The objective of this study was to clarify the different inhibitory effects against necrosis according to the injection time of hydrocortisone on adriamycin extravasated wounds. The extravasation of chemotherapeutic agents yields severe inflammatory responses, crust formation, skin necrosis, and ulceration. Thus, many studies on the prevention and alleviation of this tissue injury have been made. However, a comparative study on the inhibitory effect of antidots according to the injection time after extravasation of chemotherapeutic agents has not yet been made. We compared the effect of hydrocortisone succinate on adriamycin-induced tissue necrosis according to its injection time. Sixty mature male Sprague-Dawley rats were divided into 6 groups and each group contained 10 rats. Administration of adriamycin(1.0mg/ml) 0.5ml by subcutaneous injection on the dorsal side of the rats was followed by injection of hydrocortisone succinate(20mg/ml) 0.5ml on the same site according to a time protocol. Group 1(the co-ntrol group): adriamycin injection only; gorup 2(the normal saline group): injection of normal saline 30 minutes after adriamycin injection; group 3: injection of hydrocortisone 30 minutes after adriamycin injection; group 4: injection of hydrocortisone 6 hours after adriamycin injection; group 5: injection of hydrocortisone one day after adriamycin injection; group 6: injection of hydrocortisone 3 days after adriamycin injection. Mean areas of ulcer, measured in mm2, which developed 4 week after adriamycin injection were as follows; group 1 (the control group): 67.3; group 2(the normal saline group):44.8; group 3: 12.9; group 4: 18.9; group 5: 46.7; group 6:72.0. Significant differences among the groups were noted. The groups which received hydrocortisone injection showed smaller ulcers compared to the control group or the normal saline group. As well, earlier injection time correlated with smaller ulcer formation. These findings showed the inhibitory effect of hydrocortisone succinate on tissue damage caused by adriamycin, as well as the increased effectiveness of the inhibitory effect when earlier injections were made. An analysis of this study can be applied in clinical situations for extravasation of adriamycin by administering proper agents such as hydrocortisone succinate. The administration of these agents will also help to minimize tissue necrosis.
Animals ; Doxorubicin ; Humans ; Hydrocortisone* ; Injections, Subcutaneous ; Male ; Necrosis* ; Rats ; Rats, Sprague-Dawley ; Skin ; Succinic Acid ; Ulcer ; Wounds and Injuries

An important aspect of plastic surgery is skin flap survival. Among the prostaglandins, PGE4 is used clinically to improve peripheral circulatory disturbances due to its action of augmenting blood flow by vascular smooth muscle relaxation and its strong inhibitory action of platelet aggregation. Clinically, many investigators found that the effect of PGE4 was prolonged for a long period even after short-term application. So a new hypothesis emerges that the prolonged effect of PGE4 may be due to neovascularization and not due to vasodilatation alone. This study was designed to clarify the mechanism of the prolonged effect of topical PGE4 with regard to angiogenesis. A total of 9 male hairless mice were treated with a topical application of PGE4 onitment (PGE4 powder mixed in hydrogen base) on the experimental side and only a hydrogen base on the contralateral control side of the back skin, respectively, for 7 days, once a day. Then they were divided into 3 groups. In group 1, specimens were obtained on the 7th day post-treatment using 3 mm size punch biopsy from both sides. In group 2, specimens were obtained on post-treatment 14th day. In group 3, specimens were obtained on post-treatment 28th day. The number of blood vessels were compared between the experimental side and control side with respect to neovascularization after PGE4 application using an image-analysis program under hemtoxyline-eosin stain. Treatment on the experimental side did not affect its contralateral mate, since there was no evidence of a systemic effect. From our experimental data, we could conclude that PGE4 may induce angiogenesis by topical application without systemic effect.
Animals ; Biopsy ; Blood Vessels ; Humans ; Hydrogen ; Male ; Mice ; Mice, Hairless* ; Muscle, Smooth, Vascular ; Platelet Aggregation ; Prostaglandins ; Relaxation ; Research Personnel ; Skin ; Surgery, Plastic ; Vasodilation

BACKGROUND: Most patients who desire breast augmentation have higher expectations than the outcomes that can be achieved. The purpose of this article is to propose strategies for coping with each patient's expectation, and selecting the most appropriate surgical method. METHODS: Data were retrospectively reviewed for 138 women who underwent breast augmentation between July 1, 2012 and June 30, 2014. The augmentation methods were selected based on the patients' expectations. According to each expectation, we recommended the optimal procedure and material for each patient, and performed the augmentation in accordance with this as much as possible. The patients were asked postoperatively whether they were satisfied with their outcomes. RESULTS: Most patients (85%) were satisfied with their results during the mean postoperative follow-up period of 21.4 +/- 7.6 months (range, 8-32 months). The remaining, dissatisfied patients (15%) accepted their final results after receiving explanations or additional procedures. CONCLUSIONS: We classified common expectations of breast augmentation patients into nine categories. To minimize the gap between expectations and outcomes, we preoperatively provided realistic explanations about the limitations of the chosen materials and surgical methods with each patient. We then performed breast augmentation in consideration of the patient's expectations. Consequently, we were able to appropriately deal with each patient's expectations.
Breast Implantation ; Breast* ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Patient Satisfaction ; Retrospective Studies

The axillary approach for breast augmentation has held significant appeal to our patients. Its major advantage is the concealed scar at the apex of the axillary fossa. However, this route of access underwent legitimate criticism because of its reliance on blind dissection with the potential for associated secondary problems, such as implant ascension or distortion, implant misplacement, hematoma, or postoperative pain. However, with the use of an endoscopy combined with meticulous surgical technique, many of these problems have been eliminated, and this approach has gained widespread acceptance. The endoscopic approach to transaxillary breast augmentation offers better visualization, more controlled and precise dissection, better control of bleeding, and converting a blind procedure with blunt dissection into the current procedure, in which surgeons are in full control because the surgeons can visualize the field and dissect with precision. Furthermore, the type I dual plane dissection is possible because the surgeons can cut the origin of pectoralis major accurately. Endoscopic techniques have also improved the predictability of postoperative results and increased the safety of patient. In addition, the endoscopic technique can be used in various ways, such as subpectoral, subglandular, and subfascial dissection, as well as capsulotomy or supracapsular dissection in secondary operation cases.

Cleft lip is one of the most common congenital deformities in craniofacial region. However, despite many reports on the outcome of various surgical techniques from individual medical centers, the evaluation of the outcome has been based on the subjective observation. Therefore, developing a new technique of objective and scientific evaluation for the nasal deformity of secondary cleft lip and nasal deformity is important to improve the management of the cleft lip patients. The authors have proposed a new scoring model to evaluate objectively the nasal deformity. The authors put 'x' axis on the nostril sill of noncleft side and 'y' axis on nasal tip at a right angle to x axis. The nostril of noncleft side was turned around the y axis to form the mirror image on the cleft side, and following four parameters were recorded: (1) angle difference between two nostril axis, (2) center of the nostril and distance between two centers, (3) the overlapped area of two nostrils and (4) the overlapped area ratio of two nostrils. The post-surgery images were evaluated by the three plastic surgeons, using the scale of 5 percentiles. The four parameters of each image were measured using a newly developed software and correlation coefficients of each parameter and the evaluation scale by the surgeons were obtained. Among the scores from scoring model, errors greater than 10 percents were found only in 2 of 14 cases (2/14=14%), but among the scores from examiners, errors of greater than 10 percents were 4 from 14 cases (4/14=29%). Based on the results, deviation among the individual examiners can be reduced using the objective evaluation program developed in this study. The correlation coefficients between the normalized overlap area (0.78) and the distance between the centers of two nostrils (-0.82) with the evaluated scale by surgeons were high. However, the relative area and the degree difference of two nostril axis were found to be not such a good parameters in the evaluation of the nasal deformity. We developed scoring model from analysis of nostril shape and neural network which is able to evaluate cleft lip nasal deformity objectively after selection of proper parameters.
Axis, Cervical Vertebra ; Cleft Lip* ; Congenital Abnormalities* ; Humans ; Nose*

Prostaglandin E1(PGE1) is known to have various physiological action such as vasodilatation, decrease of blood pressure, angiogenesis, inhibition of platelet aggregation and so forth. PGE1 has been developed in many different formulations in order to overcome its chemical instability and deactivation in the lungs when administered parenterally. Lipo-AS013 is a potent drug with higher chemical stability and greater vascular wall targeting than others. The study was done on 3x10 cm model flap of dorsal skin of Sprague-Dawley rats and the flap perfusion survival were observed and documented. The flap treated with Lipo-AS013 beforehand was given intravenously Sodium fluorescein 10 minutes later, and then Percent Dye Fluorescence Index(% DFI) was calculated. The results were compared to a control group and the group administered locally epinephrine. In the control group, the % DFI and flap survival rate increased from 54.1+/-6.7 to 65.0+/-2.6(p<0.01) while in Lipo-AS013 group from 55.3+/-2.2 to 67.4+/-1.9(p<0.01), respectively. In the epinephrine group, the % DFI(p<0.05) and flap survival rate(p<0.001) decreased. In the both epinephrine and Lipo-AS013 group Percent DFI and flap survival rate are comparable with the control group. The result indicates that the potent Lipo-AS013 enhances the blood flow and flap survival. This highly potent Lipo-AS013 may have targeting ability and accumulate PGE1 onto the vascular walls. A quantitative analysis of fluorescence on the skin surface is a reliable tool to measure the blood perfusion into an ischemic flap and its viability. Further comparative study with conventional PGE1 and Lipo-PGE1 is needed in order to clarify the action and efficiency of Lipo-AS013.
Alprostadil* ; Blood Pressure ; Epinephrine ; Fluorescein ; Fluorescence ; Lung ; Perfusion ; Platelet Aggregation ; Rats, Sprague-Dawley ; Skin* ; Survival Rate ; Vasodilation

Endothelial cells are most sensitively affected by ischemic-reperfusion injury, and also the endothelial cells have very important role in immune reaction of organ transplantation and preservation of the organ. To improve the survival rate of a flap, and also to reduce the possibility of flap necrosis, the protection and preservation of the endothelial cells are very important. Because reactive oxygen species(ROS) are thought to be an important cause of ischemic reperfusion injury, we studied the cytotoxicity of ROS on endothelial cells. We performed an in vitro study to document whether green-tea polyphenol pretreatment play an important role in preventing cytotoxic damage from ROS. Neonatal Dermal Microvascular Endothelial Cells were cultured in EGM-2 MV BulletKit. Endothelial cell suspension in concentration of 4x104, was distributed into the wells of 24-well plate, cultured for 1, 3, 5, 7 days and the growth rates of the cells were measured with ELISA reader. Green-tea polyphenolic compounds(GtPP) were administered on L929 mouse fibroblasts and the possible cytotoxicity was measured with ELISA reader. Cultured endothelial cells in the concentration of 2x105 cells were treated with 0.1mM, 1mM, 10mM H2O2 and also with 0.25mM xanthine and 0.1U/L, 1U/L, 10U/L xanthine oxidase to induce oxidative stresses. Then the morphological findings of the endothelial cells were observed under the light microscope and the growth rate was analyzed with flow cytometry. To evaluate its protective effect, 0.25, 1, 10, 100microgram/ml of GtPP were administered to endothelial cells in the concentration of 2x105cells, one hour before administration of the oxidative agents, and then the cells were cultured for 24 hours. Afterwards, the morphology of endothelial cells were observed under the light microscope and the growth rate was analyzed with flow cytometry. The results are as follows: The growth of human endothelial cells were normal, and polyphenol of each concentration administered in this study did not show cytotoxicity. As a result of oxidative stress induced by H2O2 or xanthine oxidase(+0.25mM xanthine), the endothelial cell viability decreased by more than 25%, thus confirming the effects of ROS to endothelial cells. The GtPP pretreatment before H2O2 or xanthine oxidase(+0.25mM xanthine) administration, resulted significant protective effects for endothelial cells in morphology and growth rate study. Through these studies, the authors confirmed the protective effects of polyphenol against ROS. We also conceived that the polyphenol can possibly be implemented as an agent for organ or tissue preservation.
Animals ; Endothelial Cells* ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts ; Flow Cytometry ; Humans* ; Mice ; Necrosis ; Organ Transplantation ; Oxidative Stress ; Oxygen ; Reactive Oxygen Species* ; Reperfusion Injury ; Survival Rate ; Tissue Preservation ; Transplants ; Xanthine ; Xanthine Oxidase

Acquired defects involving exposed bone on the forehead is challenging to reconstruct. Skin expansion provides an ideal thin flap for forehead aesthetic unit, but it takes long time and high cost, and many patients are dissatisfied at their figures. Free flap can provide enough tissue immediately, but it takes long time and has the risk of mismatches of color and texture. This report details our experiences with two patients who had soft tissue defect on their forehead that was covered with remnant forehead flap unit. This method uses one-unit-forehead island flap based on supratrochlear and supraorbital vessel. We obtained satisfactory results in terms of aesthetic and functional consideration.
Forehead* ; Free Tissue Flaps ; Humans ; Skin

Orthognathic surgery for Class III malocclusion requires an elaborate preoperative planning using cephalometries or Mock surgery models which enable the surgeon to anticipate postoperative skeletal changes of maxilla and mandible as well as dentition. After surgery, patient's satisfaction is greatly influenced by appearance of soft tissue change. Therefore, it is imperative to predict a relatively accurate soft tissue change prior to surgery. A 5 year retrospective study was designed to evaluate the soft tissue change after sagittal split osteotomy of ramus(SSRO) for class III malocclusion. Analyses of preoperative and postoperative anthropometric measurements were performed. Patients who were treated only by SSRO for class III malocclusion and could follow up for 6 months were studied. Among them, the patients who had history of cleft palate and lip or hemifacial microsomia were excluded. Soft tissue changes were estimated by using the frontal and lateral photographs. Skeletal changes were observed by measuring amount of set back and angular changes of mandible to the reference line by using cephalometries. Relapses were also measured 6 months after the operation. We could observe skeletal changes were more profound than soft tissue changes concerning amount of set back, but soft tissue changes were also profound in angle. Relapse was more profound in skeleton than soft tissue but the amount was not significant. In spite of the variables which may affect proper assessment of the soft tissue change after skeletal relocation, this study can serve as a guide for exact prediction of the postoperative change of soft tissue and skeleton.
Cleft Palate ; Dentition ; Follow-Up Studies ; Goldenhar Syndrome ; Humans ; Lip ; Malocclusion ; Mandible ; Maxilla ; Orthognathic Surgery ; Osteotomy* ; Recurrence ; Retrospective Studies ; Skeleton

PURPOSE: Grave's disease is an autoimmune disease with chronic and systemic features. It affects the orbital fat and muscle bringing about defect in extrinsic eye motility, diplopia, optic nerve defect and lid retraction. In patients with lagopthalmos and resulting facial deformity, treatment can be done by rectus muscle recession or filling with various material. Autogenous auricular cartilage graft is often used and synthetic material such as synthetic acellular dermis, polyethylene meshs are also used for filling of the depressed area. Nevertheless, autogenous auricular cartilage grafts are difficult to utilize and synthetic materials sometimes result in protrusion or infection. Therefore, hard palate mucosa was considered as an alternative. We report two cases of patients with lower eyelid retraction corrected with autogenous hard palate mucosa. METHODS: We performed this operation in two patients of Graves' ophthalmopathy. The capsulopalpebral fascia was incised and elevated through an incision on the conjunctiva. Then, the harvested hard palate mucosa was sutured to the inferior border of the tarsus and covered with the conjunctiva. RESULTS: The lower eyelid retraction was corrected successfully. No hypertrophy or deformation of the transplanted hard palate mucosa was noted 6 months after the surgery. CONCLUSIONS: From the results above, we may conclude that the hard palate mucosa serves as an ideal spacer for the curvature and the inner lining in lower lid retraction. Hard palate mucosa is as sturdy as the autogenous cartilage but is much easier to utilize. It can be also used for lid retraction after lower lid aesthetic surgeries or traumas.
Acellular Dermis ; Ankle ; Autoimmune Diseases ; Cartilage ; Congenital Abnormalities ; Conjunctiva ; Diplopia ; Ear Cartilage ; Eyelids* ; Fascia ; Humans ; Hyperthyroidism ; Hypertrophy ; Mucous Membrane* ; Optic Nerve ; Orbit ; Palate, Hard* ; Polyethylene ; Transplants