The goal of reduction mammaplasty is a breast with natural contour and volume, aesthetically situated scars, and a well-placed, sensate nipple and areola. The most successful techniques achieve this through the excision of tissue from the lower part of the breast based on some variation. However, the Mckissock's vertical bipedicle technique is the popular method for reduction mammaplasty. As an alternative modified Mckissock's method, we have found the use of only an inferior dermal flap with a keyhole pattern to be a simple and safe method for obtaining satisfactory aesthetic results. We have used inferior dermal flap for 4 patients recently and obtained the advantages as below compare to the Mckissock's method. 1. Rich blood supply to the broad based inferior flap. 2. More easy transposition of the nipple and areola. 3. More good operation field for resection of breast tissue. 4. Short operation time. 5. Can applied to the gigantomastia.
Breast ; Cicatrix ; Female ; Humans ; Mammaplasty* ; Methods ; Nipples

Reflex sympathetic dystrophy(RSD) defines as a chronic pain syndrome with sympathetic manifestations that afflicts individuals who haute suffered a trauma to the hand. Persistent pain and dysfunctions of the hand are frequently overlooked by the surgeons. The exact pathophysiology of RSD is not known but severity of injury and prolonged immobilization of the joints are considered as resonable causes on the retrospective studies. The diagnosis of reflex sympathetic dystrophy is based on clinical manifestations, simple X-ray and three-phase bone scan. Confirmative diagnosis absolutely depends on the presence of a diffusely abnormal pattern of uptake in phase III in a patient haying pain with underlying cause and strong clinical signs of sympathetic overactivities. As with most disease processes, early diagnosis and treatment is a goal of management of RSD. Surgical restoration of anatomical structures such as tendon, nerve and joint goes ahead of any kind of procedures and it made the VAS pain score decrease from 7.8 to 3.4 in 16 patients. Also, decrease of pain could be achievable with sympathetic or stellate ganglion block with steroid medication. Active physical therapy after surgery is also verb helpful to functional recovery of the hands. Once the appropriate diagnosis is made, combined therapy composed of surgical restoration of anatomical structure, physiotherapy and steroid medication with sympathetic block will be free from pain and produce early functional recovery.
Chronic Pain ; Diagnosis ; Early Diagnosis ; Hand Injuries* ; Hand* ; Humans ; Immobilization ; Joints ; Reflex Sympathetic Dystrophy* ; Reflex* ; Retrospective Studies ; Stellate Ganglion ; Tendons

Utile recently, osteotomy & reposition surgery of prominent zygoma have been performed by means of a coronal incision or intraoral preauricular incision. But penalties are paid, such as scar, the possibility of facial nerve injury and long operative time. Reflecting on our past experiences of facial bone surgery, we developed an alternative approach. In our method, the protrusion in the cheekbone is corrected by performing an osteotomy and reposition method through intraoral incision only. During the past 3 years we have operated on 23 patients of malar prominences. The amount of the bone to be removed is determined on preoperative interview, physical examination and x-rays. Intraoral incision provide access to the zygomatic body and lateral orbital rim. After L-shaped osteotomy, two paralle vertical and one transverse osteotomies, at medical part of the zygomatic body, the midsegment is removed. Posterior portion of zygomatic arch was approached through medical aspect and was outfractured using curved osteotome. After completion of triple osteotomy, the movable zygomatic complex was reduced medially and fixed with miniplates and screws on the zygomaticomaxillary buttress. The patients were followed for 9.5 months with acceptable result and little complication. The author concludes that this technique is effective and safe method in reduction malarpalsty.
Cicatrix ; Facial Bones ; Facial Nerve Injuries ; Humans ; Operative Time ; Orbit ; Osteotomy ; Physical Examination ; Zygoma

No abstract available.
Facial Bones*

No abstract available.
Thumb* ; Toes*

'Marjolin' ulcer' is used to describe the malignant transformation of a chronic ulcer which has developed in a burn scar. Clinically, although the lesions is slowly progressive, it comes to be more aggressive when the scar barrier is disrupted. We reviewed 24 cases in patients who complained of chronic burn wounds suspected to be Marjolin's ulcer. The mean latent period for developing pathologic lesions was 31 years. Histologically, chronic ulcer and pseudoepitheliomatous hyperplasia were 21% respectively, while malignancy including squamous cell carcinoma and leiomyosarcoma was 56%. The mean elapsed time to diagnose squamous cell carcinogma was 33.2 years. In pseudoepitheliomatous hyperplasia which is considered as a transitional state to malignant tumor, wide excision and reconstruction with free muscle flap was a better procedure than skin graft for the prevention of recurrence and malignant transformation. As well, the same modality of treatment was also applied in malignant tumors.
Burns* ; Carcinoma, Squamous Cell ; Cicatrix ; Humans ; Hyperplasia ; Leiomyosarcoma ; Recurrence ; Skin ; Transplants ; Ulcer ; Wounds and Injuries*

Extravasation of toxic chemotherapeutic 'agents cause severe skin ulceration and necrosis which often need secondary surgical intervention. Still, there were not established antidote agent in case of extravasation with mitomycin-c. Dimethyl sulfoxide is known as an effective chemical scavenger of toxic hydroxyl free radical and sodium thiosulfate also was demonstrated significant protector from mitomycin-c induced ulceration by a few experimental studies. Author investigated necrotic area of mitomycin-c injected site and compare to the effectiveness of topical treatment with dimethyl sulfoxide and intradermal injection of sodium thiosulfate according to starting times, forty five mice were divided into 3 groups. Control group(n=5) had no treatment after subcutaneous injection of mitomycin-c. Experimental group I and 11 were 20 mice treated dimethyl sulfoxide and sodium.
Animals ; Dimethyl Sulfoxide ; Injections, Intradermal ; Injections, Subcutaneous ; Mice ; Mitomycin* ; Necrosis* ; Skin Ulcer ; Sodium* ; Ulcer

Bone grafts are an integral and important aspect of craniofacial reconstruction. Rips, tibia, and iliac bone have traditionally used as donor site but each of these has various problems, however using to the calvarial bone as a donor site has several advantage. These are as follows; there are abundance of material, easy to reach the donor site through coronal incision, minimal pain of donor area, less functional inability, shorter hospitalization, no need of immobilization, hidden scar at donor site, no secondary deformity and appropriate curvature obtained properly selected. From March to December 1987, we experienced three cases of autogenous calvarial bone graft such as congenital saddle nose deformity, fibrous dysplasia on the right side frontal bone, and deviated nose. The results were very excellent without any significant complication. The detail technique of autogenous calvarial bone graft and its advantages compared with the traditional methods of bone grafts are discussed.
Cicatrix ; Congenital Abnormalities ; Frontal Bone ; Hospitalization ; Humans ; Immobilization ; Nose ; Tibia ; Tissue Donors ; Transplants*

Since introduction of venous flap in 1980, many experimental studies and clinical applications of various kinds of venous flaps were reported. Venous flap has the following advantages : (1) nonbulky and goo-quality of flap (2) long & large vascular pedicle (3) easy & rapid elevation of flap (4) no sacrifice of major arteries (5) a single operative field. But, we also have some disadvantages of difficult handling of the pliable veins and the tmcertainty of flap survival. For the better result we had to design the size of the flap larger than that of defect and increase the number of draining vein to reduce the postoperative edema of the flap. We have treated the defects of soft tissue of the hand using free arterialized venous flap from the flexor aspect of the forearm & had an excellent results.
Arteries ; Edema ; Forearm ; Hand* ; Veins ; Wounds and Injuries*

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*