Free flaps have been widely used in lower leg reconstruction. However, in cases with extensive injury to the vessels as well as to the bone and soft tissues, and having only one intact major vessel in the lower leg(single vessel leg), careful selection of recipient vessels for the free flap transfer is mandatory for preventing further vascular compromise of the distal lower leg. The sural artery and its vena comitantes are frequently protected form externally harmful forces by the bulky surrounding gastrocnemius muscle and can be used as recipient vessles for free flaps without any detrimental influence on the vascularity of the distal lower leg. In our department, three latissimus dorsi muscle free flap were transferred with sural vessels as recipient vessels in the reconstruction of the single vessel legs. Except for one case of flap failure due to serious infection at the microvascular anastomoses site, all the other cases were successfully reconstructed without any necrosis of the gastrocnemius muscle or the distal leg. In addition, the sural vessels were easily accessed in any patient position and their caliber was similar to that of the vascular pedicles of the donor muscle flaps. In conclusion, the sural vessels can be another useful option in selecting recipient vessels for free flap transfer in the reconstruction of the single vessel leg.
Arteries ; Free Tissue Flaps* ; Humans ; Leg* ; Muscle, Skeletal ; Necrosis ; Superficial Back Muscles ; Tissue Donors

Scars on anterior chest after operative correction of funnel chest have been the challenging problem despite introduction of refined techiniques by numerous authors. From December 1996 to September 1998, the authors have performed prefabricated silicone implant insertion in eight female patients presenting funnel chest, using transaxillary approaches instead of substernal or inframammary incisions. In two of eight patients, augmentation mammaplasty was performed simultaneously. Except one case of seroma occurred in early stages, all eight cases of pectus excavatum were satisfactorily reconstructed by this technique. All eight patients expressed their satisfaction with the results during the follow-up visits made between 3 months and 3 years. In conclusion, endoscopic transaxillary approach for the scarless anterior chest can be useful technique in aesthetic correction of the funnel chest.
Cicatrix ; Female ; Follow-Up Studies ; Funnel Chest* ; Humans ; Mammaplasty ; Seroma ; Silicones* ; Thorax

Pneumocystis carinii causes serious pulmonary infection in immunosuppressed patients. This study was undertaken to observe the cytoskeletal proteins of P. carinii by immuno-electron microscopy. P. carinii infection was experimentally induced by immunosuppression of Sprague-Dawley rats for seven weeks, and their lungs were used for the observations of this study. The gold particles localized actin, tropomyosin, and tubulin. The actin was irregularly scattered in the cytoplasm of the trophic forms but was much more concentrated in the inner space of the cell wall of the cystic forms called the inner electron-lucent layer. No significant amount of tropomyosin was observed in either trophic forms or cystic forms. The tubulin was distributed along the peripheral cytoplasm and filopodia of both the trophic and cystic forms rather than in the inner side of the cytoplasm. Particularly, in the cystic forms, the amount of tubulin was increased and located mainly in the inner electron-lucent layer of the cell wall where the actin was concentrated as well. The results of this study showed that the cell wall of P. carinii cystic forms is a structure whose inner side is rich in actin and tubulin. The location of the actin and tubulin in P. carinii suggests that the main role of these proteins is an involvement in the protection of cystic forms from the outside environment by maintaining rigidity of the cystic forms.
Actins/analysis ; Animals ; Cytoskeletal Proteins/*analysis ; Fungal Proteins/*analysis ; Histocytochemistry ; Microscopy, Immunoelectron ; Pneumocystis/*chemistry/cytology ; Rats ; Rats, Wistar ; Support, Non-U.S. Gov't ; Tropomyosin/analysis ; Tubulin/analysis

The purpose of this study is to evaluate the effect of the presurgical infant orthopedics and the nasoalveolar molding in unilateral complete cleft lip and palate by the analytic system using standardized photographs. This study involved 34 patients with unilateral complete cleft lip and palate(24 male, 10 female, mean age 4.9 years) who underwent a rotation-advancement flap repair between 1995 and 1998 by single surgeon. Follow-up photographs were taken at a time average 3.8 years(2-7ears) after surgery. The patients were divided into three groups Group I(9 patients) consists of those who underwent cheiloplasty and primary rhinoplasty without presurgical infant orthopedics. Group II(10 patients) consists of those who underwent cheiloplasty and primary rhinoplasty with presurgical alveolar molding alone without nasal molding, and Group III(15 patients) consists of those who underwent presurgical alveolar molding with nasal molding without primary rhinoplasty. Facial proportions and angles were measured on standardized photographs using defined anthropometric points. All linear parameters were converted to the percentage values. In addition, the qualitative measurements were performed on scar quality, nostril symmetry and alar symmetry. Comparisons between group I and II and those between group II and III were made in all parameters. Results were analyzed by Mann-Whitney/ Wilcoxon rank sum test. Between group I and II, there was a significant increase in upper lip height symmetry in group II(p= 0.014). Between group II and III, upper lip height symmetry and Cupid's bow length symmetry significantly increased in group II(p=0.002, p=0.012). The other quantitative and qualitative parameters didn't make the difference between groups. In conclusion, the infant orthopedics increases upper lip height of cleft side and has the effect to obtain the upper lip symmetry. But the nasoalveolar molding has no effect to increase the nasal symmetry. So the nasoalveolar molding alone appears to be insufficient to replace the infant orthopedics with primary rhinoplasty.
Cicatrix ; Cleft Lip* ; Female ; Follow-Up Studies ; Fungi ; Humans ; Infant* ; Lip* ; Male ; Nose* ; Orthopedics* ; Palate* ; Rhinoplasty

PURPOSE: The coronal approach for repair of frontal sinus fractures is associated with significant adverse sequelae including a long scar, alopecia, paresthesias, and, uncommonly, facial nerve injury. To minimize these complications, an endoscopic approach for repair of frontal sinus fractures was developed. The authors now present the results of an endoscopy-assisted approach for the treatment of frontal sinus fractures. METHODS: From 2002 to 2009, five patients with frontal sinus fracture underwent endoscopic repair. Two slit incisions were placed in the scalp, and one or two stab incisions directly over the fractures were placed in the forehead. After subperiosteal dissection, fracture segments were reduced under direct vision and fixed with microplates or fibrin glue. RESULTS: All patients had good cosmetic results and remained free of sinus complaints. There were no perioperative complications reported. CONCLUSION: Endoscopic repair of frontal sinus fractures is an efficacious technique that significantly reduces patient morbidity. A relatively wide range of anterior table fractures can be reduced using an endoscope. In cases of complicated comminuted fractures, fibrin glue helps to achieve satisfactory endoscopic reduction. Endoscopic repair is an alternative treatment for various anterior table fractures of the frontal sinus.
Alopecia ; Cicatrix ; Cosmetics ; Endoscopes ; Facial Nerve Injuries ; Fibrin Tissue Adhesive ; Forehead ; Fractures, Comminuted ; Frontal Sinus ; Humans ; Paresthesia ; Scalp ; Vision, Ocular

PURPOSE: Full thickness skin grafts are useful in the reconstruction of facial skin defects when primary closure is not feasible. Although the supraclavicular area has been considered as the choice of donor site for large facial skin defect, many patients are reluctant to get a neck scar and some patients do not have enough skin to cover the defect owing to the same insult occurred to the neck such as burn accident. We present several cases of reconstruction of facial skin defects by freehand full-thickness skin graft from anterolateral chest wall resulting aesthetically acceptable outcome with lesser donor site morbidity. METHODS: Retrospective review was performed from March, 2007 to September, 2009. 15 patients were treated by this method. Mean age was 31.5 years. The ethiology was congenital melanocytic nevus in 7 cases, capillary malformation in 5 cases and burn scar contracture in 3 cases. Mean area of lesion was measured to 67.3 cm2 preoperatively. The lesion was removed beneath the subcutaneous fatty tissue layer. The graft was not trimmed to be thin except defatting procedure. For the larger size of defect, two pieces of grafts were harvested from both anterolateral chest wall in separation and combined by suture. RESULTS: The mean follow up period was 9.7 months. All the grafts survived without any problem except small necrotic areas in 4 cases, which healed spontaneously under conventional dressings in 6 weeks postoperatively. Color match was relatively excellent. There were 2 cases of hyperpigmentation immediately, but all of them disappeared in a few months. CONCLUSION: In cases of large facial skin defects, the anterolateral chest wall may be a good alternative choice of full-thickness skin graft.
Adipose Tissue ; Bandages ; Burns ; Capillaries ; Cicatrix ; Contracture ; Follow-Up Studies ; Humans ; Hyperpigmentation ; Neck ; Nevus, Pigmented ; Retrospective Studies ; Skin ; Sutures ; Thoracic Wall ; Thorax ; Tissue Donors ; Transplants

PURPOSE: This study was performed to design a safe air-pressure reduction system which can absorb rapidlyrising intraluminal pressure during intussusception, and comparison with other reduction systems to test itsclinical availability. MATERIALS AND METHODS: The air-pressure reduction system consisted of a pressure gauge,air insufflators, a pressure controller, buffers, and rapid exhaustion devices, and to determine itsabsorbability, it was connected with a bowel model. By using it in 20 infants with intussusception, we comparedthe absorbability of our air-pressure reduction system with preexisting systems. RESULTS: While extraluminalpressure was applied to the bowel model in which baseline intraluminal pressure was set to 120mmHg, this rose to176mmHg (56mmHg high to standard, 100%) in the direct infusion system, but to only 130 mmHg (10mmHg high tostandard, 17.9%) in a system connected to a large buffer of 10,500 mL capacity. Immediately after the applicationof extraluminal pressure for less than 1 sec, this air-pressure reduction system showed better absorbability thanthe hydrostatic reduction system. Applying this system to 20 infants with intussusception, this was successfullyreduced in 19 cases(95%), without complications. CONCLUSION: In this experiment, it was proved that the systemabsorbed rapid intraluminal pressure elevation. Its use would help prevent bowel perforation during air reductionoccurring during intussusception.
Buffers ; Humans ; Infant ; Intussusception*

PURPOSE: Tragus is one of the key structure of the normal shape of auricle. We experienced several cases of hypoplastic tragus with preauricular appendage. This article describes the methods of reconstruction of atypical tragus using accessory tragus or macrotragus to make better aesthetic results rather than simple excision. METHODS: From April, 2004 to March, 2009, 21 patients got operations by our method. Seven patients had bilateral deformity of tragus. Mean age was 12.7 years. For 17 cases of accessory tragus, simple excision, z-plasty and interpolation flap was performed. For 11 cases of macrotragus, debulking and z-plasty was performed. Mean follow-up period was 9.4 months. RESULTS: Reconstructed tragus looked symmetric with the opposite side in contour, size, direction and partial coverage of auditory meatus. There was no enlargement of remnant appendage for the follow up period and there was no complication such as hematoma, infection and chondritis. CONCLUSION: In cases of small and deformed tragus, preauricular tissue such as accessory tragus and macrotragus could be a good source of tragal reconstruction.
Congenital Abnormalities ; Follow-Up Studies ; Hematoma ; Humans

PURPOSE: NTM(non tuberculous mycobacteria) is rare cause of surgical site infection after plastic surgery in immunocompetent patients. There are some reports about NTM infection after body contouring procedure from Latin America. But, there is no report in Korea. The purpose of this article is to report 2 patients with soft tissue infection caused by NTM after body contouring procedure. METHODS: Two young female patients exhibited signs of inflammation and abscess after body contouring procedure. One patient underwent liposuction. The other underwent HPL(hypotonic pharmacologic lipo-dissolution) injection. RESULTS: The result of tissue cultures were positive for NTM. All patients responded to the combined therapeutic approach. CONCLUSION: The goal of this article is to raise awareness among plastic surgeons who may encounter such patients in their practice. NTM should be included in the differential diagnosis of surgical site infection after body contouring surgery.
Abscess ; Diagnosis, Differential ; Female ; Humans ; Inflammation ; Korea ; Latin America ; Lipectomy ; Nontuberculous Mycobacteria ; Soft Tissue Infections ; Surgery, Plastic

PURPOSE: Breast implant surgery is increasing in Korea. NTM (non tuberculous mycobacteria) infection after breast implant surgery is rare, but it has been there reported in several foreign countries. However, no report has been issued on NTM infection after breast reconstruction surgery with an implant in Korea. The purpose of this article is to report a case of NTM infection after breast reconstruction surgery with an implant. METHODS: A female patient who underwent total mastectomy and immediate breast reconstruction with a latissimus dorsi myocutaneous flap and an implant exhibited signs of inflammation after the surgery. Fluid cultures taken at the time of wound exploration were initially negative, but NTM was isolated by culture 10 days later. RESULTS: The implant was removed. M. fortuitum was identified by acid-fast culture and NTM-PCR. The patient was treated with combined antibiotic therapy. CONCLUSION: Although it is difficult to diagnose NTM infection after breast surgery, it is important that surgeons include NTM infection in the differential diagnosis of a post mammoplasty infection after breast implant surgery.
Breast ; Breast Implants ; Diagnosis, Differential ; Female ; Humans ; Inflammation ; Korea ; Mammaplasty ; Mastectomy, Simple ; Nontuberculous Mycobacteria