 1995 to July 1997. There were 11 male cases and 6 female. Average age was 27 years. Defect sites were the anterior tibial area in 6 cases, the dorsum of foot in 6, the medial malleolar area in 1, the heel area in 1, the foot in 2, and the thumb and 1st web space in 1. There were 12 free muscle flaps, 2 free serratus anterior and rib composite flaps, 2 free serratus anterior and latissimus dorsi combined muscle flap and 1 free serratus anterior and latissimus doris and rib composite flap. The average follow up period was 14 month. The survival rate was 100% in 16 cases, 80% in 1 case. There was no remarkable donor site morbidity and operative results were satisfactory in all cases. The advantages of this flap are consistent and reliable flap with minimal donor site morbidity, long constant large caliber pedicle, taking a thin flap, excellent malleability allowed a broad of range of inserting technique, and additional possibility of a composite flap.
Female ; Follow-Up Studies ; Foot ; Heel ; Humans ; Male ; Ribs ; Superficial Back Muscles ; Survival Rate ; Thumb ; Tissue Donors

Since the use of the rectus abdominis myocutaneous flap was first reported by Mathes and Bostwick in 1977, its clinical utility both as an pedicled flap and a free flap has broadened reconstructive surgery. But there is a risk of postoperative abdominal hernia formation and bulkiness due to the volume of the rectus muscle and subcutaneous fatty tissue, it is pointed out as a disadvantage in the recipient site where a thin flap is required. To overcome these problems, Koshima (1989), and Itoth (1993) described the modification of this flap which contained little or no muscle or fascia. In our department , we performed deep inferior epigastric artery free skin flap in soft tissue reconstruction in three patients: we dissected one or two muscle perforator from the rectus muscle, removed the deep fatty layer, so we could elevate a thin flap. The results were good, so we are willing to describe the operative technique and its usefulness.
Adipose Tissue ; Epigastric Arteries* ; Fascia ; Free Tissue Flaps ; Hernia, Abdominal ; Humans ; Myocutaneous Flap ; Rectus Abdominis ; Skin* ; Surgical Flaps

Arteriovenous malfomation poses an unsolved, uncontrollable surgical challenge. Many therapeutic modalities have been introduced, but the great recurrence of the malformation after the radical resection should not be ignored. The altered hemodynamic conditions and newly formed ischemic areas after the surgical resection can accelerate the dormant artervenous shunt and stimulate the expansion of regional collaterals. So, the appropriate reconstruction method must be considered to prevent its recurrence. We have our own therapeutic principles; preoperative selective embolization, radical resection with saving the important structures, and well-vascularized tissue reconstruction such as island or free flap. 5 patients with facial arteriovenous malformations (2 on the temple, 2 on the auricle, 1 on the cheek), were treated with this modality and this concept can be expected to provide great remission of arteriovenous malformation. Free flap transfers were used in 3 cases. The feeding vessels of the arteriovenous malformation were used as recipient vessels of free flap, and so such hemodynamic redistribution of flow also limited the development of new arteriovenous shunts in ischemic field of resection.
Arteriovenous Malformations* ; Free Tissue Flaps ; Hemodynamics ; Humans ; Recurrence

Malignant tumors of the eyelid pose a serious threat because of their proximity to the globe, brain & paranasal sinuses. Three types of carcinomas account for the vast majority of the malignant eyelid tumors: basal cell carcinoma, squamous cell carcinoma, and sebaceous gland carcinoma. In these malignancies, basal cell carcinoma is the most common. However, sebaceous gland carcinoma has a high recurrence rate and a moderately high 5-year mortality rate because of late diagnosis and incomplete surgical removal. This tumor may be clinically misdiagnosed frequently as a chronic unilateral conjunctivitis, chalazion, basal cell carcinoma, or squamous cell carcinoma in initial biopsy. Suspicious lid lesions should be managed with incisional biopsy initially. If they are positive for sebaceous gland carcinoma, wide excision and frozen section monitoring of surgical margin is the treatment of choice. The final diagnosis should be confirmed by special stain for lipid. We experienced 12 cases of malignant eyelid tumors including 3 cases of sebaceous gland carcinoma. In cases of sebaceous gland carcinoma, wide surgical excision with frozen section monitoring was performed and followed by eyelid reconstruction with intact eyelid tissue remained and adjuvant radiotheraphy. Guidelines for management are discussed.
Biopsy ; Brain ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Chalazion ; Conjunctivitis ; Delayed Diagnosis ; Diagnosis ; Eyelids* ; Frozen Sections ; Mortality ; Paranasal Sinuses ; Recurrence ; Sebaceous Glands

Most of the basal cell carcinomas (BCCs) are effectively treated using standard conventional therapeutic modalities, but the complete removal of the tumor is difficult if the subclinical extension of BCCs is deep and wide. These difficulties are solved by Mohs micrographic surgery which provides the highest possible cure rates and the lowest normal tissue loss. Mohs micrographic surgery is an ideal method for the treatment of skin cancer in that it provides unsurpassed cure rates and maximum preservation of normal tissue by complete surgical margin control. We studied 40 patients with 40 basal cell carcinomas (22 primary, 18 recurrent) treated by Mohs micrographic surgery from January, 1992 through October, 1995 at Dong-A University Hospital. We evaluated the depth and lateral margins of excision by Mohs microgrphic surgery according to the anatomic locations, histologic type, size, and primary/recurrent state of basal cell carcinomas. There was no recurrence during follow-up period up to 3 years. We can draw the guidelines for complete surgical margin control out of our results. The guidelines are as follows. 1. The frist excision should be done with lateral safety margin of 2 mm in primary BBCs. 2. The frist excision should be done with lateral safety margin of 4 mm in recurrent BBCs. 3. The frist excision should be done with lateral safety margin of 4 mm in longer than 15 mm-sized BBCs. 4. The additional excision should be done with the every 2 mm lateral safety margin until the tumor completely removed. 5. The frist excision should be done with the surgical depth to periosteum, perichondrium especially in BBCs on nose.
Carcinoma, Basal Cell* ; Follow-Up Studies ; Humans ; Mohs Surgery* ; Nose ; Periosteum ; Recurrence ; Skin Neoplasms

The obstruction of nasolacrimal conduit system which produces epiphora can be caused by congenital anomalies, chronic dacryocystitis, after trauma and facial paralysis. Dacryocystorhinostomy is a popular procedure for adult nasolacrimal duct obstruction. But various methods are used for flap formation and plugging. We performed 23 cases of the dacryocystorhinostomy with two mucosal flap of "U" shape from August 1993 to August 1996. Anterior flap was formed of nasal mucosa, and posterior flap was formed of lacrimal sac. The posterior flap was retracted through the nasal cavity by 6-0 black silk instead of suturing. Vaseline gauze was used as a plugging agent. Epiphora disappeared in 21 (91.3%) of 23 cases.
Adult ; Dacryocystitis ; Dacryocystorhinostomy* ; Facial Paralysis ; Humans ; Lacrimal Apparatus Diseases ; Nasal Cavity ; Nasal Mucosa ; Nasolacrimal Duct ; Petrolatum ; Silk