No abstract available.
Adolescent* ; Humans ; Liposarcoma* ; Neck*

Proper suturing technique is essential for obtaining good cosmetic results and for preventing scarring and poor healing of the wound. Characteristics of an ideal wound closure technique include: providing maximal wound eversion; maintaining tensile strength throughout the healing process; being technically simple and fast for the surgeon to perform; and allowing for precise wound edge approximation without leaving suture marks. There are a large variety of suturing methods available to the plastic surgeon and more than one of these techniques may be appropriate for any single wound closure. The simple interrupted suture is the simplest and most frequently employed type of suture. The vertical mattress suture is used principally to ensure eversion of skin edges, but is rarely indicated on the face. A common technique for wound closure is to alternate a vertical mattress suture with a simple interrupted suture along the length of the wound. This report outlines a new method for closing skin wounds which combines the horizontal and vertical mattress sutures. This horizonto- vertical mattress suture is easy and quick to perform, achieves precise wound approximation, provides good eversion of skin edges maintaining uniform tensile strength, reduces the risk of suture marks and gives good cosmetic results, and it can be widely applicable to the whole body area wound, including the face.
Cicatrix ; Skin ; Sutures* ; Tensile Strength ; Wound Closure Techniques ; Wounds and Injuries

Alveolar cleft is a tornado-shaped bone defect in the maxillary arch. The treatment goals for alveolar cleft are stabilization and provision of bone continuity to the maxillary arch, permitting support for tooth eruption, eliminating oronasal fistulas, providing an improved esthetic result, and improving speech. Treatment protocols vary in terms of the operative time, surgical techniques, and graft materials. Early approaches including boneless bone grafting (gingivoperiosteoplasty) and primary bone graft fell into disfavor because they impaired facial growth, and they remain controversial. Secondary bone graft (SBG) is not the most perfect method, but long-term follow-up has shown that the graft is absorbed to a lesser extent, does not impede facial growth, and supports other teeth. Accordingly, SBG in the mixed dentition phase (6–11 years) has become the preferred method of treatment. The most commonly used graft material is cancellous bone from the iliac crest. Recently, many researchers have investigated the use of allogeneic bone, artificial bone, and recombinant human bone morphogenetic protein, along with growth factors because of their ability to decrease donor-site morbidity. Further investigations of bone substitutes and additives will continue to be needed to increase their effectiveness and to reduce complications.
Alveolar Bone Grafting ; Bone Morphogenetic Proteins ; Bone Substitutes ; Bone Transplantation ; Clinical Protocols ; Dentition, Mixed ; Fistula ; Follow-Up Studies ; Humans ; Intercellular Signaling Peptides and Proteins ; Methods* ; Operative Time ; Tooth ; Tooth Eruption ; Transplants

It remains a problem that successful revascularization and reperfusion after ischemia are associated with high systemic complication rates and severe local tissue injuries. With prolonged ischemia, there is damage to tissue from anoxia, but further injury may occur after reperfusion. The activation of leukocytes and endothelial cells during reperfusion causes neutrophil adhesion in capillaries, resulting in plugging and further ischemia, Alternativety, neutrophil adhesion to endothelium leads to the migration of neutrophil with local edema formation, hemorrhage and thrombosis. Some chemotactic and activating factors are needed to propel neutrophils to the site of local inflammation. The chief cytikines that induce a pro-adhesive state in endothelium are tumor necrosis factor-alpha(TNF-alpha), interleukin-1 beta(IL-1 beta) and endotoxin or lipopolysaccharide(LPS). Similarly, TNF-alpha,and to a lesser extent interleukin-8(IL-8), is the important stimulus that acts on neutrophils and other leukocytes to alter their adhesion. The purpose of this study was to evaluate the pathogenetic role of IL-8 after perfusion with CDl8 monoclonal antibody(CDl8 mAb), the blocking antibody of neutrophil adherence, on reperfusion injury in rat epigastric island skin flap. A 6 X 3 cm-sized island skin flap was made on the abdomen. The epigastric pedicle was occluded for six hours with ambient temperature. Fifteen minutes before reperfusion, the flap was perfused with saline and CDl8 mAb(1 mg/kg). For evaluation of IL-8 levels, tissue fluid and serum were obtained at 4, 8, 12 and 24 hours after reperfusion. IL-8 concentrations of the CDl8 mAb group in the tissue fluid were significantly decreased at 8, 12 and 24 hours compared to the control group(P > 0.01), but the difference between the two groups was not significant at 4 hours after reperfusion IL-8 concentrations of the CDl8 mAb group in the serum were significantly decreased over time compared to the control group(P > 0.05, p > 0.01). Form the above results, we concluded that blocking neutrophil adherence using CD18 mAb within the peak level of IL-8 at 4 hours after reperfusion may be a better method of reducing reperfusion injury to the island skin flap.
Abdomen ; Animals ; Anoxia ; Capillaries ; Edema ; Endothelial Cells ; Endothelium ; Hemorrhage ; Inflammation ; Interleukin-1 ; Interleukin-8* ; Ischemia ; Leukocytes ; Necrosis ; Neutrophils ; Perfusion ; Rats ; Reperfusion Injury* ; Reperfusion* ; Skin ; Thrombosis

BACKGROUND: Silicone implants are frequently used in augmentation rhinoplasty in Asians. A common complication of silicone augmentation rhinoplasty is capsular contracture. This is similar to the capsular contracture after augmentation mammoplasty, but a classification for secondary contracture after augmentation rhinoplasty with silicone implants has not yet been established, and treatment algorithms by grade or severity have yet to be developed. METHODS: Photographs of 695 patients who underwent augmentation rhinoplasty with a silicone implant from May 2001 to May 2015 were analyzed. The mean observation period was 11.4 months. Of the patients, 81 were male and 614 were female, with a mean age of 35.9 years. Grades were assigned according to postoperative appearance. Grade I was a natural appearance, as if an implant had not been inserted. Grade II was an unnatural lateral margin of the implant. Clearly identifiable implant deviation was classified as grade III, and short nose deformation was grade IV. RESULTS: Grade I outcomes were found in 498 patients (71.7%), grade II outcomes in 101 (14.5%), grade III outcomes in 75 (10.8%), and grade IV outcomes in 21 patients (3.0%). Revision surgery was indicated for the 13.8% of all patients who had grade III or IV outcomes. CONCLUSIONS: It is important to clinically classify the deformations due to secondary contracture after surgery and to establish treatment algorithms to improve scientific communication among rhinoplasty surgeons. In this study, we suggest guidelines for the clinical classification of secondary capsular contracture after augmentation rhinoplasty, and also propose a treatment algorithm.
Asian Continental Ancestry Group ; Classification* ; Contracture ; Female ; Humans ; Implant Capsular Contracture ; Male ; Mammaplasty ; Nose* ; Prostheses and Implants ; Rhinoplasty ; Silicon* ; Silicones* ; Surgeons

PURPOSE: Holoprosencephaly(HPE) is a rare developmental defect due to incomplete cleavages of the prosencephalon during the third week of fetal development. Chromosomal anomalies, genetic syndrome, teratogen, or genetic disorder of non-syndromic HPE are usually accepted as etiology. The consequences of prechordal mesoderm defect are varying degrees of deficit of midline facial development, especially the median nasal process(premaxilla), and incomplete morphogenesis of the forebrain. We experienced a case of lobar HPE with complete cleft lip and palate. METHODS: A female newborn infant was born at 38+6 weeks' gestational age via NSVD. The infant's birth weight was 3.6kg, height 52cm, and head circumference 32.5cm, showing microcephaly, flat nose, median complete cleft lip & palate, and hypotelorism, along with defects of midfacial development including losses of premaxilla, philtrum, nasal septum, and columella. RESULTS: There were no specific findings noted from the head and neck X-ray and tests for endocrine and metabolic disorders, but clinical characteristics of midface and dysgenesis corpus callosum on brain MRI were seen, so that this case was diagnosed with HPE. CONCLUSION: HPE is divided into three categories of alobar, semilobar, and lobar prosencephaly according to the degree of cerebral hemisphere separation. Assesment of patient's brain abnormality and malformation is essential in determining the extent and benefit of surgical intervention. This case was included in the lobar type HPE which shows relatively good prognosis compared with other types and reconstruction of median complete cleft lip & palate and midfacial defects will be performed.
Birth Weight ; Brain ; Cerebrum ; Cleft Lip ; Corpus Callosum ; Equidae ; Female ; Fetal Development ; Gestational Age ; Head ; Holoprosencephaly* ; Humans ; Infant, Newborn ; Lip ; Magnetic Resonance Imaging ; Mesoderm ; Microcephaly ; Morphogenesis ; Nasal Septum ; Neck ; Nose ; Palate ; Prognosis ; Prosencephalon

Diabetes is accompanied by delayed wound healing and insufficient granulation tissue formation, possibly because of a defect in fibroblast function. Maintaining glucose level at acceptable low level is considered to be an important part of the clinical treatment of diabetes, but the exact mechanism by which diabetes delays wound repair is not yet known. This study was designed to evaluate the effects of glucose on proliferation([3H]-thymidine uptake) and collagen synthesis([3H]-proline uptake) in dermal fibroblasts from non-lesional skins and chronic wounds. The subjects were divided into 3 groups: non-diabetic control(n = 5), glucose controlled(glycated Hb < 7%) diabetics(n = 5), and glucose uncontrolled(glycosylated Hb > 8%) diabetics(n = 5). The fibroblasts were cultured in two conditions, low glucose(5 mM) and high glucose(20 mM) medium. The data were compared using Mann-Whitney test. The results are as follows: 1. There were no significant differences in the proliferation and collagen synthesis of non-lesional skin fibroblasts in all groups. 2. In high glucose medium culture, the proliferation of the fibroblasts from the wound of the glucose uncontrolled diabetic group was significantly lower than those of the other 2 groups(p< 0.05), and the collagen synthesis of the wound fibroblasts of the control group was significantly higher than those of 2 diabetic groups(p< 0.05). 3. The proliferation and collagen synthesis of the wound fibroblasts in all groups were significantly lower than those of the non-lesional skin fibroblasts(p< 0.05). 4. In the control group and the glucose controlled diabetic group, the proliferation of the wound fibroblasts in the high glucose culture media were lower than those in the low glucose culture media(p< 0.05). Also, in the glucose controlled diabetic group, the collagen synthesis of the wound fibroblasts in the high glucose culture medium was lower than that in the low glucose culture medium(p< 0.05). These results demonstrate that the glucose level may affect the proliferation and collagen synthesis of fibroblasts, and the strict blood glucose control is beneficial to the prevention and treatment of diabetic chronic wounds.
Blood Glucose ; Collagen* ; Culture Media ; DNA* ; Fibroblasts* ; Glucose* ; Granulation Tissue ; Skin ; Wound Healing ; Wounds and Injuries*

Hyper-activated depressor septi nasi is an important factor caused a nasal tip drooping and many studies have been carried out, however it still remains controversial. This study presents a surgical modality for its intervention, based on the anatomical study. Eleven fixed and six fresh cadavers were used for the study. We found that the depressor septi nasi was consisted of three fascicles. Medial fascicles were inserted into the dermocartilaginous ligament, and deep fibers of the medial fascicles were attached to the anterior nasal spine. After superficial fibers were interdigitated with the orbicularis oris, they were attached to the alveolar bone. Intermedial fascicles were inserted to the footplates of the medial cruses and the caudal septum. After they were interdigitated with the medial fascicle and the orbicularis oris, they were attached to the alveolar bone. From April to August 2008, five patients had surgical intervention for hyper-activated depressor septi nasi. Medial and intermedial fascicles were detached completely from the anterior nasal spine and the septum through intranasal approach. Tip droopings were improved in all cases. Specific complications were not found. We believe that surgical intervention through intranasal approach is a useful method for correction of tip drooping.

Cartilage extension and nasal envelop expansion play a main role incorrecting short or contracted nose. Despite numerous studies for cartilage expansion, there has been no reports of nasal skin elongation methods. We hereby preport a new method for expansion of nasal envelop with a comprehensive understanding of anatomical structures. From April 2009 to September 2010, 6 patients underwent operations to correct short or contracted nose. Two separating procedures were included for nasal envelop elongation; division of muscle(Procerus, Transverse nasali, Levator labii superior alaque nasi: PTL muscles) confluence located at nasal hinge and release of transverse nasalis sling. To estimate the degree of nasal envelop extension, forced skin traction test was performed. Comprehensive research with fresh cadaver was held to study the relationship between nasal SMAS and surrounding structures. Average 3.8mm elongation was documented by forced skin traction testafter the procedure. In the fresh cadaver study, transverse nasalis sling and PTL muscle confluence were firmly attached to the supportive framework. From our clinical experience and cadaver study, we discovered that release of transverse nasalis sling and division of PTL muscle confluence are the main factors for nasal envelop expansion in short or contracted nose.
Cadaver ; Cartilage ; Congenital Abnormalities ; Contracts ; Humans ; Muscles ; Nose ; Nose Deformities, Acquired ; Rhinoplasty ; Skin ; Traction

Nasal osteotomy for aesthetic results is required in patients who have broad nasal bone. Since the procedure is difficult, many operators hesitate the surgery. From January 2007 to July 2009, we performed 77 cases of nasal osteotomy, consisting of paramedian oblique medial osteotomy or median oblique-medial osteotomy and percutaneous lateral osteotomy. Most of the patients had satisfying results, however three patients had asymmetric shape and inappropriate inward movement of nasal bone which required revision with percutaneous lateral osteotomy. Osteotomy procedure varies, depending on surgeon's preference and experience, however, each surgeon should be aware of good and weak points of those procedures and use the most suitable method. In order to achieve maximal satisfying results, preoperative analysis of patients and minimal invasive handling should be done. Based on these efforts, this method could broadly be used in the aesthetic field.
Handling (Psychology) ; Humans ; Nasal Bone ; Nose ; Osteotomy ; Rhinoplasty