The widely prevailing Millard's rotation-advancement flap method is characterizes with the upper lip scar on a philtral column and that it is less conspicuous than LeMesurier's or Tennison's metheds. Nowadays, straight line closure methods are employed together with the Millard's. However there are still some problems which are a straight line closure that goes against the principle of plastic surgery, a noticeable scar, tenting of the peak of Cupid's bow, a short lip tendency, and depression of the lip when the muscle contracts. In this respect, we designed two or three small trapezoid skin flaps on the cleft side and the same number of releasing incision lines on the non-cleft side and then let them interdigitate one another. We called it dovetail cheiloplasty. The muscle work was done by suturing one third of the cleft side muscle to the dissected dermis of the non-cleft side skin flap just under the philtral dimple. Our patients had a primary incomplete, a microform type cleft lip or a secondary cleft lip deformity. The result of employing this method showed an inconspicuous scar, a shorter lip, and a natural formation of the philtrum. We believe this method induces the improvement of straight line closure with respect to the quality of scars and the morphology of an upper lip.
Cicatrix ; Cleft Lip ; Congenital Abnormalities ; Depression ; Dermis ; Humans ; Linear Energy Transfer ; Lip ; Microfilming ; Skin ; Surgery, Plastic

PURPOSE: As a recipient vessel, internal mammary vessels have many advantages for microvascular reconstruction of the breast. But the approach is time consuming and results in large morbidities. However, the perforating branches of the internal mammary vessels can be used to minimize such demerits. The purpose of this cadaver study is to clarify the location and diameter of the perforating branches of internal mammary vessels and to prove that they are safe and reliable recipient vessels. METHODS: We studied 11 formalin-fixed cadavers and dissected their anterior chests bilaterally. The chests were exposed using midline presternal incisions. We dissected and found all perforators at subfascial planes under loupe magnification. The number, external diameter, and the distance from the midline were measured. Result: The mean external diameter of the arterial perforators was 1.32mm and the mean external diameter of the venous perforators was 1.48mm. The largest arterial and venous perforators were most frequently found in the second intercostal space. The mean distance from the midline to the perforator was evaluated; the artery averaged 1.95cm and the vein averaged 2.08cm. CONCLUSION: This study will be helpful when using the internal mammary perforating vessels as a recipient vessel during breast reconstruction.
Arteries ; Breast ; Cadaver ; Glycosaminoglycans ; Mammary Arteries ; Thorax ; Veins

PURPOSE: The oral teratoma is found approximately in live birth at the rate from 1:35,000 to 1:200,000. In a review of literature 16 cases of midline teratoma with cleft palate were reported. We report a case of congenital palatal teratoma with cleft palate in a 1-year-old girl. METHODS: A 1-year-old girl was admitted our institution for the closure of cleft palate. On the intraoperative findings there was 4x1x0.5cm sized hairy soft mass at the midline and complete cleft palate. We did incisional biopsy intraoperatively and its pathology revealed heterotopic brain tissue. The excision of remaining mass and palatoplasty with Sommerlad's method were performed. The final pathology of the mass was mature cystic teratoma. RESULTS: After the operation there were neither recurrence nor oronasal regurgitation. CONCLUSION: We report for one patient with congenital palatal teratoma associated with cleft palate and obtained an excellent result.
Biopsy ; Brain ; Cleft Palate* ; Female ; Humans ; Live Birth ; Pathology ; Recurrence ; Teratoma*

PURPOSE: Recently, the incidence of malignant melanoma has been steadily increasing. Malignant melanoma is already known to have poorer prognosis than other primary skin cancers. Despite the poor prognosis, it is relatively less known to the public so that a number of patients visit hospital carrying advanced stage tumor. Yet, extensive study about malignant melanoma is currently insufficient, and specific guidelines and statistical figures in Korea are almost inexistent. Therefore, authors reviewed patients with malignant melanoma who have visited our hospital for last 14 years. METHODS: Between January 1994 and January 2008, 62 patients were diagnosed with malignant melanoma at our hospital. A retrospective study was performed with data from patients' charts and biopsy results. Annual incidence, mean age of onset, gender, tumor location, tumor thickness, pathologic ulceration, clinicopathologic subtype, and clinical AJCC stage were evaluated. Analysis of factors associated with survival were performed using the Cox proportional hazard model. Kaplan-Meier method was used to generate survival curves. RESULTS: Clinicopathologic features of 62 patients (32 male, 30 female) with average age of 57 years were evaluated. Most lesions were found in lower limb, and the most common subtype was acral lentiginous melanoma. We could also find that age, tumor thickness, and clinical stage were the only significant prognostic factors. CONCLUSION: Clinicopathologic features of malignant melanoma were analyzed in this study, but the result is not ready to be generalized because of the limited number of cases. Further study must be performed to report clinical guidelines for prognosis and treatment for malignant melanoma patients in Korea.
Age of Onset ; Biopsy ; Humans ; Incidence ; Korea ; Lifting ; Lower Extremity ; Male ; Melanoma ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Skin Neoplasms ; Survival Rate ; Ulcer

PURPOSE: Pyoderma gangrenosum is a rare cutaneous ulcerative disease. First described in 1930, the condition is characterized by progressive ulceration with deeply undermined purple-red edge.(1) The lower extremities are most commonly affected but other parts of the skin and mucous membranes may also be involved. Although medical treatments with topical wound therapy are commonly used, surgical intervention is still controversial. In this paper, we report an atypical case of pyoderma gangrenosum which was characterized by extensive soft tissue breakdown. METHODS: A 27-year-old male patient was referred to our institution with a 7 x 8 cm sized deeply undermined ulceration with pus-like discharge and fever. Incision and drainage was performed at another clinic 3 days prior to admission to our institution. After a thorough physical examination and the MRI review, a diagnosis of necrotizing faciitis was made. Accordingly, fasciotomy and debridement was performed. However, the wound enlarged progressively and the patient remained highly febrile for 9 days after the treatment. Septic screening did not reveal any occult infection. After a secondary review of the case, the initial diagnosis of necrotizing fasciitis was rejected and changed to pyoderma gangrenosum. With the use of dexamethasone intravenously, the wound improved dramatically and the fever was eliminated. Steroid mediation was tapered with duration of 1 month. The wound was stabilized and subsequently covered with split-thickness skin graft. RESULTS: Split-thickness skin grafting with 1:1.5 mesh was successfully taken. CONCLUSION: Initial clinical features of pyoderma gangrenosum are very similar to that of necrotizing fasciitis. High fever and progressive ulceration with severe pain could invite earlier surgical approach. The advancing wound margins (the well defined violaceous, undermined border and necrotic ulcer base) and lack of isolation of pathogenic organism was used to make the correct diagnosis of pyoderma gangrenosum. We achieved a good result with proper medication and split-thickness skin graft.
Adult ; Debridement ; Dexamethasone ; Drainage ; Fasciitis, Necrotizing ; Fever ; Humans ; Lower Extremity ; Male ; Mass Screening ; Mucous Membrane ; Necrosis ; Negotiating ; Physical Examination ; Polyenes ; Pyoderma ; Pyoderma Gangrenosum ; Skin ; Skin Transplantation ; Transplants ; Ulcer

Functional loss of the tumor suppressor gene p53 is one of the most frequently detected and diffusely distributed findings among human cancers. Their mutant protein products or point mutations can be detected through immunohistochemistry(IHC) or polymerase chain reaction and single stranded conformational polymorphism(PCR-SSCP). Evaluation of the DNA content of the tumor cell by flow cytometry(FCM) can provide indirect evidence of the functional loss of p53, because the spindle checkpoint in the mitotic phase depends on p53. To evaluate the correlation between p53 mutation and the status of lymph node metastasis or the histological grade of the tumor cell, IHC, SSCP, and FCM in the same tissue was performed from 43 patients of human breast cancer. The results obtained are as follows; 1. Functional loss of p53 was detected in 81.4% of the breast cancer cases by using triple tests and 58.1% at the cases by double test(IHC and SSCP). Positive rates by single test were 41.8% by IHC, 44.2% by SSCP, and 58.1% by FCM. 2. For breast carcinomas no correlation between lymph-node metastasis and the functional loss of p53 detected by IHC or SSCP. 3. The correlation between the functional loss of p53 detected by IHC or SSCP and the aneuploidy of the tumor cells was statistically significant. 4. The triple tests revealed a functional loss of p53 in all cases of grade III breast cancer.
Aneuploidy ; Breast Neoplasms* ; Breast* ; DNA* ; Genes, Tumor Suppressor ; Humans ; Lymph Nodes* ; Mutant Proteins ; Neoplasm Metastasis ; Ploidies* ; Point Mutation ; Polymerase Chain Reaction ; Polymorphism, Single-Stranded Conformational

PURPOSE: The congenital muscular torticollis is a neck deformity involving shortening of the sternocleidomastoid muscle, which is detected at birth or shortly after birth. This childhood disease is the third most common congenital musculoskeletal anomaly. The indication for surgery is a persistent head tilt with dificit of passive rotation and lateral bending of the neck and a tight band or tumor in the sternocleidomastoid muscle even after physical therapy. The purpose of this article is to report surgical outcomes with patients who had no or little response to physical therapy. METHODS: Surgery was performed on 29 patients and their average age was 4.1 years(from 6 months to 20.1 years). The unipolar open release and partial myectomy were done in 28 cases and the muscle lengthening was done in 1 case. Physical therapy was started from postoperative seventh day. Follow-up period was ranged from 2 months to 5.4 years(mean follow-up, 20.4 months). Result: There were neither rotation nor lateral bending deficit after surgical treatment. Mild head tilt was noticed in 3 cases and residual bend was observed in 4 cases. The subjective assessments of surgical results by parents were excellent. CONCLUSION: Our surgical outcome encourages the surgical treatment of congenital muscular torticollis for patients who failed to respond to physical therapy.
Congenital Abnormalities ; Follow-Up Studies ; Head ; Humans ; Muscles ; Neck ; Parents ; Parturition ; Torticollis

OBJECTIVES: Cholesterol interacts with serotonin and it has been found to be associated with some clinical symptoms of mood disorders. There is a paucity of data on first onset bipolar patients and from Asian population. In this study, we compared the total choelsterol (TC) level between the bipolar I patients with a single manic episode (BPSM) and the normal controls, and investigated the relationship between the TC level and treatment response in the BPSM. METHODS: Twenty-five BPSM and thirty normal controls were enrolled in this study. The pretreatment and posttreatment TC levels in the BPSM were measured and comapred to that of normal controls. Young Mania Rating Scale (YMRS) was used for assessing symptom severity in the BPSM. RESULTS: The TC level was significantly lower in the BPSM than in the controls. There were negative correlations between the YMRS scores and the pretreatment TC level in the BPSM. The posttreatment TC level was significantly higher than the pretreatment TC level in the BPSM. CONCLUSION: This study suggests that the TC level can be changed after treatment in bipolar manic patients, although more studies involving different ethnic groups will be needed. Further longitudinal studies will be needed to examine the change of total cholesterol level according to the clinical course of bipolar disorder.
Asian Continental Ancestry Group ; Bipolar Disorder ; Cholesterol* ; Ethnic Groups ; Humans ; Mood Disorders ; Serotonin

PURPOSE: Liver transplantation is considered as the treatment of choice in many acute and chronic liver diseases, and it is becoming more common. Since successful microscopic anastomosis of hepatic artery is a crucial requirement of successful liver transplantation, we studied and analyzed the result of hepatic artery anastomosis of liver transplantation in our liver transplantation center. METHODS: 145 liver transplantations were performed from February 2005 to May 2008. Male to female ratio of the liver transplantation recipients was 3.4:1. Anastomosis of portal vein, hepatic vein and biliary tract was performed by the general surgeon, and anastomosis of hepatic artery was performed by the plastic surgeon under the loupe or microscopic vision. After the hepatic artery was reconstructed, anastomosed site status and flow were checked with Doppler ultrasonography intraoperatively and with contrast enhanced CT or angiography postoperatively if necessary. RESULTS: Out of 145 liver transplantations, cadaveric liver donor was used 37 cases and living donor liver transplantation was performed 108 cases including the 2 dual donor liver transplantations. As for the baseline diseases that resulted in the liver transplantation, there were 57 cases of liver cirrhosis and hepatocellular carcinoma due to hepatitis B, taking up the greatest proportion. Single donor hepatic artery was used in 114 cases, and mean artery diameter was 2.92mm and mean artery length was 24.25mm. Hepatic artery was used as the recipient artery in every case except the 8 cases in which gastroepiploic artery was used as alternative. Out of 145 cases of hepatic artery anastomosis, 3 cases resulted in the thrombosis of the hepatic artery, requiring thrombectomy and re-anastomosis. In all 3 cases, thrombosis was found in left hepatic artery and there was no past history of hepatic artery chemoembolization. CONCLUSION: Incidence of hepatic artery thrombosis after the anastomosis of hepatic artery during liver transplantation was 2.1%, which is considered sufficiently low.
Angiography ; Arteries ; Biliary Tract ; Cadaver ; Carcinoma, Hepatocellular ; Female ; Gastroepiploic Artery ; Hepatic Artery ; Hepatic Veins ; Hepatitis B ; Humans ; Incidence ; Liver ; Liver Cirrhosis ; Liver Diseases ; Liver Transplantation ; Living Donors ; Male ; Portal Vein ; Thrombectomy ; Thrombosis ; Tissue Donors ; Ultrasonography, Doppler ; Vision, Ocular