Composite grafting remains a technique which is used reluctantly and without great hope of success. In the recent two years, unexpectedly good result of composite graft was gained from 30 cases. The purpose of our study is to identify factors influencing success and to overlook long-term problems from a cosmetic and a functional view point. A retrospective review and a questionnaire about 30 fingers of 29 patients which were operated for composite graft at Kyongju hospital of Dongguk university from March 1997 to February 1999 were carried out. In all cases of composite grafting, tie-over dressing and heat lamp were applied and left for five days. And following result and conclusion were obtained. 1. 24(80%) of 30 finger tips replaced as composite graft were survived completely or partially. 2. At children with an age range 1 to 14, the survival rate (100%) of composite grafted tips was higher than that (75%) at adults. So, patient's age was important factor for success. 3. The type of injury was more important factor than the level of amputation. The survival rate(100%) of tips to cutting injury was higher than that(75%) of tips to crushing injury. 4. The delay in time from amputation and replacement did not significantly correlate with the survival rate. But, all tips replaced within 3 hours were survived completely or partially. 5. Even if partial necrosis on grafted tips was present, a result of long-time conservative treatment with minimal debridrement was excellent. Especially in children, the tips with conservative treatment showed normal appearance, several months later. 6. Cosmetic and functional results were better in child group and in groups with higher survival rate. Most common problem in cosmetic aspect was a short digit and that in functional aspect was a tender tip. 7. As a heat lamp increased blood supply, we could obtain better outcome.
Adult ; Amputation ; Bandages ; Child ; Fingers ; Gyeongsangbuk-do ; Hope ; Hot Temperature ; Humans ; Necrosis ; Surveys and Questionnaires ; Retrospective Studies ; Survival Rate ; Transplants*

Reconstruction of lower extremity wounds in patients with abnormalities in vascular anatomy is often challenging. A 71-year-old man was admitted to our hospital after sustaining two contact burns on his right leg while sleeping on an electric blanket. Fourth-degree burns amounting to approximately 3% of total body surface area were confirmed, with eschar formation on the right instep and pretibial area. Both wounds on the lower leg required flap reconstruction. In addition, the patient had anterior tibial artery hypoplasia. We considered a two-flap reconstruction method that should leave the source artery and muscle intact and generally has a good prognosis. A peroneal artery perforator-based keystone flap was used on the right lower leg, and a right dorsalis pedis island flap on the foot dorsum. Surgery was performed successfully, and at 8 months postoperatively, the patient walked naturally and had no complaints of discomfort. Additionally, cosmetic results were satisfactory. Accordingly, we introduce a surgical method that is useful in cases similar to that described.

Reconstruction of lower extremity wounds in patients with abnormalities in vascular anatomy is often challenging. A 71-year-old man was admitted to our hospital after sustaining two contact burns on his right leg while sleeping on an electric blanket. Fourth-degree burns amounting to approximately 3% of total body surface area were confirmed, with eschar formation on the right instep and pretibial area. Both wounds on the lower leg required flap reconstruction. In addition, the patient had anterior tibial artery hypoplasia. We considered a two-flap reconstruction method that should leave the source artery and muscle intact and generally has a good prognosis. A peroneal artery perforator-based keystone flap was used on the right lower leg, and a right dorsalis pedis island flap on the foot dorsum. Surgery was performed successfully, and at 8 months postoperatively, the patient walked naturally and had no complaints of discomfort. Additionally, cosmetic results were satisfactory. Accordingly, we introduce a surgical method that is useful in cases similar to that described.

Reconstruction of lower extremity wounds in patients with abnormalities in vascular anatomy is often challenging. A 71-year-old man was admitted to our hospital after sustaining two contact burns on his right leg while sleeping on an electric blanket. Fourth-degree burns amounting to approximately 3% of total body surface area were confirmed, with eschar formation on the right instep and pretibial area. Both wounds on the lower leg required flap reconstruction. In addition, the patient had anterior tibial artery hypoplasia. We considered a two-flap reconstruction method that should leave the source artery and muscle intact and generally has a good prognosis. A peroneal artery perforator-based keystone flap was used on the right lower leg, and a right dorsalis pedis island flap on the foot dorsum. Surgery was performed successfully, and at 8 months postoperatively, the patient walked naturally and had no complaints of discomfort. Additionally, cosmetic results were satisfactory. Accordingly, we introduce a surgical method that is useful in cases similar to that described.

Reconstruction of lower extremity wounds in patients with abnormalities in vascular anatomy is often challenging. A 71-year-old man was admitted to our hospital after sustaining two contact burns on his right leg while sleeping on an electric blanket. Fourth-degree burns amounting to approximately 3% of total body surface area were confirmed, with eschar formation on the right instep and pretibial area. Both wounds on the lower leg required flap reconstruction. In addition, the patient had anterior tibial artery hypoplasia. We considered a two-flap reconstruction method that should leave the source artery and muscle intact and generally has a good prognosis. A peroneal artery perforator-based keystone flap was used on the right lower leg, and a right dorsalis pedis island flap on the foot dorsum. Surgery was performed successfully, and at 8 months postoperatively, the patient walked naturally and had no complaints of discomfort. Additionally, cosmetic results were satisfactory. Accordingly, we introduce a surgical method that is useful in cases similar to that described.

BACKGROUND: Many methods have been proposed for the correction of sunken upper eyelids. These methods include surgical treatments, such as micro-fat, dermofat, or fascia-fat grafts, or the use of alloplastic materials. Here, we present our experience of sunken upper eyelid correction involving the simple addition of anchoring the central fat pad to the medial fat pad during upper blepharoplasty. METHODS: We performed 74 cases of upper blepharoplasty with sunken upper eyelid correction between October 2013 and September 2014. The lateral portion of the central fat pad was partially dissected to facilitate anchoring. The medial fat pad was gently exposed and then pulled out to facilitate anchoring. After the rotation of the dissected lateral portion of the central fat pad by 180degrees to the medial side, it was anchored spreading to the medial fat pad. Photographs taken at 6 months postoperatively were presented to three physicians for objective assessment. Of the 74 patients, 54 patients followed at 6 months postoperatively were included in this retrospective, objective assessment. RESULTS: Sunken eyelids were effectively corrected in 51 of the 54 patients, but 3 had minimal effect because preaponeurotic fat pads had been removed during previous upper blepharoplasty. In addition to correcting sunken eyelids, lateral bulging was corrected and a better definition of the lateral portion of upper lid creases was obtained. CONCLUSIONS: Anchoring the central fat pad to the medial fat pad provides an effective means of correcting sunken upper eyelids during upper blepharoplasty.
Adipose Tissue* ; Blepharoplasty* ; Esthetics ; Eyelids* ; Humans ; Retrospective Studies ; Transplants

PURPOSE: Lymphangioma circumscriptum is a rare, congenital benign hamartous malformation, caused by the saccular dilatation of lymph channels lines by normal, single cell, lymphatic endothelia that present as local eruptions of persistent, grouped, translucent vesicles. The lymphangioma circumscriptum lesions may occur on axillary fold shoulder, neck proximal limbs and buccal mucosa. We reported a rare case of lymphangioma circumscriptum on the scalp. METHODS: A 15-year-old girl with a 5x3cm sized lymphangioma circumscriptum on scalp was examined. It was defined a boundry by ultrasound. And then, a tissue crescent type expander with 120cc normal saline was inserted on occipital area for a month. After confirmed safety margin of the excised lymphangioma circumscriptum on frozen biopsy and the scalp flap was elevated and covered with empty space. RESULTS: A histopathologic finding revealed that lymphangioma circumscriptum. During 11 months follow up, no relapse was found. CONCLUSION: We described a rare case of lymphangioma circumscriptum on scalp. By using a tissue expander and excision, we achieved no recurrence and aesthetically satisfactory outcome.
Adolescent ; Biopsy ; Dilatation ; Extremities ; Follow-Up Studies ; Humans ; Lymphangioma ; Mouth Mucosa ; Neck ; Recurrence ; Scalp ; Shoulder ; Tissue Expansion Devices

BACKGROUND: Facial laceration is the most common injury encountered in the emergency room in the plastic surgery field, and optimal treatment is important. However, few authors have investigated this injury in all age groups or performed follow-up visit after repair. In the present study, the medical records of patients with lacerations in the facial area and underwent primary repair in an emergency room over a 2-year period were reviewed and analyzed. METHODS: Medical records of 3,234 patients with lacerations in facial area and underwent primary repair in an emergency room between March 2011 and February 2013 were reviewed and identified. RESULTS: All the 3,234 patients were evaluated, whose ratio of men to women was 2.65 to 1. The forehead was the most common region affected and a slip down was the most common mechanism of injury. In terms of monthly distribution, May had the highest percentage. 1,566 patients received follow-up managements, and 58 patients experienced complications. The average days of follow-up were 9.8. CONCLUSIONS: Proportion of male adolescents was significantly higher than in the other groups. Facial lacerations exhibit a 'T-shaped' facial distribution centered about the forehead. Careful management is necessary if a laceration involves or is located in the oral cavity. We were unable to long term follow-up most patients. Thus, it is necessary to encourage patients and give them proper education for follow-up in enough period.
Adolescent ; Education ; Emergency Service, Hospital* ; Facial Injuries ; Female ; Follow-Up Studies ; Forehead ; Humans ; Lacerations* ; Male ; Medical Records ; Mouth ; Surgery, Plastic

None of the reports of delayed infection mentioned a latent period exceeding 13 months. we report an infection that developed 18 months after implantation of an absorbable plate. A 16-year-old adolescent girl had undergone reduction and fixation with an absorbable plate for Lefort I and zygomaticomaxillary complex fractures 18 months prior at our hospital. In her most recent hospital visit as an outpatient, abscess was observed in periocular area. Computed tomography revealed sinusitis with an abscess above the infraorbital rim. Wound culture yielded methicillin-resistant Staphylococcus aureus . Despite conservative treatments, wound state did not improve. Therefore, our department decided to perform surgery. Absorbable plate had been mostly absorbed but remained a bit. Bony depression of infraorbital rim and mucosal exposure of maxillary sinus anterior wall were observed. After the surgery, the patient recovered. We believe that the reason the wound infection and sinusitis manifested at the same time is because of several factor such as alcohol abuse, smoking, and mucosal exposure of maxillary sinus anterior wall. Absorbable plate takes 9 months to 3 years to be completely absorbed, thus we suggest studies with a follow-up of at least 3 years be undertaken to determine the outcomes of patients with many risk factors.
Abscess ; Absorbable Implants ; Adolescent ; Alcoholism ; Depression ; Female ; Follow-Up Studies ; Humans ; Maxillary Sinus ; Maxillofacial Injuries ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Outpatients ; Prosthesis-Related Infections ; Risk Factors ; Sinusitis ; Smoke ; Smoking ; Wound Infection ; Wounds and Injuries

PURPOSE: Unilateral breast reconstruction after mastectomy confront the challenges of recreating a natural appearing breast mound and achieving symmetricalness of the breasts. If the patient's remaining breast is large compared to reconstructed breast, the most common procedure is reduction mammoplasty of the large breast side. The authors experienced a new method of breast reconstruction using the excess breast tissue from the contralateral breast after breast reduction. METHODS: The excess tissue from the contralateral breast after vertical reduction mammoplasty with superior pedicle and remaining lower breast tissue were transferred to the mastectomy site breast through the subcutaneous tunnel on the chest wall. The main blood supplies of the flap are perforator branches of the 4th, 5th and 6th anterior intercostal artery. After elevating and detaching the flap on the lower lateral area of the breast, the turned over flap is fixed on the upper portion of the chest wall of the mastectomy site. RESULTS: On two cases of the breast reconstructions, remaining excess breast tissue from reduction mammoplasty was transferred to the contralateral breast side as pedicles. Both patient and operator were satisfied with the outcome of the reconstruction as the breasts were symmetrical and in natural shape. CONCLUSION: We have performed unilateral breast reconstruction using the excess breast tissue after reduction mammoplasty of the contralateral breast. As Oriental women's breasts are relatively smaller than those of Caucasian women, delayed breast reconstruction cases of Oriental women with large breasts(macromastia) seem to be ideal for this procedure.
Arteries ; Breast ; Equipment and Supplies ; Female ; Humans ; Mammaplasty ; Mastectomy ; Thoracic Wall