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

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.
Carcinoma, Basal Cell

No abstract available.
Sphenoid Bone*

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

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

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

Various types of appendage tumors develop secondarily within lesions of nevus sebaceus. A syringocystadenoma papilliferum is the most common benign tumor while basal cell carcinoma is the most common malignant tumor developed within a nevus sebaceus. However, a squamous cell carcinoma rarely develops within a nevus sebaceus, although it may be aggressive. We report a case of a 44 year-old man who had a fingertip-sized hemorrhagic crusted mass in a 3x4cm sized nevus sebaceus which had developed since birth on the right occipital scalp. This mass has rapidly enlarged into 1x2cm sized growth in the past 4 months. Histopathologic examination of the lesion showed that infiltrative squamous cell carcinoma with good or moderate differentiation indicatied the lesion of nevus sebaceus. Wide excision of squamous cell carcinoma including the whole lesion of nevus sebaceus was performed. Three months later, squamous cell carcinoma recurred in the same part of the scalp. Another wide excision of the recurrence was performed, but recurred again in the same part with invasion into the muscle layer. The recurrence is currently being treated by radiotherapy.
Adult ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell* ; Humans ; Nevus* ; Parturition ; Radiotherapy ; Recurrence ; Scalp