Two avulsed ears attached by very narrow subcutaneous pedicles were repaired with only cutaneous sutures and showed complete survival. The results showed that the entire auricle could be fully vascularized by just a single small vascular branch. This clinical result is compatible with our previous findings in anatomical study concerning arterial supply of the auricle.
Ear ; Sutures

Auricular arterio-venous malformation(AVM) is relatively rare and few have been reported in the literature. Two cases, presented here showed pulsating lesions of anterior and posterior auricular or even retroauricular mastoid area. They caused irregular macro and prominent ear compared with the opposite normal ear. After embolization of feeding arteries to the arteriovenous malformations, skin and subcutaneous masses were completely removed and grafted with full thickness skin: one was removed one stage and the other underwent a two stage operations. There were no evidence of recurrence for more than 2 years follow up and esthetic results were promising.
Arteries ; Arteriovenous Malformations ; Ear ; Follow-Up Studies ; Mastoid ; Recurrence ; Skin ; Transplants

The orbital pseudotumor is non-specific inflammatory disease and is unrelated with specific local or systemic disease. The major symptoms are orbital pain, limitation of the ocular movement and exophthalmos. The inflammatory change can be diffuse within the orbit or may involve a specific structure such as an extraocular muscle or lacrimal gland. It occasionally occurs acutely, but chronically in some cases. It may bring about scarring accompanied by the intraorbital soft tissue including retroorbital fat or extraocular muscles. This can be detected by ultrasound, CT orMRI. The findings by imaging procedures are thickened extraocular muscles, diffuse inflammation of intraorbital soft tissue, enlarged lacrimal gland and enhanced periorbital tissue like "a ring". Sometimes, the focal masses may be seen around the optic nerve, within the retroorbital fat or near the opbital periosteum. The diagnosis of pseudotumor is made by excluding other causes or orbital mass lesions, such as neoplasm, and other causes of orbital inflammation such as Graves' disease and local infection. Treatments are usually used systemic high-dose steroids, additionally surgical excision and radiation. Authors experienced a 52-year old female with progressively enlarged tumor in right orbital area, exophthalmos and loss of sight was treated with surgical excision, and then the defect was reconstructed with the radial forearm free flap successfully.
Cicatrix ; Diagnosis ; Exophthalmos ; Female ; Forearm ; Free Tissue Flaps ; Graves Disease ; Humans ; Inflammation ; Lacrimal Apparatus ; Middle Aged ; Muscles ; Optic Nerve ; Orbit* ; Orbital Pseudotumor* ; Periosteum ; Steroids ; Ultrasonography

Reconstruction of chest wall defects has been a continuing challenge to surgeons. Defects due to resection of tumors, infection, radiation injuries, and congenital anomalies may require chest wall reconstruction. Recent advances in plastic surgery have made reconstruction of the chest wall a reliable procedure. We reviewed fourteen consecutive chest wall reconstructions except mediastinitis over the past eight years. Among the patients, ten patients had chest wall tumors and remaining four patients had radiation necrosis, pressure sore, Poland's syndrome and Tuberculous empyema. Skeletal resection of the chest wall was done in six patients; Total or partial stemectomies were performed in three patients and an average of three point six ribs were resected in six patients. Soft tissue resection was performed in twelve patients. After resection, the thoracic skeletal defect was reconstructed with polypropylene mesh (Marlex) alone in one patient, with a composite of polypropylene mesh (Marlex) and methyl metacrylate in two patients, and with autogenous ribs in one patient. Soft tissue reconstructive procedures were predominantly muscle transpositions: five pectoralis major, three latissimus dorsi,two rectus abdominis and three fasciocutaneous flaps. Eleven patients who were alive after operation have protective and functional chest wall with excellent cosmesis at the time of last follow-up. We conclude that chest wall reconstructive procedures with prosthetic, or autogenous materials and musculocutaneous flaps are safe, durable and contributive to long-term survival and quality of life.
Empyema, Tuberculous ; Follow-Up Studies ; Humans ; Mediastinitis ; Myocutaneous Flap ; Necrosis ; Polypropylenes ; Pressure Ulcer ; Quality of Life ; Radiation Injuries ; Rectus Abdominis ; Ribs ; Surgery, Plastic ; Thoracic Wall* ; Thorax*

Although the medical applications of He-Ne lasers remain controversial, the clinical use of these devices for a variety of analgesic and wound healing applications is steadily increasing. Research studies of the effects of He-Ne laser irradiation on biologic function are growing in number and scope. Many investigators have described successful treatment of a wide variety of painful musculoskeletal, rheumatologic, and neurologic conditions with He-Ne lasers. Since we have recently initiated studies examing the effects of He-Ne lasers on wound healing and pain relief, we investigated the effect of He-Ne laser irradiation on the healing of skin defect, abrasion, burn and on the pain relief of temporomandibular joint dysfunction in admitted patients. The total number of patients was 96. The He-Ne laser power was 1 mW, dose was 1 J/cm2 and the wavelength was 632.8 nm. Each patient underwent 2 to 8 trials of irradiation on point around the wound area and painful joint at a frequency of 2 times a week. After every 1 trial up to 8 trials, we evaluated the efficacy of He-Ne laser irradiation by checking the wound size and by questioning the patients about degree of pain. Following the estimation by patients, excellent, good, and fair were accounted as effective, and poor as noneffective. The efficacy of the laser at the end of 2 to 8 trials was noticed on 78.1%, and the degree of pain relief was 73.9%. These results suggested that the irradiation of He-Ne laser is an effective and safe treatment for wound healing and pain relief. In this overview, we are summarizing some of our results which suggest a potential usefulness of He-Ne lasers for stimulation of wound healing and pain relief. Although its clinical use can be anticipated in the future, further research is required to clarify the basic mechanisms and the preferred optical parameters, such as treatment time and intensity, for increased wound healing and pain relief.
Burns ; Humans ; Joints ; Research Personnel ; Skin ; Temporomandibular Joint ; Wound Healing ; Wounds and Injuries

The importance of dressing in the territory of plastic surgery has been greatly emphasized. Especially the tie-over dressing method is very effective method which has been widely used in the areas of skin graft, and after subcutaneous shaving for osmidrosis. However, the present tie-over dressing method, using cotton balls or gauze, is poses several problems. The damp areas produced by insufficient absorption of exudate, inappropriate and uneven pressure, and excessive pressure become susceptible to infection, conclusively leading to the decreased success rate. For the last three years, we have been using the sponge, replacing the cotton balls or gauze, in total 248 cases for compressive dressing of skin graft, conchal cartilage graft, dermofat graft and subcutaneous shaving of the osmidrosis. We conclude this new method has many benefits as well as the solutions to the problems of using cotton balls or gauze.
Absorption ; Bandages* ; Cartilage ; Exudates and Transudates ; Porifera* ; Skin ; Surgery, Plastic ; Transplants

Repair of injured tendon especially is still a difficult problem in hand surgery. The challenge is to restore the gliding mechanism of the tendon. Despite increasing knowledge of tendon healing and subsequently better postoperative result, the problem formation of adhesion between the tendon and its direct surroundings remains. It is now agreed that primary repair of both flexor tendon is the treatment of choice with preservation and resto-ration of the tendon sheath. The flexor tendon sheath plays an important role in flexor nutrition, especially for the volar part of the tendon, by secreting the synovial fluid. Although data to data are indications that it will lead to fewer adhesions. Tendon sheath are sometimes restored by autologous graft. It is excellent management that the tendon sheath and pulley system are restored during tendon repair. The method of minimal injury to tendon sheath and pulley is better than restoration of that. The exploration of divided tendon through wound margin with endoscope minimizes sheath and pulley injuries. The blunt extraction of divided tendon from invisible wound site is a risky method for exploration of tendon. This endoscopic method is less traumatic, causes less pain, and requires a minimal incision. And the patient with endoscopic tenorrhaphy can exercise immediately because less operation site discomport and can be discharged early. The new tenorrhaphy technique using endoscope is expected to give better result than conventional method.
Endoscopes ; Hand ; Humans ; Synovial Fluid ; Tendons* ; Transplants ; Wounds and Injuries

There have been great concerns about the application of distraction osteosynthesis to facial reconstruction, a technique which was proposed by Ilizarov in the early 20th century. Despite of many studies and trials since then, little research has been done concerning the specific response of facial bone to distracting stress. The purposes of this study are to investigate the maximal distraction rates and lengthening amounts which are safe from poor osteogenesis and possible adverse reaction. After corticotomy, eleven Korean mongrel dogs were distracted on their mandible for 28 days at different speeds: A group-3 dogs, 1.0 mm/4 times/day; B group-3 dogs, 1.5 mm/4 times/day; C group-2 dogs, 1.75mm /4 times/day; D group-3 dogs, 2.0 mm/4 times/day respectively, which were then examined in gross architecture, radiologic and histologic changes after 7 weeks fixation. The following results were obtained: dense osseous tissue was observed in new bone with the distraction rate of 2.0 mm/day. With maximum distraction rate and lengthening, most nerve fibers of the inferior alveolar nerve were well myelinated and had relatively normal axon structures in the region of the new bone except for rare findings of minimal disfiguration of axons and demyelination in some areas. There was not any evidence of arthrotic changes in temporomandibular joint under maximum distraction, but some adaptive changes were observed. In conclusion, relatively favorable bone formation was possible at the distraction rate of 2.0 mm per day. Because there was little damage of nerve and joint against maximum lengthening (43.4% of original bone length), this technique can be considered as a useful choice for reconstruction of larger defects on facial bone. However, a more systemized longitudinal analysis is needed to determine the regional effects of distraction and the detailed mechanism of ossification on the mandible.
Animals ; Axons ; Demyelinating Diseases ; Dogs ; Facial Bones ; Joints ; Mandible* ; Mandibular Nerve ; Myelin Sheath ; Nerve Fibers ; Osteogenesis ; Osteogenesis, Distraction* ; Temporomandibular Joint

Reconstruction of soft tissue defect with exposure of the tendons and bone in the lower third of the leg and the heel represents a challenge to plastic surgeons. The sural artery flap is a fasciocutaneous flap supplied by the sural artery that accompanies the sural nerve and connects with a septocutaneous perforator of the peroneal artery via a suprafascial network of vessels. For the coverage of soft tissue defects, we operated on 10 patients using a distally-based sural artery flap. The sites of the soft tissue defect were the lower third of the leg in 7 cases and the heel in 3 cases. The size of flap varied from 3.5x4cm to 12x18cm. Nine of 10 flaps survived completely. One flap in which the sural nerve was preserved showed partial necrosis but healed spontaneously. Two flaps showed slightly venous congestion which disappeared after a few days. The advantages of the sural flap are a reliable blood supply, easy and quick elevation of the flap, preservation of the major artery and minimal donor site morbidity. The disadvantage of the flap is hypoesthesia at the lateral part of the foot. In conclusion, the distally-based sural artery flap can be used safely for soft tissues coverage in the lower third of the leg and the heel.
Arteries* ; Foot ; Heel ; Humans ; Hyperemia ; Hypesthesia ; Leg ; Necrosis ; Sural Nerve ; Tendons ; Tissue Donors

A possible therapeutic effect of acetyl-L carnitine (ALCAR) on peripheral nerve injuries and the expression of Jun, the protein products of immediate-early genes(IEGs), in the spinal cord were investigated after sciatic nerve injury in Sprague-Dawley rats. Experimental animals were divided into 3 groups: intact sciatic nerve as a control group, surgical repair alone, and surgical repair with ALCAR treatment. Toe-spreading response, pinprick response, and compound action potential were measured to evaluate the recovery of sciatic nerve injury. Recovery of behavioral function and electrophysiological function both improved in the surgical repair with ALCAR treatment group. Weak basal expression of Jun was shown in the ventral horn the of spinal cord in the control group. In the surgical repair alone group or the surgical repair with ALCAR treatment group, Jun expression persisted until 28 days after injury in the ventral horn of the spinal cord. Moreover, the surgical repair with ALCAR treatment group showed more increased expression of Jun than the surgical repair alone group. These results suggest that ALCAR facilitates the functional recovery after peripheral nerve injury.
Acetylcarnitine ; Action Potentials ; Animals ; Carnitine* ; Horns ; Peripheral Nerve Injuries ; Rats* ; Rats, Sprague-Dawley ; Sciatic Nerve* ; Spinal Cord