After total glossectomy, recovery of swallowing and speech function can greatly improve quality of life. The reconstructed tongue must be thick enough to contact with the hard palate for articulation. If the free flap is denervation, it may procede to have atrophy postoperatively. Therefor it is difficult to maintain the tongue volume for a long period of time. To resolve this problem, we have used a innervated rectus abdominis musculocutaneous flap and maintaining the volume through a neurorrhaphy. 7 patients underwent immediate reconstruction using a reinnervated rectus abdominis musculocutaneous free flap in which included intercostal nerve was anastomosed to the remaining hypoglossal nerve. The reinnervated rectus abdominis musculocutaneous free flap has provided good tongue contour with sufficient bulk and shown no obvious atrophy in all patients even though postoperative 9 months later. Considering swallowing and articulation, we concluded that reinnervated rectus abdominis musculocutaneous flap is a viable method after total glossectomy.
Atrophy ; Deglutition ; Denervation ; Free Tissue Flaps ; Glossectomy ; Humans ; Hypoglossal Nerve ; Intercostal Nerves ; Myocutaneous Flap* ; Palate, Hard ; Quality of Life ; Rectus Abdominis* ; Tongue*

PURPOSE: Rupture of a collateral ligament of the metacarpophalangeal joint is rare except in the thumb. The injured digit became flexed and deviated toward ulna side by the hypothenar intrinsic musculature. Incomplete rupture of a collateral ligament of the metacarpophalangeal joint can be often managed by splinting the affected digit in flexion position, however, in the case of complete tears that distraction of the ends of the ruptured collateral ligament is too great to allow repositioning by splinting. Primary repair of the ruptured collateral ligament or reattachment to bone by a pull-out wire, or tendon graft technique appears to be adequate. METHODS: We report a case of instability of fifth metacarpophalangeal joint due to complete rupture of radial collateral ligament. This 18-year-old male presented pain in his right outstretched hand after trauma. The diagnosis was obtained by physical examination and simple radiography. Because of persistent instability after the initial conservative treatment, open reduction and repair surgical treatment was required. RESULTS: The fifth metacarpophalangeal joint became free of pain and stable under forced lateral deviation. Postoperative results showed good metacarpophalangeal joint function and stability during 8 months follow-up period. CONCLUSION: Because of the interposition of the sagittal band between the ruptured ends of radial collateral ligament such as Stener-like lesion of the thumb, surgical repair of metacarpophalangeal joint collateral ligament of the finger was justified in case of complete laxity in full flexion.
Adolescent ; Collateral Ligaments* ; Diagnosis ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Male ; Metacarpophalangeal Joint* ; Physical Examination ; Radiography ; Rupture* ; Splints ; Tendons ; Thumb ; Transplants ; Ulna

PURPOSE: Prior to closure of the epiphysis of the distal phalanx, fracture usually occurs through the growth plate, Salter-Harris type I or II, or through the juxtaepiphyseal region 1 to 2 mm distal to the growth plate. The terminal tendon of extensor inserts into the epiphysis only, while insertion site of the flexor digitorum profundus spans both the epiphysis and metaphysis. Because of the difference between these tendon insertions, this injury mimics a mallet deformity. But, this type of injury does not involve a tear or avulsion of the extensor, unlike mallet finger of adults. Seymour was the first to describe this type of injury in children and called after his name, Seymour's fracture. This fracture is prone to infection or remain the residual deformity unless adequate treatment. METHODS: We report a case of Seymour's fracture. A 9-year-old boy presented a laceration of the nail matrix, with the nail lies degloved from the nail fold on the right middle finger gotten from an impact against a door. An X-ray examination showed the fracture line lying 1 mm distal to the growth plate. The injury was treated with debridement and the fracture was reduced by applying hyperextension force. Under the C-arm, a single 0.7 mm K-wire was used to immobilize the distal interphalangeal joint. Intravenous antibiotics were applied for 5 days after surgery. RESULTS: The K-wire was removed in the 3rd week. No infection or significant deformity was found until follow-up of 12 months. CONCLUSION: Seymour's fracture may be at first classically mallet deformity by its appearance. But it is anatomically different and more problematic injury. If it isn't corrected at the time of injury, derangement of the extensor mechanism, and growth deformity of the distal phalanx may occur. The fracture site should be debrided, removed of any interposed soft tissue, and the patient should be given appropriate antibiotics. Reduction should be maintained by K-wire fixation. We experienced no infection or premature epiphyseal closure.
Adult ; Anti-Bacterial Agents ; Child* ; Congenital Abnormalities ; Debridement ; Deception ; Epiphyses ; Fingers ; Follow-Up Studies ; Growth Plate ; Humans ; Joints ; Lacerations ; Male ; Tendons

PURPOSE: Various types of flaps, with their own advantages and disadvantages, have been described for reconstruction of soft tissue defect with exposure of tendons, bones, or joints in the hand or foot. Local flaps with random vascularity have a limitation by their length. Free flaps are time-consuming procedure that may require the sacrifice of some major vessels. The ideal flap for covering soft tissue defects of the hand or foot must provide subcutaneous tissue that tendons can glide through which, supply enough subcutaneous tissue for cover of vital neural, bony, vascular and joint structures, and it has to be aesthetically pleasing. The adipofascial flap fulfills these criteria. It allows immediate or early closure of difficult wound of hand and foot in an easy way, and is especially indicated for small to medium-sized defects. METHODS: From October 2005 to December 2006, seven cases underwent this procedure to reconstruct soft tissue defect on hand or foot. RESULTS: All flaps survived completely, and no complications were observed. CONCLUSION: The adipofascial flap is a convenient flap for coverage of soft tissue with exposure of vital structure in the hand or foot, and provide several advantages, as following; easy and safe, short operating time, one stage procedure, thinness and good pliability of the flap, preservation of the major vascular pedicles, skin preservation at the donor site, thus preserve the shape of the limb and minimize donor site scar.
Cicatrix ; Extremities ; Foot* ; Free Tissue Flaps ; Hand* ; Humans ; Joints ; Pliability ; Skin ; Subcutaneous Tissue ; Tendons ; Thinness ; Tissue Donors ; Wounds and Injuries

PURPOSE: Schwannoma, a benign peripheral nerve tumor, is slow-growing, encapsulated neoplasm that originates from the Schwann cell of the nerve sheath. Schwannoma most frequently involves the major nerve. Schwannoma occurring in the superficial radial nerve rare. This is a report of our experience with schwannoma arising from the superficial radial nerve with neurologic symptom. METHODS: A 55-year-old woman presented with eight-month history of progressive numbness and paresthesia in dorsum of the thumb and index finger. Physical examination revealed a localized mass on the midforearm. Sonographic examination showed an ovoid, heterogenous, hypoechoic lesion, located eccentrically in related to the superficial radial nerve. The lesion was mobile in the transverse but not in the longitudinal axis of the nerve, which was thought to favour schwannoma rather than neurofibroma. At operation, a 20 x 15 mm ovoid, yellowish grey mass was seen arising from the superficial radial nerve. The tumor present as eccentric masses over which the nerve fibers are splayed. Using operating microscope, the tumor was removed, preserving the surrounding nerve. RESULTS: Histology confirmed that the mass was a benign schwannoma. There were no postoperative complications. After two months the patient had no clinically demonstrable sensory deficit. CONCLUSION: An unsusual case of a schwannoma of the superficial radial nerve is presented. In case with neurologic symptom, prompt surgical decompression must be made to prevent further nerve damage and to restore nerve function early.
Axis, Cervical Vertebra ; Decompression, Surgical ; Female ; Fingers ; Humans ; Hypesthesia ; Middle Aged ; Nerve Fibers ; Neurilemmoma ; Neurofibroma ; Neurologic Manifestations ; Paresthesia ; Peripheral Nervous System Neoplasms ; Physical Examination ; Postoperative Complications ; Radial Nerve ; Thumb

Craniosynostosis is the term that designates premature fusion of one or more structures in either crania1 vault or cranial base. Various surgical methods including frontal bone advancement and crania1 vault remodeling have been developed in order to correct craniosynostosis. Nowadays, distraction osteogenesis technique has been successfully used by many plastic surgeons. We have experienced several patients with craniosynostosis who had surgical correction using distraction device. All patients obtained satisfactory results and no relapses were observed during the follow-up period. However, previous approaches have required bicoronal incisions and extensive scalp mobilization for adequate exposure. The specific technique of using the endoscope in assisting and perfoming osteotomies and inserting distraction devices made less blood loss, less blood transfused, less operative time, shorter length of stay, overall less expenses, and less visible scars. In conclusion, the endoscopic technique for early correction of craniosynostosis is safe and can be used for correction of other various deformities of craniosynostosis. Because of the minimal invasive technique, the patients with craniosynostosis can be treated at a very early age.
Cicatrix ; Congenital Abnormalities ; Craniosynostoses* ; Endoscopes ; Follow-Up Studies ; Frontal Bone ; Humans ; Length of Stay ; Operative Time ; Osteogenesis, Distraction* ; Osteotomy ; Recurrence ; Scalp ; Skull Base

PURPOSE: Pincer nail is a relatively rare deformity characterized by an increase in transverse curvature along the longitudinal axis of the nail. This curvature commonly increases from proximal to distal end of nail, leading to pinching, curling, and distortion of the underlying soft tissue and resulting frequently in severe pain. Numerous surgical procedures have been reported. Preserving the width of the nail in the correction of the pincer nail is very important for functional and aesthetic reasons. We report the results of the correction of the pincer nail using autogenous dermofat graft with a good result. METHODS: From May 2006 to September 2008, dermofat graft was performed in 6 patients with pincer nail. Patients were four women and two men, and the average age was 51. The affected digits were the unilateral great toes in four patients and the unilateral thumbs in two patients. Average follow-up period was 13 months. Surgical procedure was removal of nail using an elevator to avoid damage to the nail bed. An incision was created in distal portion of hyponychium. Paronychium was dissected from distal phalanx by periosteal elevator through incision of hyponychium and tunnel was made. Then dermofat grafts harvested from inguinal area were inserted into the tunnel. Finally, a silicone sheet was inserted eponychial fold for prevention of synechia. Objective assessment was evaluated by use of the width index and height index. RESULTS: All patients reported resolution of the pain and soft tissue pinching sensation that they had before the operation. There was good adherence between the nail plate and the underlying nail bed. The nails have regrown and were corrected in a normal and flattened appearance. The width index and height index were improved. CONCLUSION: The autogenous dermofat graft seems to provide an effective treatment of the pincer nail with preservation of the nail matrix.
Axis, Cervical Vertebra ; Congenital Abnormalities ; Elevators and Escalators ; Female ; Follow-Up Studies ; Humans ; Male ; Nails ; Sensation ; Silicones ; Thumb ; Toes ; Transplants

The goals of reconstruction of orbital blowout fracture are to restore continuity, to provide support of orbital contents and to prevent functional and anatomic defects. Various materials such as autogenous and alloplastic implants have been used to reconstruct the defect of orbital wall fracture. Autogenous implants such as bone and cartilage have the advantages of excellent biocompatibility and low rates of infection. On the other hand, they have the disadvantage of donor site morbidity. Alloplastic implants have potential risk of tissue inflammation and migration within orbit or anterior to the skin although they are easy to use without any disadvantages of donor site morbidity. To cover these disadvantages of various materials, we used the resorbable materials in mesh form(Biosorb FX(R)) in orbital wall reconstruction. Seventeen patients with blowout fracture defect were operated with 0.8mm thickness resorbable material in mesh form and fourteen of them were followed-up (Minimum, 9 months; maximum, 30 months). The results were satisfactory in most cases. Some of them showed minor problems for a short time; One patient had persistent 2mm enophthalmos, but no further surgical correction was required. Transient diplopia in four patients disappeared in two weeks. Lower eyelid swelling in two patients lasted for more than two weeks, but no inflammation, migration or extrusion of implants were observed. Resorbable materials allow initial sufficient stability and are gradually resorbed through the physiologic process. So no permanent implants that might affect facial growth, create interference with radiologic imaging, or be susceptible to infection and extrusion remain. Resorbable mesh plates we used are made of copolymers of Dextro(D)-polylactic acid and Levo(L)-polylactic in 30: 70 ratio. They were well tolerated by tissue, giving adequate support to healing of bone defect. During the follow-up period(mean 14 months), no significant problems were observed.
Cartilage ; Diplopia ; Enophthalmos ; Eyelids ; Follow-Up Studies ; Hand ; Humans ; Inflammation ; Orbit* ; Polymers* ; Skin ; Tissue Donors

PURPOSE: Several authors reported about the post- traumatic nasal aesthetic complications. However, the studies for functional or intra-nasal complications have been rarely reported. The aim of this study is to observe the incidence of intranasal synechia. METHODS: We reviewed the data from 401 consecutive patients with nasal bone fracture from september 2006 to December 2007. We enforced evaluation with preoperative CT in all patients but postoperative CT within complicated patients. We classified the nasal bone fracture according to the anatomy and severity of fracture. Type I is nasal tip fracture(15%, n=59), Type II is simple lateral without septal injury(38%, n=152), Type III is simple lateral with septal injury(23%, n=92), Type IV is closed comminuted(20%, n=82), Type V is open comminuted or complicated(4%, n=16). We studied 98 patients with nasal bone fracture who had postoperative symptoms or underwent postoperative endoscopic evaluation. And then we evaluated the postoperative endoscopic finding and nasal synechal formation after operation. RESULTS: The incidence of intranasal synechiae was 15%(n=62). According to the endoscopic findings, the incidence of intranasal synechiae was 10%(n=6) in Type I, 8%(n=12) in Type II, 16%(n=15) in Type III, 24%(n= 20) in Type IV, and 56%(n=9) in Type V, respectively. Additionally, the incidence of subjective nasal obstruction and olfactory dysfunction is 18%(n=72) and 13%(n= 51), while the incidence of symptomatic synechiae of nasal obstruction and olfactory dysfunction is 92%(57/ 62) and 55%(34/62). CONCLUSION: We identified relatively high prevalence of nasal obstruction and olfactory dysfunction in nasal synechiae. Based on the results of this study, intranasal synechiae really caused airway obstruction(92%). Our data showed significant relationship between intranasal synechiae and severity of the fracture, because of increasing mucosal handling and destructive closed reductional procedures. First of all, education of delicate procedure regarding this subject should be empathized accordingly.
Handling (Psychology) ; Humans ; Incidence ; Nasal Bone ; Nasal Obstruction ; Prevalence

PURPOSE: Despite a high frequency of acquired nail disease, congenital absence of the nail, also called as anonychia, is a rare anomaly. It may be seen as an isolated of phalangeal bone(ectrodactyly), nail-patella syndrome, birth trauma, impaired peripheral circulation, alopecia areata, and pemphigus, idiopathic atrophy of the nail, bullous drug eruptions, periodic shedding, lichen planus, Stenvens-Johnson syndrome and so forth. METHODS: We have experienced a rare case of 40-day-old neonate, suffering from intrauterine growth retardation, but without familial history, chromosomal anomalies or any other diseases. RESULTS: There was no nail on left 5th finger and distal phalangeal bone of same finger. So, We diagnosed as Congenital Anonychia with ectrodactyly of 5th Finger. CONCLUSION: We report this case as congenital anonychia of 5th finger which have developed from underlying distal phalangeal ectrodactyly. We also review other reported cased in the literatures.
Alopecia Areata ; Atrophy ; Drug Eruptions ; Fetal Growth Retardation ; Fingers* ; Humans ; Infant, Newborn ; Lichen Planus ; Nail Diseases ; Nail-Patella Syndrome ; Parturition ; Pemphigus