PURPOSE: In the correction of cleft lip, there have been various methods to minimize recurrence of the nasal deformity after primary nasal surgery. After cheiloplasty and primary nasal surgery, we tried to elongate the columella of the cleft side, to stretch the vestibular lining of cleft side, and to elevate the alar cartilage of the cleft side with a molding prong. METHODS: We had fifteen cleft lip patients; 12 unilateral cases(6.3-8.2 months), and 3 bilateral cases(3 -7.5 months). Immediately after primary repair of the cleft lip, the toboggan shaped molding prong was located to deep inside of vestibular web of the cleft side. It was persistently suspended by a silicone tube which was connected to the prong and the frontal scalp. The results were analyzed with Photoshop(R) photogrammetrically for 6-48 months with on average of 20.6 months. We measured the proportion index of columellar length-interalar distance for three times(preoperation, immediate postoperation, and postoperation) on the nasal base views. RESULTS: In unilateral, the index had a significant increase statistically between preoperation(10.73) and immediate postoperation(23.96). It is supposed that columellar length was reconstructed to 105.80% of normal side. But, it was decreased to maintain 87.7% of normal side in postoperation(20.54). The results were similar in bilateral. The linear scars by suture penetrating nose skin were not discernable. CONCLUSION: In summary, placement of the molding prong could elongate the reconstructed columella with some relapse postoperatively.
Cartilage ; Cicatrix ; Cleft Lip* ; Congenital Abnormalities ; Fungi* ; Humans ; Nasal Surgical Procedures ; Nose ; Recurrence ; Scalp ; Silicones ; Skin ; Sutures

PURPOSE: As the traditional treatment of the Wassel's type I or II of bifid thumb, Bilhaut-Cloquet, has always been the standard method despite several disadvantages such as tearing of the finger nail, injuries of the growth plate, joint instability, and long visible scarring. To overcome these drawbacks, we applied a modified Bilhaut-Cloquet Method. METHODS: The subjects used for the this study were 10 of 20 patients evaluated. The patients underwent modified methods under every type of Wassel's classification. We designed a central wedge Zig-Zag incision and removed the nail and bony tissues in the remaining digit, but not soft tissue if possible, and transferred the ligaments, tendons, and soft tissue to the remaining thumb from the extra digit. We evaluated the patients' lack of extension, the total ROM of the MP and IP joints, the ROM of IP joints, and the lateral deviations of the reconstructed thumb. RESULTS: The results were encouraging, with all patients showing a good functional and aesthetic outcome. CONCLUSION: The modified method proved a very effective procedure in the treatment of bifid thumb in all types, especially types I or II.
Cicatrix ; Classification ; Fingers ; Growth Plate ; Humans ; Joint Instability ; Joints ; Ligaments ; Polydactyly ; Tendons ; Thumb*

No abstract available.
Carpal Tunnel Syndrome*

Nasoalveolar molding (NAM) device is an effective treatment for protruding maxilla in infants with cleft palate. However, only a few studies have investigated the effect of NAM devices on the treatment of protruding maxilla in infants with cleft lip only. We have designed a combination treatment using NAM devices prior to cheiloplasy for cleft lip-only patients with severe anterior protrusion of the premaxilla. Three cleft lip-only infants with 1-cm or more of premaxilla protrusion were included. Definitive cheiloplasty was performed at 6 months of age without any preoperative correction in infant 1. Cheiloplasty was performed in conjunction with the use of NAM device and lip adhesion in infants 2 and 3. Postoperative columella length and anterior-posterior dimension of the protruding premaxilla were compared amongst the infants. We were able to obtain satisfactory postoperative columella length and general nasal appearance.
Cleft Lip* ; Cleft Palate ; Fungi* ; Humans ; Infant ; Lip* ; Maxilla ; Orthodontic Appliances

BACKGROUND: Autologous fat grafts are widely used in plastic surgery, but they have the disadvantage of unpredictability due to variable resorption. This meta-analysis examined the literature on the survival rate of autologous fat grafts using objective markers, and investigated the factors that affected the survival rate. METHODS: The reviewers searched the PubMed, EMBASE, and Cochrane Library databases from January 2001 to December 2017. A meta-analysis was performed to estimate fat graft survival and to identify variables that influenced the survival rate. RESULTS: A total of 27 studies (1,066 cases) were included in the meta-analysis. The mean survival rate of grafted fat was 56.5%. The survival rate was significantly higher for cell-assisted lipotransfer (CAL) than for non-CAL (62% vs. 53.4%; P=0.015). The survival rate for procedures performed to correct lipoatrophy was higher than that of procedures performed for other purposes (64.6%; P=0.014), and was significantly higher in patients who underwent breast pre-expansion using the BRAVA device (66.2% vs. 50.35%; P=0.001). There were no significant differences in the survival rate according to the recipient site, harvesting method, or refinement method. CONCLUSIONS: Fat transplantation showed a varying survival rate, with an average of 56%. In patients who underwent CAL or breast pre-expansion with the BRAVA device, the survival rate of transplanted fat was higher than in their counterparts, supporting the use of these techniques in fat transplantation.
Adult Stem Cells ; Analysis of Variance ; Autografts ; Breast ; Graft Survival ; Humans ; Methods ; Surgery, Plastic ; Survival Rate ; Transplants*

PURPOSE: Animal models of a chronic wound are yet to be fully developed, and animal studies on this subject has yet to take place. The purpose of this study is to create the foundation for research on chronic wound healing based on a swine model, the most similar to that of a human. METHODS: Three female 2-3 month old 'yolkshires' were used. Total of eight full thickness skin defects, 6 x 3 cm sized, were created on the back of each pigs. Three groups were created for comparison; Group I (n=4) was left as they were after full skin thickness excision, while the excised tissues of Group II (n=3) were turned inside out and sutured so that the epidermis would come in contact with the fascia. Group III (n=3) were excised full skin thickness in depth and silicone blocks were implanted in them. Dressing was not practised so that the wounds would be vulnerable to infection. RESULTS: In Group III, the skin contraction rate was the least among the three groups for each three weeks of observation respectively. Also during the three weeks, bacteral colonization was at the highest among the comparison. On the third week, inflammatory cells were still active, but the generations of epidermis and collagen synthesis were detected minimally. CONCLUSION: The Group III was relatively the most similar model of chronic wounds. and modification of the silicone blocks, could provide us with a very effective chronic skin wound model similar to human.
Animals ; Bandages ; Collagen ; Colon ; Epidermis ; Family Characteristics ; Fascia ; Female ; Humans ; Models, Animal ; Silicones ; Skin* ; Swine* ; Wound Healing ; Wounds and Injuries*

OBJECTIVE: The aim of this study was to examine how many Korean rheumatoid arthritis (RA) patients fulfilling the 2008 American College of Rheumatology (ACR) recommendation, 2007 British Society for Rheumatology (BSR) guideline and 2010 Japan College of Rheumatology (JCR) guideline for TNF-alpha blocker, meet the Korean National Health Insurance reimbursement criteria and to evaluate the reasons for failing the Korean National Health Insurance reimbursement criteria. METHODS: Data were obtained from a registry of RA patients who visited rheumatology clinics of Hallym university affiliated hospitals. Patients who were previously prescribed with methotrexate or leflunomide for more than 3 months and had at least one DAS28 examination were included in the present study. RESULTS: Of 642 patients included, 118 episodes meeting ACR guideline for using TNF-alpha blocker were identified in 88 patients (13.7%). In addition, 19 episodes meeting BSR guideline in 17 patients (2.6%) and 21 episodes meeting JCR guideline in 21 patients (6.2%) were identified. Four episodes (4.8%) meeting ACR recommendation, 0 episodes meeting BSR criteria and 5 episodes (12%) meeting JCR criteria, respectively, were eligible for TNF-alpha blocker according to the Korean National Health Insurance reimbursement guideline. The most common reason for failing the Korean National Health Insurance reimbursement criteria was the number of active joint counts (92.6%). CONCLUSION: Our results show that the majority of RA patients satisfying the ACR guideline, BSR and JCR guideline for use of the TNF-alpha blocker did not meet the Korean National Health Insurance reimbursement criteria. Patients most often failed due to active joint count criteria.
Arthritis, Rheumatoid ; Humans ; Isoxazoles ; Japan ; Joints ; Methotrexate ; National Health Programs ; Rheumatology ; Tumor Necrosis Factor-alpha

No abstract available.
Eclampsia* ; Female ; Posterior Leukoencephalopathy Syndrome* ; Pregnancy

OBJECTIVE: The development of magnetic resonance neurography(MRN) has made it possible to produce high-resolution images of peripheral nerves themselves, as well as associated intraneural and extraneural lesions. We evaluated the clinical application and utility of high-resolution MRN techniques for the diagnosis and treatment of a variety of peripheral nerve disorder(PND)s. MATERIAL AND METHOD: MRN images were obtained using T1-weighted spin echo, T2-weighted fast spin echo with fat suppression, and short tau inversion recovery(STIR) fast spin-echo pulse sequences. Fifteen patients were studied, three with brachial plexus tumors, five with chronic entrapment syndromes, and seven with traumatic peripheral lesions. Ten patients underwent surgery. RESULTS: In MRN with STIR sequences of axial and coronal imagings, signals of the peripheral nerves with various lesions were detected as fairly bright signals and were discerned from signals of the uninvolved nerves. Increased signal with proximal swelling and distal flattening of the median nerve were seen in all patients of carpal tunnel syndrome. Among the eight patients with brachial plexus injury or tumors, T2-weighted MRN showed increased signal intensity in involved roots in five, enhanced mass lesions in three, and traumatic pseudomeningocele in three. Other associated MRI findings were adjacent bony signal change, neuroma, root adhesion and denervated muscle atophy with signal change. CONCLUSION: MRN with high-resolution imaging can be useful in the preoperative evaluation and surgical planning in patients with peripheral nerve lesions.
Brachial Plexus ; Carpal Tunnel Syndrome ; Diagnosis* ; Humans ; Magnetic Resonance Imaging* ; Median Nerve ; Neuroma ; Peripheral Nerves*

PURPOSE: High self-awareness can promote communication and empathy. The Enneagram is a well-known personality tool to enhance self-awareness. We evaluated differences in empathy among medical students using the Enneagram typology. METHODS: This cross-sectional study included first and second grade students at the Inje University College of Medicine. The Jefferson Scale of Empathy was used to measure empathy and the Korean Enneagram Personality Type Indicator was used for examining personality characteristics. Empathy scores were analyzed according to the Triads, Hornevian group, Harmonic group, and each Enneagram type. RESULTS: The Instinctive triad, the Withdrawns, and the Positive outlook group were the most common, and the Feeling triad, the Assertives, and the Emotional realness group were the least common. Students in the Feeling triad and the Dutifuls had higher compassionate care (CC) scores as compared to their counterparts. Type 2 and 6 students showed the two highest empathy and CC scores. The empathy score of type 3 students was the lowest. Type 7 had the lowest CC score but the highest perspective taking score. CONCLUSION These differences in empathy according to Enneagram personality types can be applied to medical education to maintain and improve medical students' empathy.