No abstract available.

No abstract available.
Acrocephalosyndactylia*

Cranocsynostosis is the term that designates premature fusion of one or more sutures in either the cranial vault or cranial base. Especially scaphocephaly, brachycephaly and trigonocephaly are included in simple symmetric craniosynostosis. In simple symmetric craniosynostosis, the functional deformity is rare, but deformity in external appearance is always a serious problem. The purpose of forehead reshaping in simple symmetric craniosynostosis is recovery of normal cerebral growth and improvement of cranial cosmetic problem by restoration of normal calvarial anatomic structure. Various surgical methods have Bbeen developed in an effort to correct craniosynostosis. Cranial vault remodeling with or without supraorbital band advancement is a widely accpeted method of correcting simple symmetric craniosynostosis. However, the standardized surgical method has not yet been estabilished in reshaping the forehead during cranial vault remodeling of simple symmetric craniosynostosis. The authors developed a new osteotomy method, the bull's osteotomy, which is a limited osteotomy for cranial vault remodeling. It produces posterior tilting of a prominant forehead as well as increased biparietotemporal distance for effective forehead reshaping. We applied this techriaue in 8 scaphocephaly and 2 brachycephaly patients under 5 years of age who have not yet reached bony consolidation. All patinets obtained satisfactory results with properly corrected deformity and no relapse was observed during the follow-up period. This new osteotomy method is simple and effective and a consistant surgical outcome is expected. particularly the contour of the forehead on the frontotemporal area is corrected to have a smooth and natural curvature. Based on our experience using bull's osteotomy, we offer this new surgical technique for managing simple symmetric cranoisynostosis patients.
Congenital Abnormalities ; Craniosynostoses* ; Follow-Up Studies ; Forehead* ; Humans ; Osteotomy* ; Recurrence ; Skull Base ; Sutures

No abstract available.
Nose* ; Osteotomy*

In the practice of modern craniomaxillofacial surgery, there is a general agreement in favor of obtaining solid bony union through the use of titanium and vitallium rigid fixation. These metallic osteosynthesis are not free from inherent drawbacks and limitation. They are liable to have an adverse effect on the growth of the craniofacial skeleton, be a cause of secondary bony resorption, increase risk of infection, result in palpability or exposure and cause artifact in radiologic imaging. These can lead to undue secondary operations necessitating their removal. To overcome there shortcomings, there had been a continuous research on the development of a bioabsorbable skeletal fixation system using polymer of polylactic and polyglycolic acid. Recently, with introduction and commercial availability of a product(Lactosorb, Walter Lorenz) with a minimized resorption period and foreign body reaction, there is an increasing acceptance of its use as an alternative fixation device in craniomaxillofacial surgery. In effort to extend its use in facial bone fractures, Tatum and Eppley were the first report in its successful application in a clinical setting. We report on the clinical experience of such bioabsorbable rigid fixation in patients with maxillofacial trauma. In included one adult and three children in their growth period, underwent open reduction of facial bone fractures. They were followed up in terms of clinical and radiologic outcome for six months. Stalbe and adequate longterm fixation was obtained and no recurrences were noted.
Adult ; Artifacts ; Child ; Facial Bones* ; Foreign-Body Reaction ; Fracture Fixation* ; Humans ; Polyglycolic Acid ; Polymers ; Recurrence ; Skeleton ; Titanium ; Vitallium

Chin*

The patient with unilateral or bilateral inverted nipple has both functional and cosmetic impairments. The structural and histopathologic features of inverted nipple are that inverted nipple has less fibromuscular tissue than normal nipple and has short lactiferous duct and dense fibrous tissue. For these reasons, surgical correction of inverted nipple requires release of the short lactiferous ducts and providing the bulkiness under the nipple. We combined the concept of both adding the bulkiness under the nipple and creating a tight neck at its base without sacrificing the duct system. We rotated the bilateral diamond shaped deepithelized dermal flaps around the nipple areolar complex for providing the nipple bulkiness without division of lactiferous duct and reinforced it with the purse-string suture around the dermal flap for providing the stability. This two rotational dermal flap method was applied 12 inverted nipple in 6 patients and followed up for 2 months to 24 months. We have got the satisfactory results in cosmetic and functional aspect without any complication such as sensory change, relapse, and nipple necrosis.
Diamond ; Humans ; Neck ; Necrosis ; Nipples* ; Recurrence ; Sutures

The treatment of massive bone and soft tissue defect in the lower leg has a high complication rate of nonunion, chronic infection, and amputation without well-vascularized tissue coverage of the open fracture. Despite adequate free soft tissue coverage, massive skeletal defect may result in segmental bone defects, angulation deformity, and limb length discrepancies. In the last decade, major advances have occurred in the Ilizarov method of distraction osteogenesis in lower leg salvage as a delayed procedure or simultaneous distraction after free-tissue transfer. The authors have performed Ilizarov transport in conjunction with muscle and musculocutaneous flap coverage in nine cases of lower leg salvage. The flaps consist of rectus, gracilis, latissimus dorsi, parascapular, and serratus muscle or musculocutaneous fashioning using ipsilateral or contralateral pedicle in consideration of vessel condiation. Revision, recorticotomy and flap elevation were also used as a secondary procedure for satisfactory results. The conclusions, were as follows: 1) Multidisciplinary team approach with conjoining departments at the time of preoperative evaluation, postoperative care and rehabilitation care; 2) Muscle flap covered with split-thickness skin graft was preferred to musculocutaneous flap; 3) To reduce the total reconstructive period, simultaneous free tissue transfer with Ilizarov distraction should be considered.
Amputation ; Congenital Abnormalities ; Extremities ; Fractures, Open ; Ilizarov Technique ; Leg* ; Myocutaneous Flap ; Osteogenesis* ; Osteogenesis, Distraction ; Postoperative Care ; Rehabilitation ; Skin ; Superficial Back Muscles ; Transplants

The goal of nipple-areolar reconstruction is to create a nipple that is appropriately located on the breast mound and has adequate projection, shape, color and texture to match the contralateral nipple-areolar complex. Despite various reports of techniques, no single technique is considered as an established method. The common methods of nipple reconstruction consist of composite grafts and local flaps, and the areolar is usually reconstructed by skin graft and tattooing. The authors introduce a systematic approach to select the appropriate reconstructive techniques for nipple-areolar complex reconstruction. If the patient has sufficient projection of the contralateral nipple and is willing to use it as a donor site, the composite graft of nipple is primarily considered. When the composite graft is not indicated, the methods using local flap such as skate flap and CV flap are proposed. Skate flap is best suited to maintain the contour of reconstructed breast mound. Although CV flap may distort the shape of breast mound, the method is popular for its simplicity. For creation of areolar, tattooing is widely performed to minimize the donor site morbidity rather than skin graft. Despite the algorithm of reconstructive techniques, it is important for the surgeon to choose the most familiar technique for superior outcomes. The nipple-areolar complex reconstruction is an integral step in the long treatment journey. Although the techniques of nipple reconstruction seem simplistic, they play a major role and demand meticulous attention to achieve good aesthetic outcomes.
Breast ; Female ; Humans ; Mammaplasty ; Nipples ; Skin ; Tattooing ; Tissue Donors ; Transplants

Keloid and hypertrophic scar are often left untreated because of no effective treatment. However, it may cause severe pain to the patient with its displeasing appearance and unbearable itching sensation and pain that occasionally accompany. Local injection of steroid has been widely accepted as a relatively effective medical treatment modality but it holds several limitations such as a severe injection pain and restricted use in sites which is either difficult to inject or too broad. Also regarding the safety, the steroid injection cannot be used to treat the scar for a long period of time or at short intervals because of the well known adverse effects of steroid. Tranilast has several in vitro pharmacological actions such as suppression of the stimulation of fibroblast by TGF-beta1, suppression of the production of superoxides and suppression of overproduction of collagen type I and III by fibroblast and these properties have made Tranilast to be considered as an alternate treatment modality. Authors studied 35 patients with keloid and hypertrophic scar to evaluate the effectiveness and safety of Tranilast. For evaluation of efficacy, the itching sensation and pain (self-conscious symptoms) was measured with Visual Analog Scale (VAS: 10-point scare) and the severity of the symptom was scored. The erythema (nonself-conscious symptom) was evaluated with subjective determination of the investigators and the degree of improvement was measured with software program using the L*a*b* color coordinate system to quantify the effect of treatment. For evaluation of safety, laboratory tests (hematology, blood chemistry, urinalysis) and existence of adverse effects was examined. This prospective study examined 35 patients who could go through the follow-up examination for 12 weeks and the results are as follow. First, scores higher than good were achieved in 80% (28/5) of the patient 6 weeks after the first administration and in 71.4% (25/35) in 12 weeks after administration of Tranilast. Second, global improvement of symptoms was approximated to be 5.6 points in itching sensation, pain and redness. Each was 51%, 56%, and 33% respectively, and this shows that Tranilast is effective in non-self conscious symptoms as well as self-conscious symptoms. Third, the subjective evaluation of improvement of erythema by software program using the L*a*b* color coordinate system showed mean improvement of 43%. There was no specific adverse effect and the lab tests revealed no significant change by medication.
Chemistry ; Cicatrix ; Cicatrix, Hypertrophic* ; Collagen Type I ; Erythema ; Fibroblasts ; Follow-Up Studies ; Humans ; Keloid* ; Prospective Studies* ; Pruritus ; Research Personnel ; Sensation ; Superoxides ; Transforming Growth Factor beta1 ; Visual Analog Scale