The nose has number of characteristics that make it unique when planning or reconstruction of surgical defects. The topography of nose is complex with multiple adjacent convex and concave surfaces that must be preserved. The free margins of the alar rims are mobile and easily distorted in case of inadequate planning. The skin over the lower one third of the nose id liss mobile and, therefore, cannot be easily recruited for closure of small defects. In addition, the texture and color of this skin are so unique that neither distant nor nearby skin can always provide a good match. Finally, the function of the nose must always be considered by preserving or replacing the bony and cartilaginous framework, mucosal linig, and never compromising a patent airway. The bilobed flap is particularly suited for reconstruction of small sized or medium sized nasal defects up to 1.5 cm in diameter. By definition, it is a double transposition flap and it is designed to move more skin over a longer distance than would be possible with a single transposition flap in the same location. On the lower one third of the nose where the skin is the least mobile, the bilobed flap allows the surgical site to be covered with nearby skin matched for color and texture and then allows for repair of that secondary defect with another well-matched flap whose donor site can finally be closed primarily. This flap also results in little or no distortion of the nose since the flap efficiently recruits skin from distant and more lax sites. While the standard design often results in tissue protrusions or pincushioning effect, improvements in the design are outlined herein to achieve the best results for defects of the nose.
Humans ; Nose ; Skin ; Tissue Donors

No abstract available.
Adolescent* ; Ecthyma* ; Humans ; Pseudomonas aeruginosa

An important aspect of plastic surgery is skin flap survival. Among the prostaglandins, PGE4 is used clinically to improve peripheral circulatory disturbances due to its action of augmenting blood flow by vascular smooth muscle relaxation and its strong inhibitory action of platelet aggregation. Clinically, many investigators found that the effect of PGE4 was prolonged for a long period even after short-term application. So a new hypothesis emerges that the prolonged effect of PGE4 may be due to neovascularization and not due to vasodilatation alone. This study was designed to clarify the mechanism of the prolonged effect of topical PGE4 with regard to angiogenesis. A total of 9 male hairless mice were treated with a topical application of PGE4 onitment (PGE4 powder mixed in hydrogen base) on the experimental side and only a hydrogen base on the contralateral control side of the back skin, respectively, for 7 days, once a day. Then they were divided into 3 groups. In group 1, specimens were obtained on the 7th day post-treatment using 3 mm size punch biopsy from both sides. In group 2, specimens were obtained on post-treatment 14th day. In group 3, specimens were obtained on post-treatment 28th day. The number of blood vessels were compared between the experimental side and control side with respect to neovascularization after PGE4 application using an image-analysis program under hemtoxyline-eosin stain. Treatment on the experimental side did not affect its contralateral mate, since there was no evidence of a systemic effect. From our experimental data, we could conclude that PGE4 may induce angiogenesis by topical application without systemic effect.
Animals ; Biopsy ; Blood Vessels ; Humans ; Hydrogen ; Male ; Mice ; Mice, Hairless* ; Muscle, Smooth, Vascular ; Platelet Aggregation ; Prostaglandins ; Relaxation ; Research Personnel ; Skin ; Surgery, Plastic ; Vasodilation

Surgical excision of the subcutaneous tissues, with or without skin excision in the axillary hair-bearing area, has been the treatment of choice for Treating axillary a osmidrosis for the several decades. However, long periods of postoperative immobilization of a shoulder joint, partial necrosis of skin flaps or hematoma and the possibility of unsightly scars are frequent complications. For the purpose of reducing these complications, we performed ultrasonic aspiration of subcutaneous fat of the axilla, including the apocrine gland, using ultrasonic liposuction technique under confirmation of endoscopy via one small skin incision. From November 1997 to December 1998, a total of 134 patients (93 women and 41 men) received surgery for bilateral axillary osmidrosis on an outpatient basis. Sixty patients were evaluated more than 6 months after surgery. Among these patients, 6patients complained of a persistent foul odor(10%). Five patients received secondary ultrasonic aspiration for persistent foul odor and were then cured. We concluded that our method has several advantages such as 1) preservation of skin flap vascularity for the prevention of flap necrosis and axillary hair, 2) minimal scarring and bleeding, 3) shorter operation time and postoperative immobilization of the shoulder joint, 4) increased patient comfort, and 5) a safer operative method for recurred cases as a secondary method.
Apocrine Glands ; Axilla ; Cicatrix ; Endoscopy ; Female ; Hair ; Hematoma ; Hemorrhage ; Humans ; Immobilization ; Lipectomy ; Necrosis ; Odors ; Outpatients ; Shoulder Joint ; Skin ; Subcutaneous Fat ; Subcutaneous Tissue ; Ultrasonics*

No abstract available.
Cleft Lip* ; Congenital Abnormalities* ; Lip* ; Nose*

Four consecutive patients underwent composite resection of tonsillar cancer and reconstruction with a microvascular radial forearm free flap. Three patients had postoperative assessments of speech at six to nine months respectively. One patient could not attend for the postoperative assessment. The speech assessment was examined by same speech therapist. All the patients had an good postoperative speech assessment. Compared to conventional local or regional myocutaneous flaps, the thin forearm free flaps offers better postoperative articulatory recovery.
Forearm* ; Free Tissue Flaps* ; Humans ; Myocutaneous Flap ; Tonsillar Neoplasms

No abstract available.
Carcinoma, Basal Cell

No abstract available.
Sphenoid Bone*

Myopericytoma is a benign tumor that is composed of myoid-appearing oval to spindle-shaped cells with a concentric perivascular pattern of growth. The tumor is morphologically heterogeneous and can exhibit a broad histologic spectrum. We describe a case of multiple myopericytoma occurring in the head and neck skin region with involvement of the parotid gland where it is known to occur very rarely. A 40-year-old woman noticed multiple enlarging, painless, round-shaped masses on her left cheek. The patient had experienced a similar lesion of the same area 8 years earlier which was completely excised and the pathological diagnosis was spindle cell type myoepithelioma. On a computed tomographic image, one mass involved the superficial parotid gland and was well encapsulated. Excision of the facial masses and superficial parotidectomy with facial nerve preservation were performed. A diagnosis of myopericytoma was established in light of the immunohistochemical pattern with the histopathological findings. Over the 4-year follow-up period, there was no evidence of recurrence. As many perivascular myoid neoplasms share common morphologic features with myopericytoma, we should consider the differential diagnosis, and confirm the histological findings with appropriate immunohistochemical staining. After identifying myopericytoma, it should be treated with wide surgical excision to prevent local recurrence.
Adult ; Cheek ; Diagnosis, Differential ; Facial Nerve ; Female ; Follow-Up Studies ; Head ; Head and Neck Neoplasms ; Humans ; Light ; Myoepithelioma ; Neck ; Parotid Gland ; Parotid Neoplasms ; Recurrence ; Skin

Keloid and hypertrophic scar are often left untreated because of no effective treatment. However, it may cause severe pain to the patient with its displeasing appearance and unbearable itching sensation and pain that occasionally accompany. Local injection of steroid has been widely accepted as a relatively effective medical treatment modality but it holds several limitations such as a severe injection pain and restricted use in sites which is either difficult to inject or too broad. Also regarding the safety, the steroid injection cannot be used to treat the scar for a long period of time or at short intervals because of the well known adverse effects of steroid. Tranilast has several in vitro pharmacological actions such as suppression of the stimulation of fibroblast by TGF-beta1, suppression of the production of superoxides and suppression of overproduction of collagen type I and III by fibroblast and these properties have made Tranilast to be considered as an alternate treatment modality. Authors studied 35 patients with keloid and hypertrophic scar to evaluate the effectiveness and safety of Tranilast. For evaluation of efficacy, the itching sensation and pain (self-conscious symptoms) was measured with Visual Analog Scale (VAS: 10-point scare) and the severity of the symptom was scored. The erythema (nonself-conscious symptom) was evaluated with subjective determination of the investigators and the degree of improvement was measured with software program using the L*a*b* color coordinate system to quantify the effect of treatment. For evaluation of safety, laboratory tests (hematology, blood chemistry, urinalysis) and existence of adverse effects was examined. This prospective study examined 35 patients who could go through the follow-up examination for 12 weeks and the results are as follow. First, scores higher than good were achieved in 80% (28/5) of the patient 6 weeks after the first administration and in 71.4% (25/35) in 12 weeks after administration of Tranilast. Second, global improvement of symptoms was approximated to be 5.6 points in itching sensation, pain and redness. Each was 51%, 56%, and 33% respectively, and this shows that Tranilast is effective in non-self conscious symptoms as well as self-conscious symptoms. Third, the subjective evaluation of improvement of erythema by software program using the L*a*b* color coordinate system showed mean improvement of 43%. There was no specific adverse effect and the lab tests revealed no significant change by medication.
Chemistry ; Cicatrix ; Cicatrix, Hypertrophic* ; Collagen Type I ; Erythema ; Fibroblasts ; Follow-Up Studies ; Humans ; Keloid* ; Prospective Studies* ; Pruritus ; Research Personnel ; Sensation ; Superoxides ; Transforming Growth Factor beta1 ; Visual Analog Scale