Plastic surgeons have frequently encountered wide and long skin defects which require flap coverage. These include defects that occur after radical tumor resection of the head and neck region, release of severe bum scar contracture, and defects with exposure of the bone or tendons in upper and lower extremities. Lateral thigh fasciocutaneous flap, first introduced by Baek in 1983, has a long and wide skin territory. By using this flap, we performed 6 cases of burn scar contractures and 2 cases of head and neck cancer defects. In the flap elevation, it is not necessary to change the patient's position, therefore, the two-team approach shortens the operating time. The donor site can be closed primarily if the width of flap is not over 8 cm. The donor scar of the thigh is easily concealed. The lateral thigh flap can also be used as a composite or sensate flap. We conclude that, due to the lateral thigh flap being a thin and pliale fasciocutaneous flap which has a long and wide skin territory, it is very useful for reconstruction of large skin defects.
Burns ; Cicatrix ; Contracture ; Free Tissue Flaps* ; Head ; Head and Neck Neoplasms ; Humans ; Lower Extremity ; Neck ; Skin* ; Tendons ; Thigh* ; Tissue Donors

No abstract available.
Cleft Lip*

There have been so many methods described for the correction of the deviated noses but it is difficult to get satisfactory results and recurrence rate is high. There is no exact explanation why the recurrences are so high and no estabished guides for techniques according to the surgical pathology. We found the classical swinging door technique effective in cases where the caudal septum deviated from the midline. However, where the caudal septum and the tip stay in the midline, scoring or submucosal resection do not work well enough to cortet them. We used the reverse swinging door technique of our own. After elevation of mucoperichonodrium, we did sagittal section in the posterior septum and moved the septum to the midline on the pivot point of the caudal septum and. The gap created in the posterior portion of the septum were filed with bone grafts, cartilage grafts or Medopor, which were sutured to the septum, We did this technique with or without osteotmies in 56 deviated noses for last 5 years. The results were very satisfactory and there was no complication.
Cartilage ; Nose* ; Pathology, Surgical ; Recurrence ; Transplants

Infection with V. vulnificus resulting in septicemia accompanied with skin gangrene and high mortality of 50% or more freqently occurs in people with liver disenses. And it has also been demonstrated that serum iron, essential to the growth of microorganisms, has been elevated in liver damaged animals. In spite of many efforts to reveal the pathogenesis of this fatal disease, there is no clear conclusion so far. Significant increase or decrease in LD of V. vulnificus (CDC C7184) was observed when mice were treated with ferric arnmonium citrate (FAC) and a specific iron chelator, desferal(Df), originated from Streptomyces pilosus and a broad spectrurn cation chelator, calciurn disodium ethylenediaminetetraacetate (CaEDTA) widly used in heavy metal poisoning treated alone or in combination. The results were obtained as follows. FAC and Df lowered LD to approximately 1.96x 10(3) colony forming unit (CFU) and 9.77x10(2) CFU respectively from 4.46 x 10(5) CFU, LDso of the control group. However, CaEDTA elevated the I D to 4.97 X 10(7) CFU. The LD of the group administered FAC and Df simultaneously was about 9.28x10(1) CFU. Whereas, the LD of the group administered FAC and CaEDTA simultaneously was approximately 7.88 x 10(5), similar to that of the control group. This study demonstrates that there is a close association of the iron with V. vulnificus septicemia and Df lowers LD of the rnice. CaED7A, however, elevated the LD. The author hereby proposes carefully iron chelators such as CaEDTA as an agent for a new adjuvant therapy of the V. vulnificus septicernia.
Animals ; Chelating Agents* ; Citric Acid ; Gangrene ; Iron* ; Liver ; Mice* ; Mortality ; Poisoning ; Sepsis* ; Skin ; Stem Cells ; Streptomyces ; Vibrio vulnificus* ; Vibrio*

Free flaps have been widely used in lower leg reconstruction. However, in cases with extensive injury to the vessels as well as to the bone and soft tissues, and having only one intact major vessel in the lower leg(single vessel leg), careful selection of recipient vessels for the free flap transfer is mandatory for preventing further vascular compromise of the distal lower leg. The sural artery and its vena comitantes are frequently protected form externally harmful forces by the bulky surrounding gastrocnemius muscle and can be used as recipient vessles for free flaps without any detrimental influence on the vascularity of the distal lower leg. In our department, three latissimus dorsi muscle free flap were transferred with sural vessels as recipient vessels in the reconstruction of the single vessel legs. Except for one case of flap failure due to serious infection at the microvascular anastomoses site, all the other cases were successfully reconstructed without any necrosis of the gastrocnemius muscle or the distal leg. In addition, the sural vessels were easily accessed in any patient position and their caliber was similar to that of the vascular pedicles of the donor muscle flaps. In conclusion, the sural vessels can be another useful option in selecting recipient vessels for free flap transfer in the reconstruction of the single vessel leg.
Arteries ; Free Tissue Flaps* ; Humans ; Leg* ; Muscle, Skeletal ; Necrosis ; Superficial Back Muscles ; Tissue Donors

We introduce a new silicone implanting method to correct facial depression caused by trauma or congenital anomaly. It resulted in good facial aesthetics in patients with facial depression. From August 1997 to January 1999, 5 patient (3 males and 2 females), in ages from 19 to 34 years, underwent silicone implantation for facial depression using our method. Three males were injured by traffic accident and had facial depression with or without bone defect. Two females had congenital forhead depression and requested aesthetic contouring. An impression of the face was taken with alginate backed with quick setting plaster. When set, a further stone plaster model was taken from the alginate-plaster, which was removed after fixation. Wax was then carved into the patient's stone model to fill the depression. Another stone cover was taken to cover this was-stone model. Then wax was melted away and medical implant grade room temperature vulcanized silicone adhesive was squeezed into the empty space. After cured, this precisely-shaped silicone imlant was inserted into the patient. We did not experience major complicaion such as infection, implant extrusion during 4 to 18 months' follow-up periods. All patients were satisfied with the results. The clinical result of this technique would be useful for accurate and excellent aesthetic implantation.
Accidents, Traffic ; Adhesives ; Depression* ; Esthetics ; Female ; Follow-Up Studies ; Humans ; Male ; Silicones*

To increase the survival area of the venous flap, we studied the arterialized venous flap in a rabbit ear model. The ears of 12 New Zealand white rabbits(n=24) were randomized into three groups, group A receiving arterio-venous anastomosis 14 days before the arterialized venous flap elevation; group B receiving bipedicled flap elevation 14 days before arterialized venous flap elevation; group C receiving no pretreatment before the arterialized venous flap elevation. Tc -pertechnetate scan was performed on all groups immediately after the arterialized venous flap elevation to evaluate the blood flow of the flap. The survival area of the flap was measured 14 days after the arterialized venous flap elevation. Average ratio of survival area was 92% in Group A, 88% in group B, which were comparatively higher than the 12% in group C. The entire flap was visualized in groups A and B on scan images, however, only the proximal area of the anterior and posterior marginal vein was visualized in group C. Flap survival pattern was similar to that of the scan image and the slope of time-activity curve of groups A and B was much steeper than that of group C. High survival rate of group A, which received the arterio-venous anastomosis as a pretreatment, may be due to the decrease of resistance of outflow during the 14 days. Anticipated mechanisms involved are, valve insufficiency due to high pressure arterial inflow, development of vascular collaterals in the flap, and opening of arteriovenous(A-V) shunt. Bipedicled flap elevation as a pretreatment may not effect on valves, however, may impair the sympathetic nerve and cause ischmic stimuli which in turn may develop vascular collaterals and make an opening of the A-V shunt.
Ear ; New Zealand ; Survival Rate ; Veins

No abstract available.
Adenoids* ; Carcinoma, Adenoid Cystic* ; Lacrimal Apparatus*

The popularity of elective day surgery has increased significantly over the past two decades. Potential advantages of day surgery are alleviation of parental burden on time and money, less social disruption for the child and family due to the shorter period hospitalization and the absence of overnight stay. Between January of 1996 and December of 2000, we studied 391 cases that underwent day surgery (age 1 mo.-15.0 yrs). This practice is reviewed with regard to initial assessment, preparation for surgery, postoperative complications and management, and immediate follow-up by telephone visit. Up to 28% of all pediatric plastic surgical cases were performed on day-care basis mainly in laser therapy and excision of benign soft tissue mass. The incidence of postoperative minor medical complications was 3.1 In addition, we reviewed 14 patients who underwent ambulatory surgery with syndactyly and/or polydactyly of the hand. Then we compared 3 parameters (hospital charge, postoperative complications and degree of postoperative satisfaction in parents) with those of 84 inpatient children who underwent the same surgical procedures. As results, ambulatory surgery group is more economical than inpatient surgery group with postoperative satisfaction higher than inpatients surgery group with negligible complications.And based on a 5-year experience of authors, day-surgery system in pediatric plastic surgery is safe, effective and in the best interest of a select but significant proportion of children requiring elective operation.
Ambulatory Surgical Procedures* ; Child ; Follow-Up Studies ; Hand ; Hospitalization ; Humans ; Incidence ; Inpatients ; Laser Therapy ; Parents ; Polydactyly ; Postoperative Complications ; Surgery, Plastic* ; Syndactyly ; Telephone

It has been well documented that dysfunction of the Eustachian tube if the main cause of middle ear disease in most cleft palate patients. The middle ear disease is refractory to medical treatment and has frequent recurrences; the final results may end up with chronic otitis media and/or hearing loss. Currently, myringotomy with placement of ventilation tube in early infant stage have been widely accepted for treatment of otitis media in cleft palate patients. We calculated the frequency of the occurrence of otitis media in cleft palate patients who have received palatoplasty in our clinic. Preoperative otoscopic examination and tympanometric test were taken in all patients. We performed tympanostomy and ventilation tube insertion at the time of palatal repair on every patients who had evidence of otitis media in the preoperative otologic examinations. Since November 1996, 79 patients received palatoplasty and among these 63 patients(79.7%) received bilateral ventilation tube insertion simultaneously. We confirmed the previously documented high prevalence of otitis media in cleft palate patients and understood the importance of preoperative otologic examinations in the managements of cleft palate.
Cleft Palate* ; Ear, Middle* ; Eustachian Tube ; Hearing Loss ; Humans ; Infant ; Middle Ear Ventilation ; Otitis Media ; Prevalence ; Recurrence ; Ventilation