Reconstruction of extensive soft tissue defects of the lower extremity, especially when complicated by open fracture and bone loss, is usually a difficult problem for the plastic surgeon. Many methods have been devised to treat these conditions Musculocutaneous flaps add a valuable surgical alternative that bring vascularized cover to the defects, and the free microvascular transfer of these flaps gives the surgeon an added dimension of versatility. The latissimus dorsi is an extremly reliable musculocutaneous flap with a long, large-caliber vascular pedicle, so that dissection of the muscle can be performed with relative ease. The size of the latissimus dorsi muscle lends itself to coverage of large defects. While these characteristics appear to make the free latissimus dorsi musculocutaneous transfer ideal in many circumstances, it has some disadvantages. At the recipient site, the flap is ofter too bulky, and donor-site closure requires skin grafts if the flap is wider than 10cm. These skin grafts on the posterior thorax seriously detract from the final appearance of the donor site. The authors have experienced 12 cases of reconstruction of extensive lower extremity soft tissue defect in which the latissimus dorsi muscle alone was transferred and covered with a split-thickness skin graft. This method improves the recipient-site contour by decreasing the bulk of the flap and it also improves the donor-site appearance. We described technical considerations in each case and the advantages of free latissimus dorsi muscle flap and skin graft for the reconstruction of extensive soft tissue defect in the lower extremity.
Fractures, Open ; Humans ; Lower Extremity ; Myocutaneous Flap ; Skin ; Superficial Back Muscles* ; Thorax ; Tissue Donors ; Transplants

The perichondrium has neochondrogenic potential. Many authors have published their study for the cartilage regeneration from perichondrium and the clinical uses of perichondrial graft. How is the difference of thickness of the regenerated cartilage after crushing the free perichondrial graft, compare with uncrushed graft? In this study, the perichondrium was obtained from rabbit, ears, and sectioned 10x10 mm slices. The uncrushed and crushed perichondriums were grafted into subcutaneous layer of back. After the 2,4 and 8 weeks, authors obtained regenerated cartilage from both crushed and uncrushed free perichondrial graft from rabbit back, examined the survival rate and thickness by histologic study.The results are as follows: 1. The survival rate was no difference between the uncrushed perichondrium & crushed perichondrium (p>0.05). 2. The cartilage from the uncrushed perichondrium was thicker than the crushed perichondrium, at only 8 weeks(p<0.01). 3. The thickness of regenerated cartilage was similar to the cartilage of the donor site of free perichondrial graft at 4 weeks(p>0.05).
Cartilage* ; Ear* ; Humans ; Regeneration* ; Survival Rate ; Tissue Donors ; Transplants

A retrospective, multivariate statistical analysis of 394 patients who underwent cleft palate repair was performed to document the incidence of postoperative oronasal fistula formation, and to assess possible contributing factors. Fistulas of the secondary palate were included, but nasal-alveolar fistulas and intentionally unrepaired anterior palatal fistulas were excluded. Postoperative oronasal fistulas occurred in 25 of the 394 patients(6.35%). The mean age at repair was 16.4 months, and mean follow-up period was 2.5 years. Several variables that are included sex, age, extent of clefting(as estimated by the Veau classification), type of repair, and experience level of the operating surgeon were analyzed by means of the log-rank test to determine their significance in postoperative fistula formation. Sex (p=0.077), age(p=0.538), and experience level of the operating surgeon(p=0.094) did not significantly affect the rate of fistula formation. However, extent of clefting(p=0.005) and type of repair(p=0.001) are the strongest predictor of the occurrence of a cleft palate fistula.
Cleft Palate ; Fistula* ; Follow-Up Studies ; Humans ; Incidence ; Intention ; Palate ; Retrospective Studies

The nevus of Ota is a benign dermal melanocytic lesion that most commonly occurs unilaterally in areas innervated by the first and second division of the trigeminal nerve. Acquired bilateral nevus of Ota-like macules(ABNOM) are located bilaterally on the forehead, temples, eyelids, cheeks, and/or nose. They usually occur in the fourth or fifth decade of life in women(rarely in men). In contrast to the nevus of Ota, ABNOM have not been observed in the mucous membranes of the oral cavity, nose, or eyes. Traditional treatments were palliative, risky electrocautery, or cryotherapy. These methods resulted in permanent pigmentary changes and/or scarring. Recently utilizing the principle of selective photothermolysis, the Q-switched Alexandrite laser has been reported to be successful in treating benign pigmentary lesions and tattoos. Our study evaluated the treatment of 127 patients with nevus of Ota and ABNOM with the Q-switched Alexandrite laser(755 nm, 100 nsec). Nevi were treated up to 7 times with 7-8 J/cm2 at a minimum of 6 weeks interval. Good therapeutic effects were gained (up to 50% improvement was seen in 89% of patients.) and our patients were very satisfied. No patients had permanent textural change or scarring. Treatment with on Alexandrite laser for nevus of Ota & ABNOM is considered to be a safe and effective method.
Cheek ; Cicatrix ; Cryotherapy ; Electrocoagulation ; Eyelids ; Forehead ; Humans ; Lasers, Solid-State* ; Mouth ; Mucous Membrane ; Nevus of Ota ; Nevus* ; Nose ; Trigeminal Nerve

Excess hair growth in unwanted areas may result from heredity, endocrine disease, or drug therapy. Conventional methods of hair removal include shaving, wax epilation and chemical depilatories that frequently cause side effects such as contact dermatitis and that also have temporary effects. Electrolysis is a well-established medical method for permanent destruction of terminal hair follicles. However, this method is tedious and efficacy has been reported to range from 15-to-50% permanent hair loss. The evolution of the laser use for hair removal continues a year after Food and Drug Administration (FDA) approval of the first laser for these applications. The authors have experienced hair removal utilizing a long-pulsed alexandrite laser. This laser system employs the principle of thermokinetic selectivity, a revolutionary concept. The principle of thermokinetic selectivity involves the use of lasers with pulse durations below the thermal relaxation on a the large target such as the hair folllicle (40-100 msec), and significantly longer than the thermal relaxation time of smaller structures of the same chromophore (melanin) in epidermis (3-10 msec). The study was based on 76 patients treated with 20 msec pulse duration laser set to energy densities of 17-21 J/cm2. Treated areas included arms, legs, beard-chin, upper lips and bikini lines. Gross observation showed leaching of hair color, decresed size of the skin pores, easily broken hair shafts, and elimination of hair. Therefore, it can be assumed that the majority of hair follicles were destroyed by this procedure, Side effects included intermediary risk of hyperpigmentation and blister. Over 80% of treated patients were satisfied with the results. As the process of research and clinical application continues, we need the long-term results of this laser system to ensure its efficacy.
Arm ; Blister ; Dermatitis, Contact ; Drug Therapy ; Electrolysis ; Endocrine System Diseases ; Epidermis ; Hair Color ; Hair Follicle ; Hair Removal ; Hair* ; Heredity ; Humans ; Hyperpigmentation ; Lasers, Solid-State* ; Leg ; Lip ; Relaxation ; Skin ; United States Food and Drug Administration

No abstract available.
Eyebrows* ; Eyelids*

No abstract available.
Blood Pressure* ; Body Mass Index*

No abstract available.
Adult* ; Atherosclerosis* ; Cholesterol* ; Humans ; Korea*

OBJECTIVE: This study was performed to evaluate the feasibility, safety, and tolerance of early postoperative oral feeding in gynecologic patients who have underwent intra-abdominal surgery. Thus, we investigated the clinical efficacy of early postoperative oral feeding in gynecologic patients, prospectively. METHODS: From September 1998 to March 1999, we studied 80 gynecologic patients undergoing laparotomy at Department of Obstetrics and Gynecology, Yonsei University College of Medicine, prospectively. After surgery, the patients were grouped into two arms; the first early oral feeding group began a clear liquid diet on the first postoperative day and advanced to regular diet as tolerated. the second control group received nothing by mouth until return of bowel function. RESULTS: Although more patients in the study group developed nausea, the incidence of vomiting and abdominal distension were comparable in both groups. Time to development of bowel sound and flatus were significantly shorter in study group. Postoperative complications including pneumonia, atelectasis, wound complications, and febrile morbidity occurred insignificantly in both group. Postoperative changes in hematologic indices and electrolytes were comparable in both group. CONCLUSION: Early postoperative oral feeding in gynecologic patients undergoing intra-abdominal surgery is safe, well tolerated. We believe that re-evaluation of postoperative surgical care may increase our knowledge and better serve our patients.
Arm ; Diet ; Electrolytes ; Flatulence ; Gynecology ; Humans ; Incidence ; Laparotomy ; Mouth ; Nausea ; Obstetrics ; Pneumonia ; Postoperative Complications ; Prospective Studies ; Pulmonary Atelectasis ; Vomiting ; Wounds and Injuries

No abstract available.
Pemphigus*