Patients with a poor or total absence of levator function require correction of their ptosis by a sling procedure. The aim of the procedure is to utilize the action of the frontalis muscle to mechanically raise a droopy eyelid Frontalis suspension procedure using a temporalis fascia or Tutoplast Dura was performed on 36 ptotic eyelids of 23 patients(age range 2-37 years) with a poor or absent levator function. The author used a surgical technique based on a modified Fox`s method. Satisfactory results were achieved in 42 lids according to the criteria of Jordan after an average follow-up of 23 months. No serious complication was seen immediately postoperative and during the follow-up period. Temporalis fascia and Tutoplast Dura appear to be effective and safe alternative sling materials for frontalis suspension surgery.
Blepharoptosis* ; Eyelids ; Fascia ; Follow-Up Studies ; Humans ; Jordan

Macrostomia, also called a transverse or lateral facial cleft, is a relatively rare malformation. Although many surgical procedures have been introduced, and no gold standard has yet been established. Moreover, most papers published in Korea were based on the results of the research conducted on the very limited number of patients, and for this reason its findings do not offer sufficient clinical reliability. We devised a modified commissuroplasty as follows: First, new commissure was placed 1 or 2mm inside when compared with the opposite side so that the commissure may not look longer than usual because of the scar on the side. Second, z-plasty of about 5mm was performed on the nasolabial fold to prevent the displacement of the new commissure on its lower part and avoid a continuation of a scar with the medial flap placed upward. We treated 32 cases of macrostomia from August 1, 1998 to July 1, 2002. We obtained relatively satisfactory clinical results by using this modified commissuroplasty. Based on our experience, we intend to present a clinical analysis and an operation technique of our own derived from the classic commissuroplasty, so that we may contribute to the diagnosis and treatment of the patients in the future.
Cicatrix ; Diagnosis ; Humans ; Korea ; Macrostomia* ; Nasolabial Fold

The purpose of this study was to examine the impact of the self-perceived stress of high school students on their oral health care and the relationship between stress and oral health care. The subjects in this study were the students in four different high schools located in Chungcheongnam-do, on whom a self-administered survey was conducted. The answer sheets from 939 respondents were analyzed by PASW Statistics ver.18.0 for Windows. The girls were more stressed than the boys about their studies, appearance and material resource, and the sophomores felt more stress about their home and studies. The group whose academic achievement was good in the past semester had the lowest stress about home and material resource, and the group whose economic standard was higher were less stressed about appearance and material resource. As a result of comparing their oral health care by general characteristics, the groups who were sophomores and whose academic achievement was good in the past semester were most excellent in that regard, and the students whose economic standard was higher and whose average weekly allowances were larger took better care of their oral health. Concerning the influential factors for oral health care, stress about peer relationship was positively related, and stress about material resource was negatively related. Given the findings of the study, the development of oral health care programs that include how to relieve stress is required, and more intensive education is necessary as well. Besides, education for school personnel in charge of student health management and the development of related manuals are both required.
Chungcheongnam-do ; Education ; Female ; Humans ; Oral Health* ; Surveys and Questionnaires

PURPOSE: The repair of complex chest wall defects presents a challenging problem for the reconstructive surgeon. In particular, a free flap is often required when the defect is large, in which case suitable recipient vessels must be found to insure revascularization. The authors report a case of persistent bronchopleural-cutaneous fistula developed after undergoing lobectomy for lung cancer. METHODS: The defect area was repaired using a free vertical rectus abdominis muscle flap revascularized by microvascular anastomosis to the 6th intercostal pedicle. The flap obliterated the right chest cavity, closed the site of empyema drainage, and aided healing of a bronchopleuralcutaneous fistula. RESULTS: The patient has remained healed for 14 months without any postoperative complications or recurrent infection or fistula. CONCLUSION: We suggest that a rectus abdominis musculocutaneus free flap and intercostal pedicle as a recipient could be a useful method for repair of chest defects.
Cutaneous Fistula ; Drainage ; Empyema ; Fistula ; Free Tissue Flaps ; Humans ; Lung ; Muscles ; Postoperative Complications ; Rectus Abdominis ; Thoracic Wall ; Thorax

PURPOSE: Traditionally, titanium miniplate has been used for rigid fixation of mandible fractures. However, the limitations of metal plate have been reported such as hypersensitivity, interference with the cranio-facial growth of growing child, secondary bone resorption around the plate, foreign body reaction, declination of primary callus formation, and bone atrophy, and so forth. Recently, biodegradable miniplate has been introduced and used as an alternative to the metal plate despite of its lower strength. This study evaluated the usefulness and stability of biodegradable plate and screw for treatment of mandible fractures. METHODS: In this study, 61 patients(92 areas) diagnosed as mandible fracture in the last 2 years have been reviewed. We used titanium plate and screw in 32 patients, and biodegradable plate and screw(INION?) in 29 patients. Stability of plates and screws, bony healing process and its side effects were observed by clinical and radiographic assessment. RESULTS: In the titanium material group, one of malocclusion, two of mouth opening limitation, three of pain, three of palpation were shown. The plate of six patients involved in these complications were removed. In the biodegradable group, two of mouth opening limitation, two of pain, one of localized wound infection were shown and one plate was removed secondarily. CONCLUSION: There was no statistical difference between two groups in bony healing and complication rates. Biodegradable implants show efficient stability during initial bone healing and low side effects in long-term follow up periods.
Absorbable Implants ; Atrophy ; Bone Resorption ; Bony Callus ; Child ; Follow-Up Studies ; Foreign-Body Reaction ; Fracture Fixation ; Humans ; Hypersensitivity ; Malocclusion ; Mandible ; Mouth ; Palpation ; Titanium ; Wound Infection

PURPOSE: Pressure sore wound develops inevitably in long-term, immobilized and hospitalized patients. Sore wound infection is common problem and makes healing process difficult. We aimed to identify the pathogens of the purulent discharge in sore wound and to obtain information for appropriate antibiotics through a sensitivity test METHODS: The bacteriologic study was made on 120 cases of patients who admitted or visited our hospital from 2004 January to 2005 December for sore wound treatment. Culture material was collected in BBL transport media with cotton swab and cultured by MacConkey agar plate. The method of MIC by VITEK and Microscan was used for sensitivity test. RESULTS: Among 120 specimens, organisms were isolated from 77(64.2%) cases. Gram positive organisms were cultured in 73 specimens, Gram negative organisms in 46 specemens, and fungi in 2 specimens. Mixed infection by Gram (+) and Gram (-) bacteria were observed in 34 specimens. Among them, S. aureus was the most common isolate in 24(31.2%) patients and 10 (13.0%) S. Aureus isolates were MRSA. The most prevalent Gram-negative organism was Escherichia coli in 20 patients(25.9%). Vancomycin and teicoplanin showed highest sensitivity to Gram-positive organisms and imipenem and amikacin to Gram-negative organisms. CONCLUSION: Pressure sore wound demands consideration of multimodal therapeutic aspects and these findings would be useful informations to physicians, nurses and clinical assistants in understanding the nature of sore wound and selecting appropriate antibiotics.
Agar ; Amikacin ; Anti-Bacterial Agents* ; Bacteria ; Bacteriology* ; Coinfection ; Escherichia coli ; Fungi ; Humans ; Imipenem ; Methicillin-Resistant Staphylococcus aureus ; Pressure Ulcer* ; Teicoplanin ; Vancomycin ; Wound Infection ; Wounds and Injuries

PURPOSE: Pressure sore wound develops inevitably in long-term, immobilized and hospitalized patients. Sore wound infection is common problem and makes healing process difficult. We aimed to identify the pathogens of the purulent discharge in sore wound and to obtain information for appropriate antibiotics through a sensitivity test METHODS: The bacteriologic study was made on 120 cases of patients who admitted or visited our hospital from 2004 January to 2005 December for sore wound treatment. Culture material was collected in BBL transport media with cotton swab and cultured by MacConkey agar plate. The method of MIC by VITEK and Microscan was used for sensitivity test. RESULTS: Among 120 specimens, organisms were isolated from 77(64.2%) cases. Gram positive organisms were cultured in 73 specimens, Gram negative organisms in 46 specemens, and fungi in 2 specimens. Mixed infection by Gram (+) and Gram (-) bacteria were observed in 34 specimens. Among them, S. aureus was the most common isolate in 24(31.2%) patients and 10 (13.0%) S. Aureus isolates were MRSA. The most prevalent Gram-negative organism was Escherichia coli in 20 patients(25.9%). Vancomycin and teicoplanin showed highest sensitivity to Gram-positive organisms and imipenem and amikacin to Gram-negative organisms. CONCLUSION: Pressure sore wound demands consideration of multimodal therapeutic aspects and these findings would be useful informations to physicians, nurses and clinical assistants in understanding the nature of sore wound and selecting appropriate antibiotics.
Agar ; Amikacin ; Anti-Bacterial Agents* ; Bacteria ; Bacteriology* ; Coinfection ; Escherichia coli ; Fungi ; Humans ; Imipenem ; Methicillin-Resistant Staphylococcus aureus ; Pressure Ulcer* ; Teicoplanin ; Vancomycin ; Wound Infection ; Wounds and Injuries

PURPOSE: Nipple reconstruction is an important step in breast reconstruction after mastectomy. There are considerable number of reconstructive methods developed over the past years. Each of these has not only its own special advantages, but also limitations. Therefore, no single method has become the overwhelming favorite. Sometimes it seems to be compromised when the nipple must be located directly over a linear scar. METHODS: A 48-year-old female patient received a central lumpectomy with circumareolar resection of the nipple areolar complex 4 months ago. The newly designed nipple must be positioned directly astride a scar. We drew two equal-sized rectangular flaps sharing a common limb on a transverse scar and the result was two opposing plow form. Each flap size was about 1.3 cm wide and 2.5 cm long. First we elevated the flap from the distal part at a deep dermal plane, then deepened the level of dissection to raise the dermal-fat flaps. The donor site could be closed directly without any dog-ear deformity. Then we folded down the elevated flaps and loosely sutured skin with nonabsorbable materials. Each flap inner side was approximated side by side. Finally we made new natural nipple with 6mm projection. We applied tattooing in the areola area with micropigmentation device after three months. RESULTS: After ten months of follow-up periods, the nipple projection was stable and symmetric. The nipple projection was 3.1mm, compared with 2.8mm for the opposite nipple. CONCLUSION: Our experiences shows that this double opposing plow flap is a particularly useful and simple technique when there is a traverse scar crossing the center of the proposed nipple area.
Cicatrix ; Congenital Abnormalities ; Extremities ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Mastectomy ; Mastectomy, Segmental ; Middle Aged ; Nipples* ; Skin ; Tattooing ; Tissue Donors

Isolated fungal soft-tissue infections are uncommon, but may cause severe morbidity or mortality. Aspergillosis infection is rare, but the frequency in increasing over the last two decades. Here, we present a patient with utaneous aspergillosis of his right elbow with unusual clinical and radiological features suggestive of a malignant disease, which remained undiagnosed for an extended period of time. The patient presented with necrotic, black-colored skin ulcerations. We completely removed the skin ulcer with the surrounding erythematous skin lesion, and then we reconstructed the area with thoracodorsal perforator free flap. The biopsy specimen contained septate hyphae with dichotomous branching, which is morphologically consistent with a finding of Aspergillus. After surgery, we initiated antifungal medication therapy with amphotericin B and itraconazole. At the time of follow-up, the elbow with the reconstructed flap had fully healed, and no recurrent disease was found.
Amphotericin B/therapeutic use ; Antifungal Agents/therapeutic use ; Aspergillosis/*therapy ; Biopsy ; Humans ; Itraconazole/therapeutic use ; Male ; Middle Aged ; Skin Diseases/*surgery ; *Surgical Flaps ; Treatment Outcome

PURPOSE: Verrucous carcinoma is a rare, low-grade and well-differentiated squamous cell carcinoma, representing as a warty tumor. Estimation of the incidence for cutaneous lesions is not available because they are rare. We describe a case of verrucous carcinoma, a rare type, complication of a chronic pressure ulcer of duration more than 15 years. METHODS: A 17-year-old boy presented with a large lesion involving the sacral area, which had been neglected for about 15 years. He had a history of surgical extirpation 2 years ago, but not cured. Examination revealed a cauliflower-like mass arising from an irregularly oval-shaped tumor which was 6.0x4.5cm in size with signs of infection and ulcer. The lesion involved the sacrococcygeal area, spreading to both medial gluteal regions. The perianal skin did not appear to be directly affected. RESULTS: A preoperative punch biopsy revealed a extremely well differentiated verrucous carcinoma. There were positive results in immunohistochemistry in the items of p53, p63, Ki-67. An 'en-bloc' excision of the tumor with the clinically normal surrounding tissue was carried out. Reconstruction was achieved by local regional flap. Histopathological findings of the excised area fully confirmed the preoperative biopsy report. It remained free of recurrence for a period of about 8 months. CONCLUSION: We believe that in patients with buttock involvement, regardless of the extent of such tumors, surgical therapy should be considered as the first-choice of treatment as reconstruction can be performed without excessive impairment for the patient.
Adolescent ; Biopsy ; Buttocks ; Carcinoma, Squamous Cell ; Carcinoma, Verrucous* ; Humans ; Immunohistochemistry ; Incidence ; Male ; Pressure Ulcer* ; Recurrence ; Skin ; Ulcer