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

No abstract available.
Facial Bones*

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

'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*

No abstract available.
Thumb* ; Toes*

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

In the past 5 years, the authors have performed microsurgical reconstruction of the lower leg in 37 patients. Among them, modified microsurgical salvage procedures were performed in 11(29.7) cases with vascular compromise, suggested by the preoperative angiogram of the affected lower leg demonstrating no visible, or only one visible major arter. Modified salvage procedures included free flap operations using distally-based arterial inflow(n=2), temporary diversion of the single main artery with secondary vein grafting(n=2), Jungcross-leg fashioned free flaps(n=4), and end-to-side anastomosis of the main artery((n=1). In absence of arterial flow after lower leg trauma, as interpositional vein graft(n=2) was performed to restore blood flow. No vascular problems occurred after the free flap transfer. However, 9 patients experienced different degrees of limping gait, ranging from as mild(n=2), moderate(n=6) to severe(n=1) at the mean follow-up period of 18 months. In reconstruction of a vascular compromised lower leg, modified salvage procedures should be reviewed and selected after exploration of all vessels, both proximal and distal to the zone of the injury. When evaluating what method is the most appropriate, socioeconomic efficiency and patients' individual requirments should be considered.
Arteries ; Follow-Up Studies ; Free Tissue Flaps ; Gait ; Humans ; Leg* ; Veins

The ideal breast reduction should create beautiful breasts with limited scars. Unfortunately, no surgeon has ever been able to produce such a result. Most recent breast reduction techniques tend to produce minimal breast scars and avoid the classic inverted-T incision. The vertical mammaplasty can be used in mild to moderate cases of breast reduction, producing consistently good, stable results with limited scars. This technique uses adjustable preoperative markings, an upper pedicle for the areola, and a central breast reduction with limited skin undermining. The shape of the breast is created by suturing of the gland and does not rely on the skin. The adjunctive use of liposuction in fatty breasts can be considered safe and efficient. We have performed reduction mammaplasty using the vertical mammaplasty technique in 12 patients. Overall number and extent of complications were small, and patient satisfaction was high for this procedures. The advantages of vertical mammaplasty technique compared with other methods are as follows ; 1. The markings are adjustable to nearly all patients. 2. Stable contours are produced because the gland is strongly sutured. 3. Few postoperative complications occur. 4. Limited scars(only vertical scars) are created 5. The procedure is easy to learn and perform.
Breast ; Cicatrix ; Female ; Humans ; Lipectomy ; Mammaplasty* ; Patient Satisfaction ; Postoperative Complications ; Skin

Since 1981 there have been many clinical and experimental reports of venous skin flap, which was nourished solely by venous blood, or by arteria1 blood flowing through the venous network. But, the mechanism of survival has not been completely understood. Unfortunately, partial flap necrosis and unstable postoperative recovery course make surgeons hesitant in choosing the venous flap. In order to increase the survival of a venous flap, surgical delay procedure or increasing the number of draining veins have been successfully tried. Historically, tissue expansion has the same effect on skin vascularity as delaying the area The increase in the caliber of the blood vessels and adequate neovascularization of the expanded tissue can increase the size and vascularity of the flap while allowing primary closure of the donor defect. In order to investigate the survival pattern of expanded arterialized venous flap, the author conducted the following study. The arterialized venous flaps were divided into control and two experimental groups. The conventional nonexpanded arterialized venous flap of 5x5 cm in size was used as control group On experimental group I, preoperative tissue expansion was performed during 3 weeks, and then arterialized venous flap with the same size was made. On experimental group II, expanded arterialized venous flap with 10x10 cm in size was made. The mean survival rate of control, experimental group I and II was 81.2%, 98.8% and 99.1%, respectively. The angiogram of expanded flap showed dilatation of the vessels and neovascularization with tortuous vessels to the peripheral area of the flap. In conclusion, the survival of expanded arterialized venous flap was superior than that of conventional arterialized venous flap. The expanded venous flaps appear to be useful in producing large flaps, in decreasing marginal necrosis of the flap as well as minimizing donor defect.
Blood Vessels ; Dilatation ; Humans ; Necrosis ; Skin ; Surgical Flaps ; Survival Rate ; Tissue Donors ; Tissue Expansion ; Veins