The finger-tip is a specially-differentiated end structure of the human body in anatomic aspect. Although it is covered with thick dermis and a heavily-cornified epithelial layer, the finger-tip represents tremendous sensory perception because of dense sensory nerve endings. This highly sensitive skin is attached to the phalangeal bone or fascia and stabilizd during grip or pinch by the fascial septa, which form compartments of fat pads in the pulp tissue. In addition to its functional aspect, the finger tip plays an important cosmetic role because it is an exposed area like the face. So, when reconstructing finger-tips, especially the thumb or radial side of the index finger, one must take into account both the functional and esthetic results. In this study, 8 cases of great toe pulp sensory free flaps for fresh amputations (n=4) and previously reconstructed wounds (n=4) are included. In previously-reconstructedcases cases, all of them complained of incomplete recovery of sensation or cosmetic dissatifaction. The fingers covered with flaps were the index finger (n=5), ring finger (n=2), and thumb (n=1). The mean size of flaps was 3 x 1.9 cm and all of the flaps survived without significant complications, except 1 case of venous insufficiency. Sensory complications, except 1 case of venous insufficiency. Sensory perception was detected within 4 months and improved gradually during the follow-up period to 10.5 mm/8 mm in static/moving two-point discrimination test. Even though, some patients complained of postoperative paresthesia including cold intolerance (37.5%), pain (25%) and hyperesthesia (12.5%), the great toe pulp sensory flap is an aesthetically superior and sensuously more satisfactory alternative to other reconstructive procedures for fingertip defects.
Adipose Tissue ; Amputation ; Dermis ; Discrimination (Psychology) ; Fascia ; Fingers ; Follow-Up Studies ; Free Tissue Flaps* ; Hand Strength ; Human Body ; Humans ; Hyperesthesia ; Paresthesia ; Sensation ; Sensory Receptor Cells ; Skin ; Thumb ; Toes* ; Venous Insufficiency ; Wounds and Injuries

The goal of cleft lip surgery is to reconstruct normal shape of the lip. To acomplish this goal, various operative method were contrived and concept of the method decided the shape of reconstructed lips. According to the operative result, some operative methods were disappeared or have been developed with a little modifiation. Traditional Millard's rotation-advancement method for unilateral cleft lip patients is largely accepted and developed as proper method for acquiring these functional and anatomic purposes. As a trial for this development, Mulliken add some modifications. He uses exaggerated high rotation incision and it lengthens into midcolumella without backcut. Also he dosen't steal from alar base or lateral lip for vertical height. C-flap is used to lengthen the affected columella and upper lip. The isolated orbicularis oris muscle is coaptated each other for more functional result. With supraperichondral dissection of alar cartilage and transpositioning of caudal septum, he performs synchronous repair of cleft lips, nose and sometimes alveolus. It is still debated when is most suitable age for surgical correction of nasal deformity of cleft lip patients. Done at the time of primary lip repair, there are both some apprehension and inducement. The former are based on technical difficulties due to shortage and fragility of neonatal tissue and possibility of progressive deformities with growing because of iatrogenic injuries to the alar cartilages. But te latter is rationalized because early reposition of deformed nasal cartilage in proper position would induce more natural growth of nasal structures. Some long-term follow up reports reveal the early operation innocent of any growth deterioration. Mulliken treats his cleft lip patient for separated lip and nasal deformities with single operation, and does gingiovoperiosteal alveoloplasty at the same time if necessary. He uses Latham appliance from 4 to 6 week after birth in case of severly collapsed lateral alveolar segment or wide alvolar gap, and perform the definitive opertation at the age of 4 to 6 months. I use lip adhension method to correct more than 10 mm alveolar gap without severe collapse of lateral alveolar segment, but if lateral segment was severely collapsed and away from alvolar arch, I apply the Latham appliance somewhat modificate from original type, which has a metal ring fastened at the front limb of appliance for rubber banding to coaptate easily. I have experienced repair of cleft lip by Mulliken's concept with some modification of my own to 44 cases of unilateral cleft lip patients and conclude that it was very flexible method. Doing with synchonous repair of cleft lip nose, we could get harmonious lip and nose with symmetric nostril sill, cupid's bow and red line. Columella was lengthened primarily. Normal growth of nose was anticipated by anatomic repositioning of alar septal cartilage.
Alveoloplasty ; Cartilage ; Cleft Lip* ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Humans ; Lip ; Nasal Cartilages ; Nose ; Parturition ; Rubber

BACKGROUND AND OBJECTIVES: Right heart catheterization is traditionally performed using a femoral vein approach that involves admission, bed rest, and risks of bleeding and hematoma. Recent studies have confirmed safety of the use of forearm vein for right cardiac catheterization. In the present study, we evaluated the feasibility of right cardiac catheterization via the antecubital fossa vein in Korean patients. SUBJECTS AND METHODS: The medical records of all patients who underwent right heart catheterization at our hospital between January 2003 and December 2014 were reviewed retrospectively. Right cardiac catheterizations via the antecubital fossa vein and the femoral vein were compared in terms of demographic data (age, sex, weight, height, and body mass index), indications for right cardiac catheterization, and procedural and outcome data (initial success rate, procedure time, compression to ambulation time, and complications). RESULTS: We reviewed 132 cases (antecubital fossa vein approach, n=37; femoral vein approach, n=95). The demographic data, initial success rate (100% vs. 100%) and procedure time (21.6±16.8 min vs. 25.6±12.6 min, p=0.14) were similar in both groups. The antecubital fossa vein group had a shorter mean compression to ambulation time than the femoral vein group (0.0 min vs. 201.2±48.1 min, p<0.01). No complications were observed in either group. CONCLUSION: Our study indicated the ease of performance of right cardiac catheterization via the antecubital fossa vein. Thus, the antecubital fossa vein can be an alternative access site for right cardiac catheterization in Korean patients.
Bed Rest ; Cardiac Catheterization* ; Cardiac Catheters* ; Femoral Vein ; Forearm ; Hematoma ; Hemorrhage ; Humans ; Medical Records ; Retrospective Studies ; Veins* ; Walking