There are many complications related to paralyzed patients. Heterotopic ossification in pressure sore patients is reported to be rarely developed, but once it occurs, it frequently causes joint stiffness which may aggrevate the pressure sore wound. This paper was based on a clinical study of heterotrophic ossification in 6 quadriplegic and paraplegic patients from 1988 to 1997 at St. Paul's Hospital. All were males aged between 22 and 58 years (mean age, 45.5 years). The sites of pressure sore were in the ischial and trochanteric areas. Heterotopic ossification had developed around the hip joint and the ischial area. The mean onset time was 3.6 years (minimum 10 months maximum 8 years) after trauma. Plain X-ray, bone scan CT and pathological examination were helpful in confirming the diagnosis of heterotopic ossification. The mechanism of heterotopic ossification is not exactly known, but chronic trauma or inflammation could be one etiology. There are still many difficulties in management of heterotopic ossification, but prevention is the most important treatment.
Diagnosis ; Femur ; Hip Joint ; Humans ; Inflammation ; Joints ; Male ; Ossification, Heterotopic* ; Pressure Ulcer* ; Wounds and Injuries

PURPOSE: Among reasons for reoperations in augmentation mammoplasty, palpable implant, due to thin skin is relatively common, but not easy to correct, especially if thin skin area is wide. The capsule around the implant is a physiologic response to foreign body, naturally formed, and suitable for use as a flap because of its high vascularity. Authors report that capsular flap is very effective and successful method for correction of implant palpability in secondary breast augmentation. METHODS: From September 2007 to September 2008, the capular flaps were performed on 5 patients having palpable and wrinkling breast implants due to very thin skin among the cases on whom secondary augmentation mammaplasty had been performed. After the capsular flap was elevated according to thin skin area, the capsular flap was turned down or over to cover the thin skin area and made the thin skin area thick. RESULTS: Post-implant palpable breast wrinkling had been successfully corrected by capsular flaps and breast implants were not palpable any more during the follow-up period (average 9.2 months). All patients who suffered from deformed breast were satisfied. CONCLUSION: Authors suggest that the capsular flap be a ideal, effective and useful method in management of implant palpability.
Breast ; Breast Implants ; Female ; Follow-Up Studies ; Foreign Bodies ; Humans ; Mammaplasty ; Skin

No abstract available.
Breast Neoplasms* ; Breast* ; Humans ; Necrosis*

In this study of a developed soft tissue filler, adipose tissue equivalents were constructed using adipose stem cells (ASCs) and micronized acellular dermal matrix (Alloderm). After labeling cultured human ASCs with fluorescent green protein and attaching them to micronized Alloderm (5X10(5) cells/1 mg), ASC-Alloderm complexes were cultured in adipogenic differentiation media for 14 days and then injected into the dorsal cranial region of nude male mice. The viabilities of ASCs in micronized Alloderm were determined at 1, 4, 7, and 14 days, and complexes, which had been cultured for 14 days and implanted in vivo for 2 months, were histologically evaluated by light, confocal, and scanning electron microscopy. The viabilities represented that ASCs in micronized Alloderm were alive during the culture period. ASC-Alloderm complexes cultured for 14 days contained round cells with large lipid vesicles by light microscopy and many spherical cells by SEM. ASCs in implanted ASCAlloderm complexes harvested from mice at 2 months postinjection were histologically found to have differentiated into adipocytes which had green fluorescence dye. Micronized Alloderm may be found useful as scaffold for human ASCs when constructing fat tissue for three-dimensional soft tissue filling. The present study suggests that ASC-Alloderm complexes can be used as injectable three-dimensional soft tissue fillers.
Adipocytes/*cytology ; Adipogenesis ; Adipose Tissue/cytology ; Animals ; Cell Differentiation ; Cells, Cultured ; Collagen/*chemistry ; Fluorescent Dyes/chemistry ; Injections, Subcutaneous ; Male ; Mice ; Mice, Nude ; Microscopy, Electron, Scanning ; Stem Cell Transplantation/*methods ; Stem Cells/cytology/pathology ; Time Factors ; Tissue Engineering/*methods ; Transplantation, Heterologous

No abstract available.
Myxoma*

Pressure sores are common complications in patients with spinal injuries or cerebrovascular accidents. The management of pressure sores requires prolonged hospitalization and repeated surgical interventions with a high recurrence rate. Particularly osteomyelitis following initial pressure sores persistently complicates wound healing and recovery. Furthermore, it may also ultimately result in serious sepsis; thus an early diagnosis of osteomyelitis in pressure sore patients is crucial along with appropriate surgical and antibiotic therapy. Although many diagnostic methods were reported, there is no single 'gold' standard for early diagnosis of pressure sore-associated osteomyelitis. Authors reviewed pre-operative CBC, plain X-ray, Tc-99m bone scan, and post-operative biopsy results in 37 patients who had received surgical treatment for pressure sores in a 5-year period from September 1991 to August 1996. Based on these reviews, authors compared and analyzed the sensitivity and specificity in diagnosing osteomyelitis.The results were as follows: 1. Of 37 patients studied, 25 cases were confirmed histologically as osteomyelitis. Ischial region revealed the highest incidence of pressure sore-related osteomyelitis(78%, 14 out of 18 cases) while the regional incidence was as following in descending order : ischial, sacral, and greater trochanteric area. 2. Tc-99m bone scan had superior sensitivity(100%) and specificity(83%) to other pre-operative studies in diagnosing osteomyelitis.In conclusion, authors suggest that Tc-99m bone scan is the best diagnostic method because of its high sensitivity and specificity if osteomyelitis is clinically suspected in pressure sore patients. And in case the test result is positive, agressive surgical bone resection and appropriate antibiotic therapy based on bacterial culture from deep bone specimen should be combined to prevent complications or recurrences.
Biopsy ; Early Diagnosis ; Femur ; Hospitalization ; Humans ; Incidence ; Osteomyelitis ; Pressure Ulcer* ; Recurrence ; Sensitivity and Specificity ; Sepsis ; Spinal Injuries ; Stroke ; Wound Healing

PURPOSE: The jejunal free flap is the most standard and reliable procedure of reconstruction of the circumferential pharyngoesophageal defect because it provides pliable, elastic, secreting mucosa and posses reliable vascular anatomy. In this report, the authors introduce the modification of jejunal free flap for decreasing the complications in fatty complicated patients. METHOD: After harvesting the jejunum with mesentery and mesenteric vessels, both ends of jejunum were excised remaining the mesenteric portion. The jejunal portion of this composite flap was placed to reconstruct esophagopharyngeal defect area and the mesenteric portion was used to obliterate the dead space at paratracheal region and to cover the vital structure and the vascular anastomotic region. RESULT: A 72 year-old man with recurrent hypopharyngeal cancer who had about 15cm sized circumferential pharyngoesophageal defect after total pharyngectomy was reconstructed with jejunomesenteric composite free flap without any complications. CONCLUSION: The mesenteric flaps at both side of jejunomesenteric composite free flap provide the advantages that could obliterate dead space, that could provide cover for the vital cervical vascular structure in case of vascularity was compromised due to previous radiation therapy, and that could preserve as much vascularity at both ends of jejunal flap as possible.
Free Tissue Flaps ; Hypopharyngeal Neoplasms ; Jejunum ; Mesentery ; Mucous Membrane ; Pharyngectomy

Melkersson-Rosenthal syndrome is a rare condition and clinical diagnosis was established on the basis of the triad: facial or lip edema, peripheral facial palsy and scrotal or plicated tongue. Labial swelling(Cheilitis granulomatosa) is the most common feature of this syndrome complex. The lips may enlarge up to three times their normal size, resulting in aesthetic deformity and functional disability. The condition appears to be a granulomatous disorder causing edema and inflammation of the soft tissues of the face, lips, oral cavity and particularly, the facial nerve. Traditional medical interventions are only marginally successful in treating this syndrome. We report the case of a young man with cheilitis granulomatosa as a manifestation of Melkersson-Rosenthal syndrome successfully treated by transverse and vertical star-shaped resection with a transmodiolar labial suspension suture at mouth angle. Our result shows symmetry of the lip, a normalized anterior projection, dimensional harmony between upper and lower lip and no disfiguring cicatrices.
Congenital Abnormalities ; Diagnosis ; Edema ; Facial Nerve ; Facial Paralysis ; Inflammation ; Lip ; Melkersson-Rosenthal Syndrome* ; Mouth ; Sutures ; Tongue

Hyponatremia and increased urine output after calvarial remodeling have been noted in pediatric patients with craniosynostosis. If not treated properly, patients develop hypoosmotic conditions that can lead to cerebral edema, increased intracranial pressure, and collapsed circulation. Postoperative hyponatremia after central nervous system surgery is considered as the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Recently, however, cerebral salt wasting syndrome (CSWS) instead of SIADH has been reported frequently. CSWS is associated with a decreased serum sodium level, increased urinary sodium level, increased urine output, decreased ECF volume, increased atrial natriuretic peptide (ANP) level, and increased brain natriuretic peptide (BNP) level. We experienced nine patients with craniosynostosis who underwent calvarial remodeling. By postoperative day 1, the ANP and BNP levels increased by 3-6 folds compared with the preoperative levels. They returned to the normal levels by postoperative day 5. The ADH level was within the normal range even after operation. The urinary sodium level increased in all patients by postoperative day 1 and 3. But the serum sodium level, and serum and urine osmolarity were normal due to appropriate replacement of sodium and fluid. After calvarial remodeling, the potential development of CSWS should be considered and distinguished from SIADH. The patients with CSWS require normal saline resuscitation and should prophylactically receive normal saline.
Child ; Child, Preschool ; Craniosynostoses/complications/*surgery ; Craniotomy/*adverse effects ; Diagnosis, Differential ; Female ; Humans ; Hyponatremia/*diagnosis/*etiology ; Inappropriate ADH Syndrome/*diagnosis/*etiology ; Infant ; Male ; Reconstructive Surgical Procedures/adverse effects ; Research Support, Non-U.S. Gov't ; Skull/*surgery

PURPOSE: In tissue engineering, it is important that the scaffolds have high affinity with cells for making efficient use of cells. The authors studied the binding affinity of human adipose stem cells(ASCs) to micronized acellular dermal matrix(alloderm) using biotin and avidin linkages. METHODS: Human ASCs were harvested from adipose tissue obtained by abdominoplasty. ASCs(1x10(4), 5x10(4), 1x10(5), 5x10(5), 1x10(6), 5x10(6) cells) were attached to micronized alloderm(1mg) in three groups; 1) control group in which no ASCs and alloderm was treated; 2) serum group in which alloderm was exposed to fetal bovine serum; and 3) biotin group in which biotinylated cells were attached to biotinylated alloderm. The binding affinities were determined 1 day after making ASC-alloderm complexes. The proliferation rates were determined by XTT assays in 4, 7, 14, and 21 days and scanning electron microscopic examination was performed in 7 and 21 days after culture of ASC-alloderm complexes. RESULTS: The binding affinities of the biotin group were significantly increased in all cell concentrations. Maximum binding affinity was observed at 5x10(4)/mg of micronized dermal matrix in biotin group. The viabilities were lowest in biotin group in contrast to binding affinity, but the difference was not significant. SEM showed well attachment of cells to micronized dermal matrix in all groups. CONCLUSION: The use of avidin/biotin facilitated human ASCs attaching to micronized acellular dermal matrix. This attachment would not disturb adipose stem cells viabilities. The present study suggests that avidin/ biotin can be used as making efficient use of cells in adipose tissue engineering.
Abdominoplasty ; Acellular Dermis ; Adipose Tissue ; Avidin ; Biotin ; Collagen ; Electrons ; Humans ; Mesenchymal Stromal Cells ; Stem Cells ; Tissue Engineering