The gigantic lipoma could be categorized into subcutaneous and subfascial type. We experienced eight cases from seven patients. Five cases of them were proved to be subcutaneous gigantic lipomas, and three cases were proved to be subfascial gigantic lipomas. Among the subcutaneous type, three cases of liposarcomas were confirmed by final biopsy results. And three cases of recurrences were shown. Among the subfascial type, one case of chondrolipoma was confirmed by final biopsy result and no recurrence was not found. In brief, subcutaneous and subfascial gigantic lipoma had a specific characteristics as followings: Subcutaneous type showed asymptomatic mass with bulging, multilobulated and poorly marginated. And it was difficult for complete removal with a high recurrence rate. Radical excision and liposuction recommended for its treatment. On the other hand, subfascial type showed diffuse expansion, late onset of symptom. And it was readiness for complete removal with no recurrence after complete excision.
Biopsy ; Hand ; Humans ; Lipectomy ; Lipoma* ; Liposarcoma ; Recurrence

In the treatment of this complicated diabetic foot patient, we need an effective treatment principle because the complicated diabetic foot patient needs a longer hospitalization period and suffers from more frequent recurrences. We reviewed 43 diabetic foot patients who were treated in our department during the past 4 years. The 43 patients were divided into 4 groups according to their combined complications. Group A was the simple diabetic foot group(no complication group, n = 17). Group B was the diabetic foot group combined with the extensive cellulitis(n = 9). Group C was the diabetic foot group combined with the peripheral vascular disease(n = 8). Group D was the diabetic foot group combined with the renal failure(n = 9). As a results, wide range of reconstructive methods can be selected in the simple diabetic foot group. In group B, early and wide debridement was important to control the infection and later flap reconstruction was appropriate. In group C, the bypass operation should be desperate before improving the circulation of lower extremities, and therefore we successfully reconstructed the foot with various metohds including plantar V-Y advancement flap, considered as the most useful in our series. In group D, recurrence was more frequent and lower extremity amputations above the ankle level couldn't be avoided in spite of many operations and longer hospitalization. Therefore consideration of early amputaiotn is recommended for the effective treatment of this group.
Amputation ; Ankle ; Debridement ; Diabetic Foot* ; Foot ; Hospitalization ; Humans ; Lower Extremity ; Peripheral Vascular Diseases* ; Recurrence ; Renal Insufficiency*

The rib cartilage has been the most popular autogenous tissue for microtia reconstruction. Donor site complications, especially chest wall deformities occurring after harvest of costal cartilage graft are presented and discussed in many reports. In this study, 100 chest donor sites were evaluated in 34 patients (25 male and 9 female) who underwent costal cartilage grafts for microtia reconstruction from 1992 to 1999, and reviewed for donor site complications by radiography and physical examination. Ribs from which costal cartilage had been harvested showed increased inward bowing on radiographs in 38 of 100 donor sites; the upper ribs record a higher incidence of deformity than lower ribs. The frequency of rib deformity in donor site was 21 percent when cartilages were harvested from patients older than 10 years of age, whereas it was 73.3 percent in patients younger than 10 years. This difference was statistically significant. In our study, the incidence of chest wall deformity was 57 percent, concerning donor site morbidity after the supraperichondrial rib harvesting procedure, whereas it was 35 percent in patients after the subperichondrial rib harvesting procedure. In conclusion, surgeons should consider the possibility of thoracic deformity when planning costal cartilage grafting. To avoid these deformities, costal cartilage harvesting should be made at lower levels of the rib cage, and delayed operation time for thoracic maturation is recommended. More care should be taken to preserve the perichondrium and the germinative zone of the costochondrial junction.
Cartilage* ; Congenital Abnormalities ; Humans ; Incidence ; Male ; Physical Examination ; Radiography ; Ribs ; Thoracic Wall* ; Thorax* ; Tissue Donors ; Transplants

The craniosynostosis is the term that designates premature fusion of one or more sutures in the cranial vault and thus causes deformities of cranial base and vault. When a suture fused prematurely, the skull and growing brain beneath the suture are forced to expand in the fused suture area. Between April of 1992 and September of 1999, six patients of bilateral coronary synostosis were operated with frontal bone advancement and calvarial remodeling. The supraorbital bar was reshaped with partial osteotomy, greenstick fracture and interpositioning bone grafts. The frontal bone was divided along the metopic suture and transposed one another to make an esthetic shape of the forehead. The parietal bone was expanded with multiple barrel stave osteotomies and fixed to advanced frontal bone with interpositional bone graft. The six patients were operated at the mean age of 10 months. The mean operation time was about 5 hours and mean transfusion volume was 190 cc. There was no postoperative complications and no need for more revisional operation. For a superior result of correciton of craniosynostosis, early surgical intervention is mandate. Efforts for reducing complications, parents' understanding and periodic follow- up are important factors for successful correction.
Brain ; Congenital Abnormalities ; Craniosynostoses ; Forehead ; Frontal Bone ; Humans ; Osteotomy ; Parietal Bone ; Postoperative Complications ; Skull ; Skull Base ; Sutures ; Synostosis* ; Transplants

In this study, 42 Polytetrafluoroethylene prostheses (Gore Tex: internal diameter 1.5 mm, length 8 mm, fibrilar length 30micromiter, wall thickness 0.2 mm) were used to reconstruct the vascular gap of rabbit femoral vein. To enhance the patency rate and promote the healing process, the prostheses were connected to rabbit femoral vein by means of stair-like sleeve anastomosis. The specimens were obtained in 12 hours (n=4), 1 day (n=4), 3 days(n=4), 1 week (n=10), 2 weeks (n=10), 3 weeks(n=10). After determination of patency, the specimens were prepared with H&E stains and investigated under microscope. After 1 week, endothelial-like cells were observed around anastomotic area from the adjacent vein. After 3 weeks, all microvenous grafts were completely covered by endothelial lining. The anastomotic area was more prominent in the endothelial lining than in the central area. There was some evidence of migrating cells from adjacent soft tissue through micropores of PTFE prostheses. Overall patency rate of PTFE prostheses connected by stair-like sleeve anastomosis was 85.7%. We concluded stair-like sleeve anastomsis of PTFE prostheses in the rabbit femoral vein result in better overall patency rate than end-to-end anastomosis.
Coloring Agents ; Femoral Vein* ; Polytetrafluoroethylene* ; Prostheses and Implants ; Transplants ; Veins

Subungal malignant melanoma is a relatively rare disease with reported incidence between 1% to 3% of all melanoma cases in the USA, 10% to 31% in Japan. It is a serious disease with a survival period of 5 years. This poor prognosis is the result of late diagnosis in many of the cases, usually the patient not presenting himself early enough in the course of the disease. However, far more important is the frequent failure of the physician or surgeon to recognize the clinical signs and to perform a biopsy from the correct site, which leads to an accurate diagnosis. Therefore we focused the nail color change of the subungal malignant melanoma to diagnose the disease at the early stage. Five patients who visited our hospital with nail color change into black took the biopsy. This should be done on nail bed and matrix lesions which shows color change into black. A wedge form is taken from the area with maximal clinical concern, including normal tissue at the edge of the lesion. In cases of melanoma in situ (4 cases) diagnosed during the previous biopsy, surgical treatment was done as soon as possible. The melanoma was excised by Mohs technique and the margins were checked by frozen section. If the margins and base of tumor did not have micrometastasis, immediate reconstruction using various flaps was done. In case that micrometastasis was suspicious however, special staining using HMB45 immunostaining was done for confirmation. After a few days for special staining, delayed reconstruction was done. By means of the early diagnosis and Mohs micrographic operation technique, we could excise the tumor completely and preserve the tendon, bone, joint and length of digits.
Biopsy ; Delayed Diagnosis ; Diagnosis* ; Early Diagnosis ; Frozen Sections ; Humans ; Incidence ; Japan ; Joints ; Melanoma* ; Neoplasm Micrometastasis ; Prognosis ; Rare Diseases ; Tendons

Zinc is an essential trace element required for bone formation, however not much has been clarified yet for its role in osteoblast. We hypothesized that zinc would increase osteogenetic function in osteoblasts. To test this, we investigated whether zinc treatment enhances bone formation by stimulating osteoblast proliferation, bone marker protein alkaline phosphatase activity and collagen synthesis in osteoblastic MC3T3-E1 cells. MC3T3-E1 cells were cultured and treated with various concentrations of zinc (0, 1, 3, 15, 25 uM) along with a normal osteogenic medium (OSM) as control for 1, 5, 10 days. As measured by MTT assay for mitochondrial metabolic activity, cell proliferation was stimulated even at low zinc treatment (1-3 micrometer) compared to OSM, and it was stimulated in a zinc concentration-dependent manner during 5 and 10 days, with the most pronounced effect at 15 and 25 uM Zn. Cellular (synthesized) alkaline phosphatase (ALP) activity was increased in a zinc concentration-dependent manner, so did medium (secreted) ALP activity. Cellular collagen concentration was increased by zinc as time went by, therefore with the maximum zinc stimulatory effect in 10 days, and medium collagen concentration showed the same pattern even on 1 and 5 day. This zinc stimulatory effect of collagen synthesis was observed in cell matrix collagen staining. The study results imply that zinc can increase osteogenic effect by stimulating cell proliferation, ALP activity and collagen synthesis in osteoblastic cells.
Alkaline Phosphatase ; Cell Proliferation ; Collagen ; Durapatite ; Osteoblasts ; Osteogenesis ; Zinc

Two significant unsolved problems in parotidectomy procedures are Frey's syndrome and postoperative depression deformity. The recent trend in the management of these problems has been the use of the prophylatic procedures performed at the time of parotidectomy to prevent its postoperative symptoms or complaints. We used a tissue barrier between the elevated cheek skin flap and the exposed facial nerve in order to prevent Frey's syndrome and depression deformity on the cheek. We used buccal fat, dermis fat graft or flap, superficial temporal fascia(STF) island flap and skin island or free flap as a tissue barrier. Thirty-nine patients had been operated and reviewed for over 3 years and 23 of them were treated with various kinds of tissue barriers. Frey's syndrome, depression deformity and other complications were reviewed. As a result, there was no permanent facial nerve palsy, Frey's syndrome and dissatisfaction with facial contour excluding minor complications of hematoma, scar and temporary facial palsy compared to the cases without the barrier. We concluded that the buccal fat is easy and simple to perform and it can be the first choice in children and young women. The dermis fat graft or flap is suitable for the old patient who requires pertinent volume. STF island flap is a pliable, wide and well vascularized flap, so it is well fit to cover the wide defect in man or old patient. In malignant or extensive lesions, skin island or free flap is recommendable for the simultaneous reconstruction of skin resurfacing and volume filling after the radical resection including the parotid gland. Various autogenous tissue barriers can be effectively and properly applicable to prevent the serious complications after the parotidectomy depending on the cases.
Cheek ; Child ; Cicatrix ; Congenital Abnormalities ; Depression ; Dermis ; Facial Nerve* ; Facial Paralysis ; Female ; Free Tissue Flaps ; Hematoma ; Humans ; Paralysis ; Parotid Gland ; Skin ; Sweating, Gustatory ; Transplants

Two significant unsolved problems in parotidectomy procedures are Frey's syndrome and postoperative depression deformity. The recent trend in the management of these problems has been the use of the prophylatic procedures performed at the time of parotidectomy to prevent its postoperative symptoms or complaints. We used a tissue barrier between the elevated cheek skin flap and the exposed facial nerve in order to prevent Frey's syndrome and depression deformity on the cheek. We used buccal fat, dermis fat graft or flap, superficial temporal fascia(STF) island flap and skin island or free flap as a tissue barrier. Thirty-nine patients had been operated and reviewed for over 3 years and 23 of them were treated with various kinds of tissue barriers. Frey's syndrome, depression deformity and other complications were reviewed. As a result, there was no permanent facial nerve palsy, Frey's syndrome and dissatisfaction with facial contour excluding minor complications of hematoma, scar and temporary facial palsy compared to the cases without the barrier. We concluded that the buccal fat is easy and simple to perform and it can be the first choice in children and young women. The dermis fat graft or flap is suitable for the old patient who requires pertinent volume. STF island flap is a pliable, wide and well vascularized flap, so it is well fit to cover the wide defect in man or old patient. In malignant or extensive lesions, skin island or free flap is recommendable for the simultaneous reconstruction of skin resurfacing and volume filling after the radical resection including the parotid gland. Various autogenous tissue barriers can be effectively and properly applicable to prevent the serious complications after the parotidectomy depending on the cases.
Cheek ; Child ; Cicatrix ; Congenital Abnormalities ; Depression ; Dermis ; Facial Nerve* ; Facial Paralysis ; Female ; Free Tissue Flaps ; Hematoma ; Humans ; Paralysis ; Parotid Gland ; Skin ; Sweating, Gustatory ; Transplants

PURPOSE: Differences in phenotypes between the two most common subtypes of Prader-Willi syndrome (PWS) indicate that a distinct response to growth hormone (GH) treatment may exist. To test this hypothesis, we compared the results of GH treatment in individuals with PWS due to uniparental disomy (UPD) to those of individuals with deletions. METHODS: Sixty-five children with PWS who had been treated with GH for more than two years were included in this study. Twenty-one individuals were confirmed as having UPD and 44 individuals had a deletion. Height, body weight, body mass index (BMI), and insulin like growth factor-1 (IGF-I) measurements were recorded before GH treatment and at intervals of 12 months thereafter. RESULTS: After two years of GH therapy, no significant differences were noted for yearly improvements in height standard deviation scores (SDS) between the groups (second year SDS, 0.93 +/- 0.94; deletion, 0.84 +/- 1.31; UPD, P = 0.717). Body weight SDS, BMI SDS, and IGF-I SDS also showed no differences between the two groups. CONCLUSION: Our study showed no significant differences in yearly improvements in height SDS between the deletion and UPD groups, at least for the first two years.
Body Height ; Body Weight ; Child ; Genotype ; Growth Hormone ; Humans ; Insulin ; Insulin-Like Growth Factor I ; Phenotype ; Prader-Willi Syndrome ; Sequence Deletion ; Uniparental Disomy