UUse of the gastrocnemius muscle flap has proven to be highly effective in reconstruction of knee and lower leg defect due to its easy procedure, anatomical consistency, and less donor site morbidity.The gastrocnemius muscle is anatomically spindle shape, the volume of the distal part of the muscle for coverage is actually quite small and also even smaller when disuse atrophy is accompanied due to trauma. Although the defect is inside flap's arc of rotation, it is out of gastrocnemius muscle flap's indication when the defect size is extensive, and even though the defect is small, it is also out of indication when the defect is a bit out of arc of rotation. There has been a lot of modification to increase the flap's arc of rotation or dimension. However, it is difficult to achieve satisfactory results due to limitation and expense in clinical application. Authors used, for soft tissue reconstruction on broader area, gastrocnemius musculo-adipofascial flap, rather than classical gastrocnemius muscle flap, based on the fascial plexus of gastrocnemius muscle. We obtained a good result in lower extremity reconstruction of 7 cases from March 1999 to July 2000 and report this result with several cases.
Humans ; Knee ; Leg ; Lower Extremity* ; Muscle, Skeletal ; Muscular Disorders, Atrophic ; Tissue Donors

Neurothekeoma is a relatively uncommon tumor of nerve sheath origin. Most of these tumors are benign and malignant transformation was not reported. Usually, these tumors arise during childhood or early adulthood life with female preponderance. They have a predilection for the head, neck and shoulder region but any part of the body may be affected. Their usual size is between 0.5-3.0 cm. Rapid growth and ulceration are rare, and local recurrence tends to occur after incomplete excision. We report a case of neurothekeoma developed in the scalp of a 21-year-old woman. It was first noticed about 1year ago. This mass had been increasing in size slowly. On physical examination, 2 x 1.5 cm sized papule with localized alopecia was identified on the frontal scalp area. It was excised in 5.5 x 3.6 cm. The histologic finding of the lesion showed that lobules, fascicles or rests of spindle shaped or epitheloid cells in a myxoid of mucosubstance. The tumor cells were positive for S-100 and vimentin but showed negative for EMA, cytokeratin, desmin, actin and HMB45. After surgical excision of tumor, split-thickness skin graft was done. Three months after the operation, rectangular shape tissue expander (180 cc Sebbin(R)) was inserted on both sides of the previous wound. After removal of tissue expander, the wound closed with local flap. The patient did not have any evidence of recurrence for 6 months.
Actins ; Alopecia ; Desmin ; Female ; Head ; Humans ; Keratins ; Neck ; Neurothekeoma* ; Physical Examination ; Recurrence ; Scalp* ; Shoulder ; Skin ; Tissue Expansion Devices ; Transplants ; Ulcer ; Vimentin ; Wounds and Injuries ; Young Adult

Desmoid tumors are rare soft tissue neoplasms derived from fascial or musculoaponeurotic structures. These tumors are histologically benign but may behave aggressively at the local level with frequent recurrence after complete resection. Wide regional excision with negative pathologic margins is the treatment of choice for most desmoid tumors. A 36-year-old man was presented with a huge mass of 25 cm in diameter from right side of neck extended to ipsilateral chest wall. He was complaining discomfort during neck exercise and focal paresthesia on his right 2nd, 3rd, and 4th finger volar side without functional limitation. The lesion was evaluated preoperatively through MRI, angiographies and bone scan. It was originated from right scalenius medius muscle of neck extended to ipsilateral axilla and chest wall adhering to the brachial plexus. Tumor resection sparing brachial plexus was executed and postoperative radiotherapy was accompanied. After 9 months, there was no evidence of tumor recurrence and no major function limitation of right arm and hand.
Adult ; Angiography ; Arm ; Axilla ; Brachial Plexus ; Fibromatosis, Aggressive* ; Fingers ; Hand ; Humans ; Magnetic Resonance Imaging ; Neck* ; Paresthesia ; Radiotherapy ; Recurrence ; Soft Tissue Neoplasms ; Thoracic Wall* ; Thorax*

There are many complications related to paralyzed patients. Heterotopic ossification in pressure sore patients is reported to be rarely developed, but once it occurs, it frequently causes joint stiffness which may aggrevate the pressure sore wound. This paper was based on a clinical study of heterotrophic ossification in 6 quadriplegic and paraplegic patients from 1988 to 1997 at St. Paul's Hospital. All were males aged between 22 and 58 years (mean age, 45.5 years). The sites of pressure sore were in the ischial and trochanteric areas. Heterotopic ossification had developed around the hip joint and the ischial area. The mean onset time was 3.6 years (minimum 10 months maximum 8 years) after trauma. Plain X-ray, bone scan CT and pathological examination were helpful in confirming the diagnosis of heterotopic ossification. The mechanism of heterotopic ossification is not exactly known, but chronic trauma or inflammation could be one etiology. There are still many difficulties in management of heterotopic ossification, but prevention is the most important treatment.
Diagnosis ; Femur ; Hip Joint ; Humans ; Inflammation ; Joints ; Male ; Ossification, Heterotopic* ; Pressure Ulcer* ; Wounds and Injuries

The purpose of this study was to investigate the functional recovery of end-to-side neurorrhaphy in rats. There have been several studies about the results of end-to-side neurorrhaphy from a histologic or eletrophysiologic view point. However, histologic or electrophysiologic parameters may not correlate with the actual nerve function. In this study we assessed the results of end-to-side neurorrhaphy functionally using walking track analysis. Forty-eight male Sprague-Dawley rats were randomly divided into 4 group, with 12 rats in each group. Group 1 was the sham-operation group. Group 2 was the peroneal nerve transection group. In group 3, the peroneal nerve was severed and end-to-end neurorrhaphy was carried out. In group 4, the peroneal nerve was severed and coapted end-to-side to the lateral face of the tibial nerve after removal of the epineurium arid perineurium. Walking track analysis was done every 2 weeks up to 16 weeks. Group 3 recovered 80.4% in peroneal function at postoperative 16 weeks, whereas group 4 recovered only 46.0%. In group 2, it was impossible to measure the peroneal function by walking track analysis because of plantar flexion contracture after 6 weeks. We concluded that the end-to-side neurorrhaphy group showed better results compared with the nerve transection group. However, the end-to-end neurorrhaphy group showed still better results in the walking track analysis of rats.
Animals ; Contracture ; Humans ; Male ; Peripheral Nerves ; Peroneal Nerve ; Rats* ; Rats, Sprague-Dawley ; Tibial Nerve ; Walking*

Basal cell carcinoma is the most common skin cancer, especially on the eyelid and nose. As it rarely invades to a underlying bone or metastasizes an distant site, and is usually found at an early stage, it is regarded as a curative disease. However, basal cell carcinoma on the eyelid and nose may be resected incompletely due to efforts to preserve important structures or as a result of esthetic considerations. We experienced two cases of basal cell carcinoma with local invasion to underlying bone. One was a recurred case on the nasal area extending to the nasal bone arts medial wall of the ethmoid sinus. The lesion was widely resected and covered with a radial forearm free flap. The other was on the eyelid extending to the orbit. It was treated with orbital exenteration and resection of the involved eyelid. The defect was reconstructed with the temporalis muscle flap with split-thickness skin graft. These patients were followed up for 7 months with no evidence of recurrence. Since basal cell carcinoma can invade to the bone and metastasize to a distance site, it should be resected radically in the regions of the eyelid and nose.
Carcinoma, Basal Cell* ; Ethmoid Sinus ; Eyelids ; Forearm ; Free Tissue Flaps ; Humans ; Nasal Bone ; Nose ; Orbit ; Recurrence ; Skin ; Skin Neoplasms ; Transplants

Benign odontogenic neoplasms are rare, but malignant odontogenic neoplasms are extremely rare. The majority of malignant epithelial neoplasms occurring in the jaws are the result of metastasis from distant primary neoplasms of direct invasion from contiguous carcinoma of the oral mucosa, sinus mucosa, salivary gland or skin. A few remaining primary intraosseous carcinoma of the jaw are presumed to be of mostly odontogenic origin since epithelial remnants of odontogenesis are numerous in the maxilla arts mandible. Although calcifying odontogenic cyst(COC) is a well-established pathologic entity, it has been recognized that there is an odontogenic neoplasm with histologic features similar to the COC(malignant epithelial odontogenic host cell tumor; EOGCT) that has been diagnosed as COC. Some authors have reported previously in the literature describing malignant EOGCT. We experienced one case of malignant EOGCT with aggressive growth pattern and histologic features strongly implying its malignant potential. The lesion was excised by anterior mandibular resection, total 1 resection of the tongue and bilateral functional neck dissection. The tongue was reconstructed by using the infrahyoid muscle neurovascular island flap and neurovascular radial forearm free flap. The mandible was reconstructed by using the osteocutaneous fibular free flap.
Carcinoma ; Forearm ; Free Tissue Flaps ; Jaw ; Mandible* ; Maxilla ; Mouth Mucosa ; Mucous Membrane ; Neck Dissection ; Neoplasm Metastasis ; Odontogenesis ; Salivary Glands ; Skin ; Tongue*

Leiomyosarcoma is a malignant tumor showing smooth muscle differentiation, and it accounts for 2% to 8% of soft tissue sarcoma. Clinically, substantial mortality and morbidity are related to the propensity for distant metastasis and local recurrence, respectively. Microscopic findings characteristically reveal intersecting bundles of spindle-shaped cells having fibrillar cytoplasm and blunt-ended nuclei. Immunohistochemistry for intermediate filaments is helpful in establishing a definitive diagnosis. We experienced a case of large protruding leiomyosarcoma that developed on an old burn scar of the medial calf of a 45-year-old man. On preoperative evaluation, we recommended amputation due to a distant metastasis to the lung(stage IV). As the patient refused amputation of his lower leg, the tumor was radically excised and immediate reconstruction was done using free latissimus dorsi muscle flap and skin graft. Four months after excision despite adjuvant chemotherapy, amputation was performed due to local recurrence.
Amputation ; Burns ; Chemotherapy, Adjuvant ; Cicatrix ; Cytoplasm ; Diagnosis ; Humans ; Immunohistochemistry ; Intermediate Filaments ; Leg ; Leiomyosarcoma* ; Middle Aged ; Mortality ; Muscle, Smooth ; Neoplasm Metastasis ; Recurrence ; Sarcoma ; Skin ; Superficial Back Muscles ; Transplants ; Ulcer*

Minimal cleft lip has been defined as a cleft which does not extend over the vermilion. Minimal cleft lip has no specific classification and few methods for its correction. Based on our operative experience with secondary cleft lipnose deformities, we have developed principles of operation for minimal cleft lip: minimal incision, nostril and alar reconstruction, philtrum reconstruction. alignment of cupid's bow, and vermilial notching correction. Nine patients of minimal cleft lip were operated on from March 1992 to June 1998 in our department. Each partients was evaluated for lip and nose deformities presurgically: the nasal tip, columella, ala, scar, cupid's bow, lip pout and lip length. Every patients required a different technique for repair. Satisfactory results were obtained by treating the cleft following the principles.
Cicatrix ; Classification ; Cleft Lip* ; Congenital Abnormalities ; Humans ; Lip ; Nose

Surgical excision of the subcutaneous tissues, with or without skin excision in the axillary hair-bearing area, has been the treatment of choice for Treating axillary a osmidrosis for the several decades. However, long periods of postoperative immobilization of a shoulder joint, partial necrosis of skin flaps or hematoma and the possibility of unsightly scars are frequent complications. For the purpose of reducing these complications, we performed ultrasonic aspiration of subcutaneous fat of the axilla, including the apocrine gland, using ultrasonic liposuction technique under confirmation of endoscopy via one small skin incision. From November 1997 to December 1998, a total of 134 patients (93 women and 41 men) received surgery for bilateral axillary osmidrosis on an outpatient basis. Sixty patients were evaluated more than 6 months after surgery. Among these patients, 6patients complained of a persistent foul odor(10%). Five patients received secondary ultrasonic aspiration for persistent foul odor and were then cured. We concluded that our method has several advantages such as 1) preservation of skin flap vascularity for the prevention of flap necrosis and axillary hair, 2) minimal scarring and bleeding, 3) shorter operation time and postoperative immobilization of the shoulder joint, 4) increased patient comfort, and 5) a safer operative method for recurred cases as a secondary method.
Apocrine Glands ; Axilla ; Cicatrix ; Endoscopy ; Female ; Hair ; Hematoma ; Hemorrhage ; Humans ; Immobilization ; Lipectomy ; Necrosis ; Odors ; Outpatients ; Shoulder Joint ; Skin ; Subcutaneous Fat ; Subcutaneous Tissue ; Ultrasonics*