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

The patient-reported outcome measures (PROMs) are important in assessing the patient’s overall health, lesion-specific outcomes, and condition-specific outcomes. PROMs are also known as “scoring systems” and are usually in questionnaires. There are almost a hundred different PROMs available in foot and ankle surgery. Each PROM has its merits, demerits, and validity. Selecting an appropriate PROM is important for adequately evaluating a patient’s health status. This article summarizes the most frequently used PROMs in the literature on foot and ankle surgery and presents the authors'recommendations.

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

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

Paederus dermstitis (or dermatitis linearis), caused by the insect genus Paederus, is characterized by linear erythernatous, vesicopustular lesions. In 1968, we proved that causative agent is Paederus fuscipes. During the 20-year period since then (from June 1968 to September 1988), we have experienced 156 cases of the diseaes in our clinic, and the clinical features were studied with the following results. (1) They were found only during summer months from June to September. Most prevalent in June(47%), followed by August, July and September, in decreasing order. (2) People in their twenties were affected most often(10%), with females outnumbering males, by approximately 2.8 to 1. (3) The lesions were found exclusively over exposed areas, such as face, neck, and extremities (4) Experiments on a volunteer revealed that the same skin lesions as in the patients can be produced by rubbing the anal portion of the insect. (5) Spongiosis and subcorneal pustule of epidermis were the main histopathological findings. (6) The insects appear ant-like and measures 6.5 to 7mm in length. It has a black, round head with pslpuli black, rectangular, short elytra, yellowish brown pronotum and abdomen composed of 6 segments, of which two caudal ones(hypopygium) were dark brown. The meso and metathorax, and the lower ends of the femurs in meso and metapedes appear dark brown. (7) Wide use of potent pesticides, herbicides, or insecticides as well as the urbanization may have reduced the out breaks of the disease in recent years.
Abdomen ; Dermatitis* ; Epidermis ; Extremities ; Female ; Femur ; Head ; Herbicides ; Humans ; Insecticides ; Insects ; Male ; Neck ; Pesticides ; Skin ; Urbanization ; Volunteers

PURPOSE: To report the clinical outcomes and complications of flexor hallucis longus (FHL) tendoscopy using 3 portals. MATERIALS AND METHODS: Between January 2012 and April 2013, 10 patients (10 ankles) received tendoscopic surgery for the treatment of FHL tenosynovitis. Patients complaining of pain and tenderness along the course of FHL despite over 6 months of conservative treatments were indicated for surgery. The mean age was 41.7 years (range: 18-57) and the follow up period was 12.7 months (range: 6-20). Tendoscopy was performed using posteromedial, posterolateral, and plantar portals. Clinical evaluations included preoperative and postoperative visual analogue scale (VAS), American orthopaedic foot and ankle society (AOFAS) score, and patients' satisfaction. RESULTS: Tendoscopic findings included tenosynovitis in 10 cases, degenerated vinculae in 6 cases, stenosis of the tendon at its entrance into the fibro-osseous tunnel in 5 cases, and degenerative partial tendon tear in 3 cases. Two cases had associated symptomatic os trigonum and 3 cases had posterior ankle impingement syndrome. Preoperative pain decreased from median VAS 6 (range: 4-10) to 2.1 (range: 1-5) at the last follow up and AOFAS score improved from 50.1 (range: 36-63) to 82.1 (range: 61-89) (p<0.05). Nine patients were satisfied or very satisfied with the outcome. Injury of the lateral plantar nerve occurred in one case. CONCLUSION: FHL tendoscopy using 3 portals is a feasible and useful minimal invasive surgical technique for the management of FHL tenosynovitis.
Ankle ; Constriction, Pathologic ; Follow-Up Studies ; Foot ; Humans ; Talus ; Tendons ; Tenosynovitis*

The most important prognostic factor of breast cancer is the status of lymph node or distant metastasis, which is resisted by basement membrane and stromal matrix. MMP (matrix metalloproteinase)-2 is a 72-kilodalton type IV collagenase/ gelatinase and degrades the type IV collagen which is a main component of the basement membrane. Therefore, MMP-2 is believed to be one of the key molecule for cancer invasion and metastasis. Enzymatic activity of MMP is inhibited by TIMPs (tissue inhibitors of metalloproteinase). TIMP-2 forms a complex with latent pro-MMP-2 and inhibits the active forms of MMP-2. The balance of MMPs and TIMPs is suspected as the important factor of invasion and metastasis of the tumor cells. We studied the association between the expression of MMP-2/TIMP-2 and growth pattern of tumor border, lymph node metastasis, and estrogen receptor expression in the 57 cases of invasive ductal carcinoma of the breast using immunohistochemical staining methods. The results revealed increased expression of MMP-2 in the infiltrating tumor border and tumors with positive lymph node metastasis and negative estrogen receptor with no statistical significance (p>0.05). But the expression of TIMP-2 was increased in expanding tumor border and tumors with positive lymph node metastasis and negative estrogen receptor without statistical significance (p>0.05).
Basement Membrane ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Collagen Type IV ; Estrogens* ; Gelatinases ; Lymph Nodes* ; Matrix Metalloproteinases ; Neoplasm Metastasis* ; Tissue Inhibitor of Metalloproteinase-2*

Bone marrow aspirate concentrate and matrix-induced chondrogenesis (BMIC) is an interesting treatment option for osteochondral lesions of the talus with promising short- to mid-term results. The various terminologies used to describe this surgical method need to be addressed. These include bone marrow-derived cell transplantation, matrix-induced bone marrow aspirate concentrate, and matrixassociated stem cell transplantation. BMIC is a one-stage, minimally invasive surgery performed arthroscopically or using a mini-open arthrotomy approach without a malleolar osteotomy in most cases. The lesion is replaced with hyaline-like cartilage, and treatmentrelated complications are rare. BMIC is a safe and effective treatment option and should be considered in large lesions or lesions with a prior treatment history.

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*

Background: The purpose of this study was to examine the between-mode equivalence and the relative efficiency of the 2 available modes of patient-reported outcome (PRO) data collection: a web-enabled touch screen tablet and a smartphone in a sample of patients who underwent foot and ankle orthopedic surgery. Methods: A total of 136 patients who visited the clinic after foot/ankle surgery participated in the study. All patients completed the PRO questionnaire set using tablets at the hospital. After 24 hours of completing the first PRO questionnaire, the patients completed the same PRO questionnaire at home using their personal smartphones. The outcomes were statistically compared, and the patients’ preferences were surveyed. Results: The intraclass correlation coefficients for comparing the results of PRO measurements between the 2 modes were 0.970 for the visual analog scale, 0.952 for the Foot Function Index, 0.959 for the foot and ankle outcome scale, and 0.957 for the patient’s satisfaction. Sixty-eight participants (58.6%) responded that they were able to answer the questionnaires with more honesty at home using their smartphones. Regarding the mode, 60 participants (48.1%) responded that they have no preference between the devices. Conclusions The results of this study showed the equivalence of the 2 modes of PRO data collection: web-enabled touch screen tablets and smartphones. Smartphones may be the preferred mode of PRO measurement, due to their easy accessibility, increased privacy, and the patients’ increased honesty in answering questionnaires.