PURPOSE: Heterotopic ossification in pressure sore patients is reported to rarely develop, but once it occurs, it frequently causes joint stiffness and mobilization restriction. The aim of this article is to report our experience of atypical bone growing at femur neck fracture site with chronic, extensive pressure sore in patient with paraplegia secondary to spinal injury. METHODS: A 28-year-old male patient presented with atypical bone growth at femur neck fracture site with pressure sore. He had undergone atypical growth bone removal and separation of united iliac bone and femur, and then pressure sore was covered by advanced rotation flap. RESULTS: The patient mobilized hip joint and rode in a wheelchair. Complications such as dehiscence, infection, hematoma and flap necrosis did not occur. CONCLUSION: We experienced successful correction of atypical bone growth removal and recovery of pressure sore. We report our experience of atypical bone growth of fracture site and the related literature was reviewed.
Adult ; Bone Development ; Femoral Neck Fractures ; Femur ; Femur Neck ; Hematoma ; Hip Joint ; Humans ; Joints ; Male ; Necrosis ; Ossification, Heterotopic ; Paraplegia ; Pressure Ulcer ; Spinal Injuries ; Wheelchairs

PURPOSE: Axillary osmidrosis is a distressing disorder characterized by unpleasant odor from axillary area and it is mainly associated with apocrine glands but also associated with eccrine glands. For surgical treatment of osmidrosis, recently ultrasound assisted liposuction(UAL) had been performed for many patients. According to the recent studies about ultrasound assisted liposuction for the treatment of osmidrosis, histologic studies about apocrine gland had been applied for 35 cases, but there were rare mention about eccrine gland and the relationship between two glands. The purpose of this article is to evaluate the effect of ultrasound assisted liposuction for the treatment of axillary osmidrosis on apocrine and eccrine glands. METHODS: From January 2004 to January 2007, 35 patients underwent ultrasound assisted liposuction for the treatment of osmidrosis and 5 patients underwent histologic studies. Histologic examinations were performed before and after ultrasound assisted liposuction and each biopsy was performed in central axillary area. The volume ratio of both glands, presence of degeneration were examined. And in aspirates, distribution and density of both glands and their morphological changes were examined. RESULTS: Preoperative biopsy results showed average volume ratio of apocrine glands to eccrine glands was 65:35. According to the postoperative biopsy results, the volume of apocrine glands in dermis were significantly reduced and glands were degenerated, but the volume of eccrine glands were slightly reduced and glands were mildly damaged. And the average volume ratio of two glands was 20:80. According to biopsy results of aspirates, the volume ratio of two glands was 85:15 and apocrine glands had significantly greater proportion. CONCLUSION: By comparison of each biopsy result, apocrine glands were more significantly reduced and degenerated than eccrine glands in all 5 cases. However, further studies with large sample sizes and close examinations are required.
Apocrine Glands ; Biopsy ; Dermis ; Eccrine Glands ; Humans ; Lipectomy ; Odors ; Sample Size

PURPOSE: Blepharoptosis can result from either congenital or acquired causes. Blow out fracture or facial bone fracture including blow out fracture can be one of the causes. Authors experienced 3 cases of severe blepharoptosis after blow out fracture treated only with observation after reduction of associated fracture. METHODS: Reconstruction of orbital wall was conducted on all cases diagnosed as blow out fracture using 3 dimensional computed tomography, and conservative treatment was done on accompanying severe blepharoptosis. RESULTS: At the time of injury, all cases showed severe blepharoptosis requiring frontalis muscle transfer for correction. But blepharoptosis was recovered in an average of 18 weeks without any surgical procedure except reconstruction of orbital wall. CONCLUSION: Once Blepharoptosis occurred after blow out fracture, thorough evaluation must be done at first. If definitive cause of blepahroptisis cannot be found as authors' cases, injury of oculomotor nerve may result in blepharoptosis. So, as for blepharoptosis after blow out fracture, conservative treatment following reconstruction of fractured orbital wall can be one of good management.
Blepharoptosis ; Facial Bones ; Muscles ; Oculomotor Nerve ; Orbit

PURPOSE: Blow out fracture resulting from facial trauma is of high frequency among facial bone fractures, and can cause severe complications. So, proper post-operative management and close observation are needed. So far, Computed tomography has been the best method in evaluating following orbit wall reconstruction. However, cost-effectiveness, accessibility to patients and hazard of radiation exposure of computed tomography require supplementary measure for the evaluation following orbit wall reconstruction. This study was performed to describe the effectiveness of ultrasonography in the evaluation following orbit wall reconstruction. METHODS: A retrospective study was performed on 40 patients who underwent orbit wall reconstruction from June, 2008 to July, 2008. The patients' ages ranged from 13 to 65 years with the mean of 27.5 years. The patient group was composed of 27 males and 13 females. The follow up period ranged from 2 weeks to 28 weeks with the mean of 11 weeks. Preoperatively, all fractures were diagnosed using computed tomography. Ultrasonography for all cases, and computed tomography for 2 cases were performed for evaluation following orbit wall reconstruction. RESULTS: Reduction of herniated orbital soft tissue and orbit implant was identified by using ultrasonography in 38 cases out of 40 cases. In other cases which we could not identify the orbit implant, computed tomography was performed. CONCLUSION: Compared to computed tomography, ultrasonography is a simple, inexpensive and convenient method. Ultrasonography can be used as supplementary measure to computed tomography in the evaluation following orbit wall reconstruction for elective patients.
Facial Bones ; Female ; Follow-Up Studies ; Humans ; Male ; Orbit ; Retrospective Studies

PURPOSE: Nasal bone fracture is the most common type of facial bone fracture and most of nasal bone fracture is combined with septal fracture frequently. Nasal septum is important to support the distal nose and to maintain the nasal airway. But nasal septal fractures are usually unrecognized and untreated at the time of operation. Recently, various materials were using for nasal packing after closed reduction, however these materials are not focused on the correction of nasal bone and nasal septal fracture and many patients are suffered from nasal packing materials. Thus, the purpose of this study is to compare routine packing materials and rolled silastic sheet with respect to postoperative effect of correction of nasal bone fracture and discomfort of nasal packing materials. METHODS: We examined 320 patients treated nasal bone fracture from January 2008 to December 2010. For Group I(n=92), Merocel(R) was used for nasal packing, for Group II(n=152) vaseline gauze was used, and Rolled silastic sheet(RSS) with vaseline gauze packing(VGP) was used for Group III(n=76). Under the general anesthesia, all patients were operated by closed reduction and nasal packing was done using three kinds of packing materials. At the time of postoperative 7 days, packing material was removed and studied for pt's satisfaction and postop. complications. RESULTS: In patients with RSS with VGP, the complaints (nasal obstruction, foreign compressive sensation and discomfort during food ingestion) of keeping the nasal packing were decreased(p<0.05) and the postoperative complication(deviation) were decreased comparing to vaseline gauze packing and Merocel(R) packing, however, these differences were not statistically significant(p>0.05). CONCLUSION: Postoperative nasal packing with RSS with VGP was more comfortable to the patients and it was more effective method to correct the nasal bone fracture and nasal septal fracture.
Anesthesia, General ; Dimethylpolysiloxanes ; Facial Bones ; Humans ; Nasal Bone ; Nasal Septum ; Nose ; Petrolatum ; Sensation

BACKGROUND: The zygoma is a major portion of the midfacial contour. When deformity occurs in this area, a reduction should be conducted to correct it. If a sagittal fracture at the temporal root of the zygomatic arch occurs, this also requires reduction, but it is difficult to approach due to its anatomical location, and the possibility of fixation is also limited. Thus, the authors attempted the reduction of sagittal fracture by two- or three-point fixation and the Gillies approach without direct manipulation. The preoperative and postoperative results of the patients were evaluated. Follow-up was performed to establish a treatment guideline. METHODS: A retrospective study was done with 40 patients who had sagittal fractures at the temporal root of the zygomatic arch from March 2009 to June 2012. Only two- or three-point fixation was performed for the accompanying zygomatic-orbital-maxillary fracture. The Gillies approach was used for complex fractures of the zygomatic arch, while the temporal root of the zygomatic arch was only observed without reduction. Preoperative and postoperative computed tomography and X-ray scans were performed to examine the results. RESULTS: The result of the paired t-test on preoperative and postoperative bone gap differences, the depression level, and the degree of temporal protrusion showed a marked decrease in the mean difference at a 95% confidence interval. The results were acceptable. CONCLUSIONS: In the treatment of sagittal fractures at the temporal root of the zygomatic arch, it is acceptable to use indirect reduction and non-fixation methods. This leads to a satisfactory aesthetic and functional outcome.
Congenital Abnormalities ; Depression ; Facial Asymmetry ; Follow-Up Studies ; Humans ; Retrospective Studies ; Zygoma ; Zygomatic Fractures

Rheumatoid arthritis is a long lasting autoimmune disorder that primarily affects joints, and patients with rheumatoid arthritis are predisposed to development of chronic skin ulcers. In addition, skin ulcers with rheumatoid arthritis tend to persist despite treatment because of sustained inflammation and poor healing capacity. Treatment of skin ulcers involves medications, wound coating agents, and surgical procedures including skin grafting, however, wound dressing or skin grafts are generally excluded because of excessive cost and time and poor intake rate. The dorsal metacarpal artery perforator (DMAP) flap, a vascular island flap for coverage of soft tissue defects on the fingers, provides promising results including matched quality and color. We experienced a case of DMAP flap for reconstruction of a rheumatoid ulcer, and a DMAP flap may be considered as a good faithful option for treatment of patients with rheumatoid ulcer.
Arteries* ; Arthritis, Rheumatoid ; Bandages ; Fingers ; Humans ; Inflammation ; Joints ; Perforator Flap* ; Skin ; Skin Transplantation ; Skin Ulcer ; Transplants ; Ulcer* ; Wounds and Injuries

BACKGROUND: The subciliary approach is commonly used for reconstruction of orbital wall or zygomaticomaxillary fractures. However, this approach is associated with postoperative complications, especially lower eyelid malposition. We report the experience of managing postoperative lower eyelid malposition with triamcinolone acetonide. METHODS: A retrospective review was performed for all traumatic facial fractures requiring surgery via the subciliary approach at Chosun University Hospital in 2014. For each patient meeting inclusion criteria, the medical chart was reviewed for demographic information and postoperative course, including the presence of postoperative eyelid malposition or scleral show. RESULTS: The review identified 189 cases in which the subciliary approach was used, and postoperative lower eyelid malposition was found in 7 cases (3.7%). For these 7 patients, the mean therapeutic period (interval to correction of the malposition) was 10.5 weeks (range, 8 to 14 weeks). On average, patients received 3 injections of triamcinolone. In all cases, degrees of the malposition were improved, and none of the patients required an operative intervention to correct the malposition. CONCLUSION: Triamcinolone injection is an appropriate treatment modality for lower eyelid malposition after subciliary approach. Treatment duration is relatively short, requiring fewer than 4 outpatient clinic visits, with relatively earlier recovery compared to conservative "wait-and-see" management.
Ambulatory Care Facilities ; Ectropion ; Eyelids* ; Humans ; Orbit ; Postoperative Complications ; Retrospective Studies ; Triamcinolone Acetonide* ; Triamcinolone*

A pressure sore, such as quadriplegia, is developed in patients who have been idle in bed for a long time, particularly in the spinal cord. The treatment is particularly difficult in cases of multiple recurrent sores, osteomyelitis with pathologic fractures, other underlying conditions such as diabetes mellitus, immuno-suppression, or radiotherapy. Over the last 20 years, the development and popularization of rectus abdominis flap have significantly increased for reconstruction of a wide variety of difficult clinical problems. From March 2000 to Dec 2001, 6 neurologically impaired patients underwent reconstruction of chronic pressure sores utilizing an inferiorly based rectus abdominis musculocutaneous flap. Postoperative follow-up ranged from 6 to 15 months. The average thickness of rectus abdominis muscle in quadriplegic patient is less than half of that in healthy patient. In most cases, mild venous congestions are developed, but these were resolved by medical treatment. All wounds have healed without any significant complications such as flap loss, infection, hernia, and sepsis. In conclusion, rectus abdominis muscle for these reconstructions provides a simple, reliable solution to often difficult reconstructive problem. We recommended this highly viable, versatile and reliable flap as one to be considered in planning the reconstruction of the quadriplegia patient with pressure sores when other local and regional flaps are unavailable.
Diabetes Mellitus ; Estrogens, Conjugated (USP) ; Follow-Up Studies ; Fractures, Spontaneous ; Hernia ; Humans ; Myocutaneous Flap ; Osteomyelitis ; Pressure Ulcer* ; Quadriplegia* ; Radiotherapy ; Rectus Abdominis* ; Sepsis ; Spinal Cord ; Wounds and Injuries

Nasoalveolar molding (NAM) device is an effective treatment for protruding maxilla in infants with cleft palate. However, only a few studies have investigated the effect of NAM devices on the treatment of protruding maxilla in infants with cleft lip only. We have designed a combination treatment using NAM devices prior to cheiloplasy for cleft lip-only patients with severe anterior protrusion of the premaxilla. Three cleft lip-only infants with 1-cm or more of premaxilla protrusion were included. Definitive cheiloplasty was performed at 6 months of age without any preoperative correction in infant 1. Cheiloplasty was performed in conjunction with the use of NAM device and lip adhesion in infants 2 and 3. Postoperative columella length and anterior-posterior dimension of the protruding premaxilla were compared amongst the infants. We were able to obtain satisfactory postoperative columella length and general nasal appearance.
Cleft Lip* ; Cleft Palate ; Fungi* ; Humans ; Infant ; Lip* ; Maxilla ; Orthodontic Appliances