With the continuous development of diagnostic techniques of precancerous lesion and an improved patient-transfer system, it is unusual to examine patients who have a life-threating malignant skin lesion. However it is still a problem in some far-advanced inoperable skin tumors which have been neglected and have become aggravated, Another problem in oncologic surgery is previous irradiation around a lesion. The only effective way to treat these lesions is to excise widely and cover with an appropriate free flap. But in such conditions, selection of recipient vessel is not easy. Many surgeons have used vein graft as the conduit from a distant non-radiated vessel to the free flap. This technique requires a long segment of vein for anastomosing both the artery and vein. We used intra-lesional vessels as the recipient vessel of the free flap, which were suspiciously damaged by irradiation and malignant cell infiltration. The guidelines include: 1) malignancy-infiltrated vessels are to be dissected until a clear field is obtained under a frozen section 2) irradiated vessel can be used only if active spurting is present without intraluminal thrombosis. All of our case obtained satisfactory results in all cases except one of irradiated squamous cell carcinoma at inguinal area whose gracilis myocutaneous free flap loss was in 10%. But even this case, the cause of partial loss of the flap may not be due to a vascular problem but an internal failure of the flap. We concluded, that carefully selected intra-lesional vessels, although they may be damaged by irradiation or malignant cell infiltration can be used as the recipient vessels of free flaps.
Arteries ; Carcinoma, Squamous Cell ; Free Tissue Flaps* ; Frozen Sections ; Humans ; Skin ; Thrombosis ; Transplants ; Veins

No abstract available.
Spondylitis, Ankylosing*

No abstract available.
Classification*

In treatment of Vitamin D-resistant rickets, the authors supplemented supramalleolar stepcut osteotomy for complex deformity of tibia consisted of varus, anterior bowing and intemal torsional supramalleolar level which accompanied severe waddling gait. The results of 10 tibia operations from 5 patients were generally satisfactory in terms of appearance and function.
Congenital Abnormalities ; Gait ; Humans ; Osteotomy ; Rickets ; Rickets, Hypophosphatemic ; Tibia ; Vitamin D ; Vitamins

The repair of striated muscle after acute trauma occurs simultaneously by the regeneration of disrupted muscle and formation of connective scar. But, there had been no attention concerning effects of local anesthetics on the degeneration and regeneration process of the injured muscle. The author induced a constant contusion injury on the calf of rats. Lidocaine and/or epinephrine was intramuscularly injected at the site of injury. Morphological and histochemical observation was conducted and the results were as follows: 1. Traumatized striated muscle showed evidences of the healing process for upto 90 days. 2. Morphological and histochemical changes in the traumatized muscle became more severe after the injection of lidocaine and/or epinephrine. 3. Formation of collagenous scar tissue significantly increased after injection of lidocaine and/or epinephrine. Injection of lidocaine or epinephrine developed similar amount of scar after 15 days. 4. Cross section area of the regenerated muscle fibers decreased in the injection groups than in the control groups. Atrophy was significant on day 90 in all types of fiber after injection of the mixture of lidocaine and epinephrine, and in type B after injection of epinephrine. In conclusion, injection of the lidocaine and epinephrine inhibited regeneration of the traumatized striated muscle. Mixture of the drugs showed more inhibitory effect than a single drug.
Anesthetics, Local ; Animals ; Atrophy ; Cicatrix ; Collagen ; Contusions ; Epinephrine ; Lidocaine ; Muscle, Striated ; Rats ; Regeneration

No abstract available.
Chickenpox ; Polymerase Chain Reaction ; Pregnancy

No abstract available.
Porokeratosis*

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