PURPOSE: Reconstruction of full-thickness defects of the nasal ala has always been a challenge. Local flaps can be used easily, and good result can be achieved when it is indicated. But local flaps often result in facial scars and bulky ala that require secondary revisions. Composite auricular chondrocutaneous graft may matches nasal alae well in terms of contour, color and texture, however, the size of composite graft is limited. We performed free vascularized helical root flaps for reconstruction of nasal ala. METHODS: Bilateral ala was excised and the defects were reconstructed with a chondrocutaneous free helical root flap. Each side of ala was reconstructed in 3 months interval. Superficial temporal vessels of vascularized helical root flap were anastomosed to facial vessels. Great saphenous vein was used for interpositional vascular graft. RESULTS: Flaps survived successfully. The contour, texture and color match were satisfactory. Functional problem of nasal obstruction caused by scar stenosis of nostrils was also resolved. CONCLUSION: The free vascularized helical root flap is a reliable method in reconstruction of nasal alar defects. The donor deformity was minimal.
Cicatrix ; Congenital Abnormalities ; Constriction, Pathologic ; Humans ; Nasal Obstruction ; Saphenous Vein ; Succinates ; Tissue Donors ; Transplants

PURPOSE: Reconstruction of soft tissue defects of the foot often requires free-flap transfer. Free muscle flap transfer and skin grafts on the muscle has been an option for these defects. Here we present our experiences of foot reconstruction using an endoscopy-assisted free muscle flap harvest. METHODS: Using endoscopy-assisted free muscle flap harvests, four patients with soft tissue defects of the foot were treated with a free muscle flap and skin graft. The gracilis muscle was used for two patients and the rectus abdominis muscle for two. A single small transverse skin incision was placed on the lower abdomen for the rectus abdominis muscle. A small transverse skin incision on the proximal thigh was the only incision for harvesting the gracilis muscle flap. The small incisions were enough for the muscle flap to be pulled through. RESULTS: The flaps survived successfully in all cases. Contours were good from both functional and aesthetic aspects. No breakdowns or ulcerations of the flap developed during long-term follow-up. Resultant scars were short and relatively hidden. Functional morbidities such as abdominal bulging were not noted. CONCLUSION: Endoscopy-assisted harvest of muscle flap and transfer with skin graft is a good option for soft tissue defects of the foot. Morbidities of the donor site can be minimized with endoscopic flap harvest. This method is preferable for young patients who want a small donor site scar.
Abdomen ; Cicatrix ; Follow-Up Studies ; Foot ; Free Tissue Flaps ; Humans ; Muscles ; Rectus Abdominis ; Skin ; Thigh ; Tissue Donors ; Transplants ; Ulcer

We aimed to explore the associations of dietary patterns with blood lipid profiles and obesity in adults with type 2 diabetes. The data were obtained from the Forth Korean National Health and Nutrition Examination Survey, 2007-2008. Adults 30 yr or older, from which had both biochemical and dietary data were obtained. Among them, 680 subjects were defined as having diabetes based on criteria of fasting glucose > or = 126 mg/dL, anti-diabetic treatment, or previously diagnosed diabetes. Dietary data from a 24-hr recall were used to derive dietary patterns by factor analysis. Four dietary patterns by factor analysis were identified: 'Bread & Meat & Alcohol', 'Noodles & Seafood', 'Rice & Vegetables', and 'Korean Healthy' patterns. Serum cholesterol levels in the highest quartile of the 'Bread & Meat & Alcohol' pattern were significantly higher compared with those in the lowest quartile. In addition, total cholesterol and triglyceride levels in the highest quartile of the 'Korean Healthy' pattern were significantly lower after adjusting for potential confounders. Dietary patterns of adults with diabetes were found to be associated with blood lipid profiles. 'Korean Healthy' pattern including whole grains, legumes, vegetables, and fruits could thus improve lipid profiles among those with type 2 diabetes.
Adult ; Aged ; Cholesterol/blood ; Demography ; Diabetes Mellitus, Type 2/*blood/complications/pathology ; *Diet ; Female ; Food Habits ; Humans ; Lipids/*blood ; Male ; Middle Aged ; Nutrition Surveys ; Obesity/complications ; Republic of Korea ; Triglycerides/blood

This erratum is being published to correct of title.

Elbow snapping by annular ligament is rare and may be difficult to diagnose, when this condition is not familiar. We report a case of elbow snapping by annular ligament diagnosed by ultrasonography, which was confirmed by arthroscopic observation. The ultrasonographic findings were thickening of the annular ligament and snapping in and out of the radiocapitellar joint during elbow flexion and extension on dynamic ultrasonography.
Diagnosis* ; Elbow Joint ; Elbow* ; Joints ; Ligaments* ; Ultrasonography

PURPOSE: Articles reporting on the wear rate of polyethylene cup in hybrid THA are rare. So, we now report the results of wear rate of polyethylene in cementless Harris-Galante acetabular components and cemented Harris precoat femoral stem. MATERIALS AND METHODS: The cementless Harris-Galante acetabular components and cemented Harris precoat femoral stem of one-hundred hips in 71 patients were followed up for 2.5 ~ 7.5 years (mean 4.7 year) . The clinical results were evaluated by Harris hip score (HHS) and wear rates were measured using Livermore technique. RESULTS: The most recent follow-up of HHS was improved from 52 to 91 in average. The mean linear wear rate in cemetless acetabular component was 0.17 0.06mm/yr (range 0.05 ~ 0.35) . Two femoral components were revised for aseptic loosening and one acetabular component revised for aseptic loosening. Wear rate in the revision group was higher than mean wear rate. In chronological change of wear rate according to final follow up period, there was decreasing tendency for mean wear rate with time. There was no correlation found between mean wear rate and body weight. There was a decreasing tendency on mean wear rate with acetabular cup shell size and increasing tendency with level of activity. CONCLUSION: We concluded that cemented femoral stem was the reason for the trend in lower wear rate of polyethylene cup than which had been previously reported in cementless THA, but further follow-up studies will be needed to confirm that.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Body Weight ; Follow-Up Studies ; Hip ; Humans ; Polyethylene*

OBJECTIVE: To evaluate the changes of bladder management methods after the discharge from hospital, and to identify the problems associated with their method changes of bladder management after the discharge. METHOD: The subjects of this study were 128 spinal cord injury patients with a neurogenic bladder dysfunction who were admitted to the hospital and received the neurogenic bladder management and training. We reviewed the medical records of these patients for the management methods of neurogenic bladder and interviewed the patients whether they are still using the same methods after the discharge. RESULTS: The number of patients who were doing the intermittent catheterization at the time of discharge from hospital was markedly reduced after the discharge and most of the patients in this group have switched to the external collecting device method, using Cred, Valsalva or tapping method. The reasons of this change were that the intermittent catheterization method was not only difficulty and complicated but also restricted their social activities. CONCLUSION: We concluded that a long term close follow up and continuous encouragement are very important in the management of neurogenic bladder patients who are discharged with the intermittent catheterization method.
Catheterization ; Catheters ; Follow-Up Studies ; Humans ; Medical Records ; Spinal Cord Injuries ; Spinal Cord* ; Urinary Bladder ; Urinary Bladder, Neurogenic*

PURPOSE: Nipple-sparing mastectomy (NSM) has become increasingly popular due to improved cosmesis without compromising oncologic safety. Radial and inframammary incisions are usually used to achieve NSM, with periareolar incisions usually being avoided because of the risk to nipple-areola complex viability. In an attempt to maximize esthetic effects, we performed NSM through periareolar incision with immediate reconstruction. We report our initial experience. METHODS: This case series consisted of all consecutive patients (n = 34) who underwent NSM through a periareolar incision in our institution between August 2017 and December 2018. All patients underwent NSM through periareolar incision followed by immediate reconstruction with an implant or deep inferior epigastric perforator flap. Patient demographics, tumor and treatment characteristics, and short-term postoperative outcomes were reviewed. RESULTS: The mean patient age was 46.74 ± 6.69 years (range, 38–62 years), and the mean operation time was 96.68 ± 28.00 minutes. Indications included in situ cancer in 12 cases and invasive cancer in 22 cases. There was 1 major complication (postoperative hematoma) requiring operative reintervention. No other complications including fistula, implant exposure, or reconstruction failure was observed. At the time of writing, no case of local recurrence has been observed. CONCLUSION Our initial report shows that NSM with immediate reconstruction may successfully be performed through periareolar incision. This method maximizes esthetic effects and may be an appropriate surgical option for NSM.

This study was performed to evaluate the antibacterial activity of water-soluble mangostin derivatives (WsMD) of the ethanol extract of the peel of Garcinia mangostana L. (mangosteen) and the ethanol extracts of the fruit of Psoralea corylifolia L. and the root of Glycyrrhiza uralensis (licorice) against oral bacteria associated with endodontic infections. Cytotoxicity of the three natural products was tested on human embryonic kidney 293 cells (HEK 293) using the methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay or the cell counting method. Antimicrobial activity was evaluated based on the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). The highest concentrations of the WsMD of the ethanol extract of the peel of mangosteen and ethanol extracts of P. corylifolia L. fruit and licorice root without cytotoxic effects on HEK 293 cells were 20, 400, and 320 µg/ml, respectively. The MIC and MBC values of the WsMD of the ethanol extract of the peel of mangosteen and ethanol extracts of P. corylifolia L. fruit against 35 isolates (23 species) of pulpitis- and periapical disease-causative bacteria were 1.25–20 µg/ml and 25–200 µg/ml, respectively, except for Dialister invisus KCOM 1973. The ethanol extract of licorice root had MBC values of 40–320 µg/ml against 27 of 35 bacterial strains. These results showed that the WsMD of the ethanol extract of mangosteen peel had the highest antibacterial activity among the three natural extracts and suggested it as a potential root canal irrigation agent.

PURPOSE: Mayer-Rokitansky-Kuster syndrome(MRK) is second common cause of primary amenorrhea. It is a syndrome of vaginal aplasia and Mullerian duct anomaly. Vaginal aplasia varies from agenesis of whole vagina to aplasia of upper 2/3. For reconstructing vagina, various methods are introduced. Gracilis myocutaneous flap was the first attempt in that the flap is used in vaginal reconstruction. Various flap-based vaginal reconstruction methods have been introduced. Modified Singapore flap (pedicled neurovascular pudendal thigh fasciocutaneous flap) is one of those methods that used posterior labial artery as pedicle, and pudendal nerve branch as sensory root. As its donor lies on inguinal crease that is easily hidden and there are benefits on sexual intercourse by early sensory recovery, authors think that modified Singapore flap is effective for young MRK syndrome patients. METHODS: Eight patients underwent surgery between 2008 and 2010. The flap was designed on both groin area with external pudendal artery branch as a pedicle. All flaps were fixated in pelvic cavity with absorbable suture, and additional compression on neovaginal wall was supplied by polyvinyl alcohol sponge(Merocel(R)). RESULTS: All patients were successfully reconstructed without flap related complications such as congestion or partial flap loss. The average size of the flap(each side) was 69.34cm2. Polyvinyl alcohol sponge(Merocel(R)) was inserted into neovagina for 5 days on every patient. One case of rectal laceration was occurred while making pelvic pocket by OBGY team. Other complications such as lumen narrowing, wound contracture or vaginal prolapsed were not reported during 8 months of follow up. CONCLUSION: Modified Singapore flap is a sensate fasciocutaneous flap that is thinner than other myocutaneous flap such as VRAM, and more durable over skin graft. Therefore this is a good choice for vaginal reconstruction in MRK syndrome. And known complications of Modified Singapore flap could be reduced with careful procedure and mild compression techniques.
Amenorrhea ; Arteries ; Coitus ; Contracture ; Estrogens, Conjugated (USP) ; Female ; Groin ; Humans ; Lacerations ; Polyvinyl Alcohol ; Pudendal Nerve ; Singapore ; Skin ; Sutures ; Thigh ; Tissue Donors ; Transplants ; Vagina