As the use of free tissue reconstruction becomes more routine, attention is being focused not only on flap survival, but also on functional refinements in these flaps. One of the more important aspects of improving the outcome of these reconstruction may relate to the return of sensation. The anterolateral thigh free flap is based on the descending branch of the lateral circumflex femoral artery. This fasciocutaneous flap is indicated whenever a relatively thin flap is required in reconstruction. A neurosensory flap can be employed based on the anterior branched of the lateral femoral cutaneous nerve of the thigh. Since 1996, 15 patients with soft tissue defect on various regious were treated by using the anterolateral thigh sensate free falp. All flaps survived without total loss. Anastomosis of the sensible nerve on the recipient site with the anterior branch of the lateral femoral cutaneous nerve of the thigh was performed. All patients showed recovery of sensation in the anterolateral thigh sensate free falp beginning between the 4th and 6th month postoperatively. Follow-up periods ranged from 8 to 34 months and the results of sensory recovery were satisfactory. Therefore, resensitization of an anterolateral thigh free flap should be attempted by a nerve anastomosis in this transplant. The longterm success in this study suggests the benefits of microsurgical neurotization in free tissue transplantation.
Femoral Artery ; Follow-Up Studies ; Free Tissue Flaps* ; Humans ; Nerve Transfer ; Sensation ; Thigh* ; Tissue Transplantation ; Transplants

Basal cell carcinoma(BCC) and squamous cell carcinoma (SCC) are very prevalent neoplasms of the human skin. Ultraviolet radiation in sunlight is a well-established mutagen of the p53 gene and is one of basal cell carcinoma and squamous cell carcinoma. The newly-formed vascular network is important for neoplasms to grow beyond a size of about 1 mm2. Recent reports have suggested the hypothesis that a mutant p53 protein is closely related with capillary density. Immumohistochemistry for p53 protein and CD34 was performed in 20 cases of BCCs and 14 SCCs to evaluated the relationship between p53 protein and capillary density. The results were as follows:1. The microvessels stained by CD34 were mainly located in the interface of tumor cells and stroma. 2. There was no difference in the microvessel density according to the histologic types and age of the patients, but a higher microvessel density was noted in male patients. 3. The aggressive BCCs and the less-differentiated SCCs showed higher p53 immunostaining. 4. The mean microvessel density of cases showing strong positive immunostaining of the p53 gene(54.73+/-17.75) was higher than that of others(39.75+/-18.30). These results suggested that p53 protein expression and microvessel density are not related to the histologic types and age of the patients, but that differentiation and biologic behavior such as the infiltrating property of tumors and the microvessel density are closely related to p53 protein expression.
Capillaries ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell* ; Genes, p53 ; Humans ; Male ; Microvessels* ; Skin* ; Sunlight

PURPOSE: The survival of composite graft is dependent on three steps, (1) plasmatic imbibitions, (2) inosculation, and (3) neovascularization. Among the many trials to increase the survival rate of composite graft, prostaglandin E1 (PGE1) has beneficial effects on the microcirculatory level with vasodilating, antithrombotic, anti-inflammatory and neoangiogenic properties. Lipo-PGE1 which is lipid microspheres containing PGE1 had developed to compensate the systemic and local side effects of PGE1. This study was proposed to determine whether Lipo-PGE1 administration enhanced the survival of composite graft through neovascularization quantitatively in a rabbit ear model. METHODS: Fourteen New Zealand White Rabbits each weighing 3~4 kg were divided in two groups: (1) intravenous Lipo-PGE1 injection group and (2) control group. A 2 x 1 cm sized, full-thickness rectangular composite graft was harvested in each auricle. Then, the graft was reaaproximated in situ using a 5-0 nylon suture. For the experimental group, 3 microgram/kg/day of Lipo-PGE1 (5 microgram/mL) was administered intravenously through the marginal vein of the ear for 14 days. The control group was received no pharmacologic treatment. On the 14th postoperative day, composite graft of the ear was harvested and immunochemistry staining used Monoclonal mouse anti-CD 31 antibody was performed. Neoangiogenesis was quantified by counting the vessels that showed luminal structures surrounded by the brown color-stained epithelium and counted from 10 random high-power fields (400x) by independent blinded observer. Statistical analysis (Wilcoxon Signed Ranks test for nonparametric data) was performed using SPSS v12.0, with values of p<0.05 considered significant. RESULTS: The mean number of the microvessels was 15.48 +/- 8.65 in the experimental group and 9.82 +/- 7.25 in the control group (p=0.028). CONCLUSION: The use of Lipo-PGE1 facilitated the neoangiogenesis, resulted in the improvement of the survival rate of graft. On the basis of this results, we could support wider application of Lipo-PGE1 for more effective therapeutic angiogenesis and successful survival in various cases of composite graft in the human.
Alprostadil ; Animals ; Ear ; Epithelium ; Humans ; Immunochemistry ; Mice ; Microspheres ; Microvessels ; Nylons ; Phenobarbital ; Rabbits ; Survival Rate ; Sutures ; Transplants ; Veins

For the venous flap to survive, it apparently needs to be a flow-through of venous blood.1 Nevertheless, controversy remains, regarding the fact that an island flap based on a terminating venous pedicle is capable of maintaining viability.2-15 This study was designed to investigate the role of perivenous areolar tissue in the viability of island flaps with an exclusively venous pedicle in the rabbit ear model as described by Inada et al.16 Ten groups of flaps were studied: Group A-flaps based on a proximal venous pedicle; group B-flaps based on a distal venous pedicle; group C- nonvascularized grafts; each subgroup A1-, B1-flaps with perivenous areolar tissue; each subgroup A2-, B2-flap which was skeletonized pedicle; each subgroup A3-, B3-flap was same as A1-, B1-flap, which was sutured over a silastic sheet; each subgroup A4-, B4-flap with a skeletonized venous pedicle sutured over a silastic sheet; subgroup C1-control, placed directly on bed; subgroup C2-control which was sutured over a silastic sheet. Groups A3, A4, B3 and B4 had 20 flaps and the remaining groups had 10 flaps each. Flaps in group A1, A3, B3 had total survival. In groups A4, B4, C2, no flaps were survived. The survived flaps in groups A3 and B3 had tissue oxygen content values between those of arterial and venous levels. Histological examination of the pedicle of survived flaps in groups A3 and B3 showed small vascular channels present in the areolar tissue surrounding the venous pedicle. Static and dynamic computerized radioactive tracer experiments showed that the survived flaps in groups A3 and B3 were promptly perfused and drained through their pedicles. This study confirms the importance of the perivenous areolar tissue for survival of the venous skin flap in the rabbit ear model.
Ear ; Oxygen ; Skeleton ; Skin ; Surgical Flaps* ; Transplants

OBJECTIVES: Schizophrenia has been considered to be characterized by an abnormality in attention, especially in the executive control. Emotion is an important component of the executive control. The aim of this study was to investigate the influence of emotion on the executive control in patients with schizophrenia. METHODS: Participants were 20 healthy controls and 19 subjects with schizophrenia. They viewed full-color pictures selected from the International Affective Picture System. During each trial, an emotional picture, which was either positive or negative, lit up on either the left or right side. Participants were instructed to respond to the emotional valance of each stimulus by pressing a button with their left or right index finger, while ignoring its presented side. RESULTS: There was a group difference in the response time, and patients with schizophrenia exhibited an impairment in the executive control of emotional information. However, there was no difference in the response time between the emotional conditions. In the patient group, the missing rate in the positive emotional condition was correlated with the severity of social anhedonia, whereas the missing rate in the negative emotional condition was correlated with the severity of positive symptoms. CONCLUSION: Patients with schizophrenia have a deficit in the executive control of positive emotional information as well as negative emotion, but it may be due to different underlying mechanisms.
Anhedonia ; Executive Function ; Fingers ; Humans ; Reaction Time ; Schizophrenia

OBJECTIVES: Schizophrenia has been considered to be characterized by an abnormality in attention, especially in the executive control. Emotion is an important component of the executive control. The aim of this study was to investigate the influence of emotion on the executive control in patients with schizophrenia. METHODS: Participants were 20 healthy controls and 19 subjects with schizophrenia. They viewed full-color pictures selected from the International Affective Picture System. During each trial, an emotional picture, which was either positive or negative, lit up on either the left or right side. Participants were instructed to respond to the emotional valance of each stimulus by pressing a button with their left or right index finger, while ignoring its presented side. RESULTS: There was a group difference in the response time, and patients with schizophrenia exhibited an impairment in the executive control of emotional information. However, there was no difference in the response time between the emotional conditions. In the patient group, the missing rate in the positive emotional condition was correlated with the severity of social anhedonia, whereas the missing rate in the negative emotional condition was correlated with the severity of positive symptoms. CONCLUSION: Patients with schizophrenia have a deficit in the executive control of positive emotional information as well as negative emotion, but it may be due to different underlying mechanisms.
Anhedonia ; Executive Function ; Fingers ; Humans ; Reaction Time ; Schizophrenia

The area overlying the ischium is a frequent site for the development and recurrence of pressure sores because they directly overlie the points of maximum pressure on the sitting surface. Furthermore, they are frequently complicated by abnormal lesional bursae, or by extension, fistula toward the perineum or peritoneal cavity. In all cases of the ischial pressure sores, total en bloc excision of the ulceration, underlying bony prominence with immediate closure, and healthy, well-vascularized soft tissue is required to obtain the satisfactory result. It is well known that the choice of the treatment of the ischial pressure sore is the gluteal or posterior thigh flap. There have been many reports on the reconstruction of the ischial pressure sores such as cases involving the fasciocutaneous flap, muscle and musculocutaneous flaps, V-Y advancement flaps, rotation flaps, and long random flaps. In spite of these varieties, the recurrence of the ischial pressure sore after treatment still remains about seventy-five percent according to Conway and Griffith.9 Consequently, any surgical plane for ischial pressure sores must provide a stable, durable soft tissue cover that can be reused in the event of recurrence. From February to December 2002, we have performed the reconstruction of the ischial pressure sores on the posterior thigh's transposition flap in order to get following advantages: simplicity of the operation, sufficiency of padding with skin flap, preservation of the adjacent normal tissues and the capability of recycling this same flap in case of recurrences. Its design is somewhat different from and more extended widely than that of the gluteal or posterior thigh flap. This flap was elevated above the deep fascia to be cutaneous with appropriate backcut incision; some perforators from the inferior gluteal artery were also preserved. We present some cases of ischial pressure sores treated with a laterally based posterior thigh transposition flap herein. Therefore, the need to perform repetitive surgery in the future must be considered so that the maximum number of reconstructive options can be preserved. Although the follow-up period has not always been satisfactory, we have not had any serious complications in these patients until recently.
Arteries ; Fascia ; Fistula ; Follow-Up Studies ; Humans ; Ischium ; Myocutaneous Flap ; Perineum ; Peritoneal Cavity ; Pressure Ulcer* ; Recurrence ; Recycling ; Skin ; Thigh* ; Ulcer

The chin is located on the center of the face and plays an important role in making an esthetic and harmonious appearance of the face. A deformity of this part can either be an isolated problem, or coexist with malformations of the jaw or other facial structures. Surgery of the chin is performed to correct the size, shape, and appearance of the tip of the chin. The operation, also known as a genioplasty(chin reshaping), is performed most commonly to enlarge the chin. For those with a receded chin, it would improve the projection of the chin and result in better balance with the remainder of the face. Occasionally, the operation may also be performed to reduce the volume of an over-sized chin. Since the first description of the genioplasty by Hofer, 1942, it was performed more frequently and effectively in that patient's satisfaction has been higher than any other esthetic surgery. We have carried out 20 cases of esthetic genioplasty in recent 10 years from 1990 to 2000. We have restored the chin contour by using several methods including silastic or Medpor implant onlay support, ostectomy, horizontal sliding osteotomy. In this paper, we have retrospectively reviewed the experiences with many kinds of genioplasty through the patient's records, photographs and radiologic films. The results were summarized as follows: 1) The mean age of the patients was 26.2 years old, and the sex ratio was nearly equal. 2) The methods of operations included 8 cases of augmentation genioplasty, 8 cases of reduction genioplasty, 4 cases of horizontal osteotomy. 3) The procedures were done mainly with intraoral approach. 4) No special postoperative complications were noted except one case of infection. We have noted that all the patients who received the esthetic genioplasty were satisfied with the results and had no special complications except in one case. In this study, we present the various clinical experiences of correcting each malformed chin. The preoperative planning, operation methods, and postoperative complications are presented in detail.
Chin ; Congenital Abnormalities ; Genioplasty* ; Humans ; Inlays ; Jaw ; Osteotomy ; Postoperative Complications ; Retrospective Studies ; Sex Ratio ; Surgery, Plastic

BACKGROUND: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates. METHODS: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. RESULTS: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital, 101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). CONCLUSION: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.
Death Certificates* ; Education ; Emergencies ; Mortality ; Retrospective Studies ; Seoul

PURPOSE: Lacerations requiring formal wound closure compose a significant number of all childhood injuries presenting to the emergency department. The problem with conventional suture technique are that suture removal is quite cumbersome, especially in children. Unwanted soft tissue damage can result in the process of suture removal, which calls for sedation, stressful for both medical personnel and child. The purpose of this study is to introduce the convenient suture technique for pediatric facial lacerations. METHODS: Children under the age of four, presenting to the emergency department with facial lacerations were enrolled in the study. From March 2008 to June 2009, 63 patients (41 males and 22 females) with an average age of 1.4 years were treated with our convenient suture technique using utilized a loop suspended above a double, flat tie. Clean, tension free wounds were treated with our technique, wounds with significant skin defect and concomitant fractures were excluded. RESULTS: The Patients were followed-up in 1, 3 and 5 days postoperatively. On the third hospital visit, suture removal was done by simply cutting the loop suspended above the wound margin and gently pulling the thread with forceps. There were no significant differences in the rates of infection and dehiscence compared with conventional suture technique. CONCLUSION: The use of our technique was to be simple with similar operative time compared with conventional suture technique. Removal of suture materials were easy without unwanted injuries to the surrounding tissue which resulted in less discomfort for the patient and greater parental satisfaction, minimized the complications. It can be considered as a viable alternative in the repair of pediatric facial lacerations.
Child ; Emergencies ; Humans ; Lacerations ; Male ; Operative Time ; Parents ; Skin ; Surgical Instruments ; Suture Techniques ; Sutures